Lusutrombopag (Mulpleta®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:
  • Treatment of thromobocytopenia in adult patients with chronic liver disease who are scheduled to undergo a procedure
Patients must meet the following criteria for the indications above:
  • Patient is at least 18 years of age and has a documented diagnosis of chronic liver disease, AND
  • Patient has a current platelet count < 50 x 109, AND
  • The 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 8-14 days after starting Mulpleta therapy
  • Not approvable for a patient who is undergoing a low-risk procedure (e.g. spinal surgery, cardiac surgery, large polypectome, liver biopsy) within 8-14 days after starting Mulpleta therapy
  • Not approvable for a patient who is undergoing a low-risk procedure (e.g. paracentesis, routine endoscopay, or central line placement)
  • Not approvable to be administered to patients with chronic liver disease in an attempt to normalize platelet counts
Dosing:
  • Begin Mulpleta 8-14 days prior to a scheduled procedure
  • Patients should undergo their procedure 2-8 days after the last dose
  • The recommended dosing is 3 mg orally once daily for 7 days
Approval:
  • One 7 day course

Last review date: June 10, 2019