Mulpleta®
Drug - Mulpleta® (lusutrombopag) [Shionogi Inc]
June 2019
Therapeutic area - Thrombopoiesis Stimulating Proteins
Initial approval criteria
Patient must:
- Be ≥ 18 years old AND
- Have diagnosis of chronic liver disease (CLD) AND
- Have a platelet count of < 50 x 109/L AND
- NOT have Child-Pugh class C liver disease, absence of hepatopetal blood flow, a prothrombotic condition other than CLD or a history of splenectomy, partial splenic embolization, or thrombosis AND
- Have an invasive procedure scheduled AND
- Have lusutrombopag scheduled to begin 8 to 14 days prior to the procedure, with the procedure occurring 2 to 8 days following the last dose of lusutrombopag AND
- NOT be taking Doptelet
- NOT be scheduled for a thoracotomy, laparotomy, open-heart surgery, craniotomy, or organ resection
AND
- Date of procedure must be submitted at time of request
Quantity limits
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411
