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Suggest Dosage Of Promacta
Question:
17 July 2015
Dear Dr Sanghvi
Thank you for your advice to my previous thread http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=204219
You advised earlier that maximum dosage for aplastic anemia is 150 mg per day. But I read earlier from this article (re. section 5.2) that the maximum dose for East Asians is 150 mg/day. Was there a subsequent change in the recommendation of maximum dose for East Asians?
http://www.nejm.org/doi/suppl/10.1056/NEJMoa0000/suppl_file/nejmoa0000_protocol.pdf
You advised that “Approximately 40% patients show improvement within 12 weeks. “ Do you mean 12 weeks after eltrombopag initiation or 12 weeks after being on maximum dosage?
You also advised that “If no any improvement seen with maximum dosages then it should be discontinued after 18 weeks. “ Do you mean 18 weeks after eltrombopag initiation or 18 weeks after being on maximum dosage?
My niece has been on eltrombopag for 8 months (has been on 75 mg for 3.5 months since late March). Our doctor suggest stopping eltrombopag becauseI no noticeable improvement is seen. According to your experience, Is 75 mg a dosage unlikely to yield noticeable improvements? What is the dosage at which signs of noticeable improvements can be seen? In your opinion, my niece should continue trying eltrombopag and increase the dosage up to 150 mg?
Would appreciate your expert advice.
Best Regards,
17 July 2015
Dear Dr Sanghvi
Thank you for your advice to my previous thread http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=204219
You advised earlier that maximum dosage for aplastic anemia is 150 mg per day. But I read earlier from this article (re. section 5.2) that the maximum dose for East Asians is 150 mg/day. Was there a subsequent change in the recommendation of maximum dose for East Asians?
http://www.nejm.org/doi/suppl/10.1056/NEJMoa0000/suppl_file/nejmoa0000_protocol.pdf
You advised that “Approximately 40% patients show improvement within 12 weeks. “ Do you mean 12 weeks after eltrombopag initiation or 12 weeks after being on maximum dosage?
You also advised that “If no any improvement seen with maximum dosages then it should be discontinued after 18 weeks. “ Do you mean 18 weeks after eltrombopag initiation or 18 weeks after being on maximum dosage?
My niece has been on eltrombopag for 8 months (has been on 75 mg for 3.5 months since late March). Our doctor suggest stopping eltrombopag becauseI no noticeable improvement is seen. According to your experience, Is 75 mg a dosage unlikely to yield noticeable improvements? What is the dosage at which signs of noticeable improvements can be seen? In your opinion, my niece should continue trying eltrombopag and increase the dosage up to 150 mg?
Would appreciate your expert advice.
Best Regards,
Brief Answer:
She can take promecta upto 150 mg per day.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
As I said earlier, XXXXXXX dosage of promecta for aplastic anemia is 150 mg per day. No any recent change in guidelines.
40% of patients show improvement within 12 weeks of initiation.
It should be stopped if no response after 18 weeks on maximum dosage.
She was taking 75 mg promecta. 75 mg dosage is not sufficient for all patients.
Noticeable improvement occur at various dosage. It is not same for all patient. Some patients develop noticeable improvement with 50 or 75 mg dosage. Some patients may require 150 mg dosage and some patients don't show improvement even with 150 mg per day. So it is variable.
Your neice should take dosage upto 150 mg per day. If she doesn't show improvement within 18 weeks of maximum dosage then it should be discontinued.
This drug is strictly prescription based medicine and it should be taken on written prescription of your treating doctor only.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
She can take promecta upto 150 mg per day.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
As I said earlier, XXXXXXX dosage of promecta for aplastic anemia is 150 mg per day. No any recent change in guidelines.
40% of patients show improvement within 12 weeks of initiation.
It should be stopped if no response after 18 weeks on maximum dosage.
She was taking 75 mg promecta. 75 mg dosage is not sufficient for all patients.
Noticeable improvement occur at various dosage. It is not same for all patient. Some patients develop noticeable improvement with 50 or 75 mg dosage. Some patients may require 150 mg dosage and some patients don't show improvement even with 150 mg per day. So it is variable.
Your neice should take dosage upto 150 mg per day. If she doesn't show improvement within 18 weeks of maximum dosage then it should be discontinued.
This drug is strictly prescription based medicine and it should be taken on written prescription of your treating doctor only.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr Sanghvi,
Thanks a lot for your prompt reply.
.
You mentioned that 75 mg dosage is not sufficient for all patients. Is this based on clinical trial of eltrombopaq or your clinical experience?
You earlier advised that 20% patients develop new genetic abnormalities by change in chromosome. Is the change associated with` the duration and/or dosage of use of eltrombopag. i.e. the longer period of use and/or the higher dosage, the more likely to have chromosome change?
Are there any commonalities of those patients (e.g. their personal profile, disease conditions/progression, response to eltrombopag, duration of use or dosage of eltrombopag, etc.) who developed chromosome change?
My niece has been on eltrombopag for 8 months (on 75 mg for 3.5 months since late March). Her doctors are very prudent in adjusting the dosage and are quite reluctant to further raise the dose beyond 75 mg, probably because they have not tried this new drug on AA patients, but only ITP patients for whom the maximum dosage is 75 mg for East Asians. We are also worried about possible chromosome change. So, want to get more information/advice for discussion with our doctors on the way forward. Trust you understand our concerns.
Appreciate very much your advice.
Regards.
Thanks a lot for your prompt reply.
.
You mentioned that 75 mg dosage is not sufficient for all patients. Is this based on clinical trial of eltrombopaq or your clinical experience?
You earlier advised that 20% patients develop new genetic abnormalities by change in chromosome. Is the change associated with` the duration and/or dosage of use of eltrombopag. i.e. the longer period of use and/or the higher dosage, the more likely to have chromosome change?
Are there any commonalities of those patients (e.g. their personal profile, disease conditions/progression, response to eltrombopag, duration of use or dosage of eltrombopag, etc.) who developed chromosome change?
My niece has been on eltrombopag for 8 months (on 75 mg for 3.5 months since late March). Her doctors are very prudent in adjusting the dosage and are quite reluctant to further raise the dose beyond 75 mg, probably because they have not tried this new drug on AA patients, but only ITP patients for whom the maximum dosage is 75 mg for East Asians. We are also worried about possible chromosome change. So, want to get more information/advice for discussion with our doctors on the way forward. Trust you understand our concerns.
Appreciate very much your advice.
Regards.
Brief Answer:
Dosage and cytogenetic abnormality are mostly based on clinical trials.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Dosage can be increased upto 150 mg per day.
All patients may not respond to 75mg per day. These facts are mostly based on clinical trials. My experience is also there but it is limited. Because we don't have large number of patients with this situation.
Approximately 20% patients develop new genetic abnormality. Most of this depend on patients genetic factor. However no more data available on specific factors.
You should not worry much about that. Just try with higher dosage and if she doesn't respond then discontinue the drug.
It is strictly prescription based medicine so consult your treating doctor and plan accordingly.
Dosage and cytogenetic abnormality are mostly based on clinical trials.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Dosage can be increased upto 150 mg per day.
All patients may not respond to 75mg per day. These facts are mostly based on clinical trials. My experience is also there but it is limited. Because we don't have large number of patients with this situation.
Approximately 20% patients develop new genetic abnormality. Most of this depend on patients genetic factor. However no more data available on specific factors.
You should not worry much about that. Just try with higher dosage and if she doesn't respond then discontinue the drug.
It is strictly prescription based medicine so consult your treating doctor and plan accordingly.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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