Avatrombopag (Doptelet®)

SELF ADMINISTRATION

Indications for Prior Authorization:
  • For the treatment of thrombocytopenia in adult patient with chronic liver disease who are scheduled to undergo a procedure
Patients must meet the following criteria for the indication(s) above:
  • Patient is at least 18 years old and has documented diagnosis of chronic liver disease, AND
  • Patient has a current platelet count < 50 x 109/L; AND
  • Patient is scheduled to undergo an invasive procedure with intermediate-to-high bleeding risk (e.g., spinal surgery, cardiac surgery, large polypectomy, liver biopsy) within 10 to 13 days after starting Doptelet therapy
  • Not approvable for a patient who is undergoing a low-risk procedure (e.g. paracentesis, routine endoscopy, or central line placement)
  • Not approvable to be administered to patients with chronic liver disease in an attempt to normalize platelet counts
The following condition(s) do not meet criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:
  • Chronic immune thrombocytopenia
Dosing:
  • Begin Doptelet 10-13 days prior to the scheduled procedure.
  • The recommended daily dose is based on the patient's platelet count prior to the scheduled procedure.  Patients should undergo their procedure 5 to 8 days after the last dose of Doptelet
    • Platelet Count (x 109/L) less than 40 : 60 mg (3 tablets) x 5 days
    • Platelet Count (x 109/L) 40 to less than 50 : 40 mg (2 tablets) x 5 days
Approval:
  • One 5 day course

Last review date: May 28, 2019