Avapag (Avatrombopag 20 mg Tablets)

Avapag (Avatrombopag 20 mg Tablets) is a thrombopoietin receptor agonist, approved by the FDA on May 21, 2018, for the treatment of low platelet count disease in adult patients associated with chronic liver disease, and where other treatments have not responded well. 

It was discovered and manufactured by the Swedish Orphan Biovitrum AB (Sobi™) and marketed with the brand name DOPTELET.

Avapag 20 mg is a generic of DOPTELET, manufactured and marketed by Everest Pharmaceuticals LTD., Bangladesh. It is available in all the regions where it is approved for the treatment of FDA-indicated diseases.

Avatrombopag tablet indications

This low platelet count treatment medication has been approved for the treatment of the following indicated low platelet count diseases

• Thrombocytopenia in adult patients associated with chronic liver disease who are scheduled to undergo a procedure.
• Thrombocytopenia in adult patients with chronic immune thrombocytopenia, whereas other thrombocytopenia treatments do not respond well enough. 

Avatrombopag Mechanism of Action

This drug works by increasing the platelet production in the blood, stimulating the bone marrow to produce more blood cells.

It mimics the natural platelet production hormone thrombopoietin to produce more platelets, binding the thrombopoietin receptor on the surface of large bone marrow cells by stimulating the bone marrow to produce more megakaryocytes ( large bone marrow cells).  When megacaryocytes are increased, the number of platelets is also naturally increased.

Avatrombopag Dose

Dosing for the low platelet count treatment can be different depending on the patient’s medical condition and previously diagnosed diseases. The general dosing information is 

• To treat chronic liver disease associated with thrombocytopenia, patients should take 60 mg of Avapag daily for 5 days if their platelet count is less than 40 × 10⁹/L. And 40mg daily if platelet count is less than 50X109/L
• Dosage and administration process can be adjusted according to the registered doctor’s prescription.
• Take the medication as prescribed by the doctor. Do not take more or less.
• It can be taken with or without food according to the prescription.
• For the missing dose, try to take it at least 12 hours before the next dose. Otherwise, skip the missed dose and inform your healthcare provider. Do not take a double dose to make up for the missed dose. An overdose can cause an adverse reaction. If an overdose occurs, call your doctor right away. 

Proper administration guidance

When to use: It is usually taken once daily. Follow the dosing schedule instructed by your doctor.
Taking the medicine: Take the medication as directed by your doctor, usually with meals or as otherwise directed by your doctor.
Monitoring liver function: While you are taking this drug, your doctor may order periodic tests to check your liver function and adjust your dosage if necessary.
Drug interactions: You should inform your doctor about any other medications or dietary supplements you are taking, including prescription drugs, nonprescription drugs, and supplements. This medication may interact with a number of other medications, so follow your doctor’s instructions to avoid unwanted interactions.
Monitoring and interactions: You should see your doctor regularly to monitor your health and the effectiveness of the drug. Discuss any side effects you experience and ask your doctor about any questions or concerns.

Avatrombopag Side Effects

Blood Clots

Avapag 20 mg tablet may cause serious side effects, like blood clots in people with chronic liver disease or chronic immune thrombocytopenia. This risk is high in people with a previous blood-clotting history. Tell your healthcare provider right away if you have signs and symptoms of a blood clot, including:

• Swelling, pain, or tenderness in your legs.
• Stomach pain or tenderness. 
• Shortness of breath
• Chest pain

The most common side effects of Avapag when used to treat low blood platelet counts in adults with chronic liver disease (CLD) who are scheduled to have a medical or dental procedure are:

• Fever
• Nausea
• Tiredness
• Stomach pain
• Swelling of hands or feet

The most common side effects of Avapag when used to treat low blood platelet counts in adults with chronic immune thrombocytopenia (ITP) are:

• Easily bruising
• Joint pain
• Nosebleed
• Bleeding gums
• Upper respiratory tract infection
• Purple or red spots on your skin
• Runny nose

What should I tell my health care provider before starting Avatrombopag?

Before starting this drug, tell your doctor the following points:

• Tell your medical history: Let your doctor know about any health conditions you have or had in the past, such as liver or kidney disease, chronic illnesses, drug allergies, or platelet-related problems.
• List your medications and supplements: Inform your doctor about all the medicines you’re taking, including prescription and over-the-counter drugs, as well as any vitamins or supplements. This helps prevent any unwanted interactions.

Can pregnant or breastfeeding women take Avatrombopag?

Pregnant women should be aware of the potential harm of taking Avapag medication during pregnancy because it can harm the fetus. It is also recommended for those women who are breastfeeding their children that the active ingredients in this medication can harm children. In both cases, patients should follow the advice of their registered doctor before taking this medication.

Avatrombopag Drug Interactions

• Strong CYP3A inducers (Rifampin, Carbamazepine, Phenytoin, St. John’s Wort)
• Strong CYP3A inhibitor (Warfarin, Aspirin, Clopidogrel)

Avatrombopag 20 mg price in China

In China, Avatrombopag 20 mg (Avapag) price depends on local availability. According manufacturer’s information, Avapag 20 mg may cost $4.0-$4.5 (each tablet). Price is variable and can be changed at any time.

Frequently Asked Questions (FAQs)

Are there any risks associated with this treatment?

Yes, there are some risks associated with Avapag 20 mg if patients have other critical or non-critical issues.

• Deep vein thrombosis (risk of blood clots)
• Pulmonary embolism (risk of blood clots)
• Liver enzyme elevations
• Thrombocytosis
• Worsening ITP after stopping Avapag