📋 Indications & Clinical Dosage
*Treatment of chronic idiopathic thrombocytopenicpurpura in splenectomised patients' refractory to other treatments, second-line treatment of chronic idiopathic thrombocytopenic purpura in non-splenectomised patients when surgery is contraindicated:*
Adult: Initially 50 mg once daily, dose to be adjusted to achieve a platelet count of 50x109/liter or more, consult product literature for dose adjustments, discontinue if inadequate response after 4 wks treatment at max. dose; max. 75 mg per day. Reduce daily dose by 25 mg; reassess in 2 week. If platelet count reaches desired level after 2 week at the lowest dose, discontinue treatment.
Treatment of thrombocytopenia associated with chronic hepatitis C infection, where the degree of thrombocytopenia is the main factor preventing the ability to maintain optimal interferon-based therapy:
Adult: Initially 25 mg once daily, dose to be adjusted to achieve a platelet count sufficient to initiate antiviral therapy then a platelet count of 50-75x109/liter during antiviral therapy, consult product literature for dose adjustments, discontinue if inadequate response after2 weeks treatment at max. dose; max.100 mg per day
Children: Not recommended.
⚠️ Precautions & Warnings
Moderate to severe hepatic impairment (Child-Pugh score more or equal to 7), risk factors for thromboebolism. Obtain peripheral bloodsmear and complete blood count, serum ALT, AST and bilirubin before and during treatment, elderly. Ensure adequate contraception in childbearing women.
🔄 Drug Interactions
Methotrexate, statins, topotecan, antacids, dairy products, mineral supplement, lopinavir, ritonavir, corticosleroids, danazol, azathioprine, IV immunoglobulins.
⚠️ Adverse Reactions / Side Effects
Hemorrhage, abdominal pain, alopecia,
arthralgia, bone pain, cataract, constipation, diarrhoea, dry eye, fatigue, GI disturbances, headache, insomnia, myalgia, nausea, paraesthesia, peripheral oedema, pruritus, rash, palpitation, erythema, bone pain, dyspepsia, musculoskeletal pain, increased ALT/AST.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid, risk cannot be ruled out.
Lactation / Breastfeeding:
Not recommended
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.