Hematologist
CION Cancer Clinics
TPO receptor agonists for ITP: eltrombopag and romiplostim | CION Cancer Clinics
Eltrombopag and romiplostim raise your platelet count by pushing the bone marrow to make more platelets. They do not switch off the immune attack in ITP, so they work while you take them. Eltrombopag is a tablet; romiplostim is a weekly injection. This page explains who they suit, how they are monitored, which side effects need attention, and what they cannot do. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
BP
Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What do eltrombopag and romiplostim actually do in ITP?
- How are the two medicines different?
- What happens after your haematologist starts one of these?
- Who are these medicines for, and who do they not suit?
- Which words will you see on your notes?
- What do families often get wrong about these medicines?
- Common questions about eltrombopag and romiplostim
The short answer
What do eltrombopag and romiplostim actually do in ITP?
Eltrombopag and romiplostim push your bone marrow to make more platelets. They do not stop the immune attack that removes platelets in ITP, so they work only while you keep taking them under your haematologist's care.
Why they are called TPO receptor agonists
Your body makes a natural signal called thrombopoietin, or TPO, that tells the marrow to build platelets. Both medicines copy that signal. They switch on the same receptor, a docking point on the cells that grow into platelets, so more platelets leave the marrow each day. In ITP (immune thrombocytopenia, where the immune system clears platelets too early) this extra supply can outpace the loss.
What they are trying to achieve
The aim is not a normal count at any cost. The aim is a count safe enough that you stop bleeding, stop bruising from small knocks and can live without frequent steroid courses. Many people reach that. Some do not respond, and your team will tell you honestly if that is your situation.
What they cannot do
These medicines raise the count slowly. They are not the tool for a bleed happening today, when faster treatments such as steroids or IVIG (antibodies given through a drip) are used instead.
This page explains how the medicines work. It cannot tell you whether you should take one, or how much. Only your treating haematologist can set that.Tablet or injection
How are the two medicines different?
They do the same job by slightly different routes. The choice usually rests on your daily routine, your liver, and how often you can reach a clinic.
Eltrombopag
A tablet taken at home. Calcium, iron, antacids, milk and curd can stop it being absorbed, so it has to be kept well apart from them. Your team will give you the exact timing.
Worth knowing
- Liver blood tests are checked regularly
- Meal timing matters more than with most tablets
Romiplostim
A small injection under the skin, given once a week, usually at a clinic. The amount is adjusted to your latest platelet count, so a blood test often comes with each visit.
Worth knowing
- No food rules around it
- Needs regular travel to a centre
Other medicines in the same family
Avatrombopag is another tablet that works the same way. It is not available or covered everywhere. Ask your haematologist which ones can realistically be obtained where you live.
What they share
Both need regular counts, both can take a few weeks to show a rise, and with both the count may fall back if the medicine is stopped suddenly.
Not sure whether this applies to you?
Ask an oncologistOnce you start
What happens after your haematologist starts one of these?
-
Tests before the first dose
A full blood count, liver tests and a check of other medicines you take. Your team will also want to be sure the low count really is ITP and not another cause, such as a marrow problem.
-
The early weeks
Counts are checked often, frequently every week. The dose is raised or lowered in small steps. It is normal for the count not to move much at first.
-
Finding a steady level
Once the count sits in a safe range, tests become less frequent. Other ITP medicines, such as steroids, are often reduced by your team at this stage.
-
Long-term follow-up
Regular counts and liver tests continue for as long as you take the medicine. Tell your team about any new tablet, supplement or planned procedure.
-
If the plan is to stop
Some people are later tapered off by their haematologist. This is done slowly and with close counts, because the platelets can drop quickly, sometimes lower than before.
Being straight with you
Who are these medicines for, and who do they not suit?
They are usually offered to adults whose ITP has lasted for months and keeps coming back after steroids, or who cannot keep taking steroids. They are rarely the first treatment anyone receives.
When they are often considered
Your haematologist may suggest one if you still bruise or bleed despite earlier treatment, if steroids caused weight gain, high sugar or mood changes you could not live with, or if you want to avoid removal of the spleen. Some children with long-lasting ITP are also treated with them by a paediatric haematologist.
When they may not suit you
They may be a poor fit if you have had a blood clot, have liver disease, are pregnant or planning a pregnancy, or cannot manage the regular blood tests. They do not help a low count caused by dengue, chemotherapy or a blood cancer, which need a different plan.
What your report cannot tell you
A single count does not tell you whether the medicine is working. Reference ranges differ between laboratories, and your result is read alongside your symptoms and repeat tests. Do not change, skip or stop a dose on your own because one number looks high or low. Call your team instead.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
!
Signs that cannot wait
Go to the nearest emergency department now, or call 108, if you have sudden chest pain, breathlessness, a swollen and painful leg, weakness on one side of the body, or bleeding that will not stop. Tell the staff you have ITP and name the medicine you take. Yellowing of the eyes or very dark urine also needs a call to your team the same day.
On your prescription
Which words will you see on your notes?
- TPO receptor agonist (TPO-RA)
- The family name for medicines that copy the body's own signal to make platelets.
- Persistent or chronic ITP
- ITP that has not settled after several months. These are the stages when these medicines are usually discussed.
- Response
- The count has risen to a level your team considers safe, and bleeding has eased. It is not the same as the ITP having gone away.
- LFTs
- Liver function tests. A routine blood test watched closely with eltrombopag.
- Rebound
- A sharp fall in the count after the medicine is stopped. The main reason stopping is always planned.
- Marrow fibrosis
- Scarring in the bone marrow. It is uncommon, but your team watches your blood film for early signs.
Commonly believed
What do families often get wrong about these medicines?
"Once the count is normal, the ITP is gone and the tablets can stop."
A good count usually means the medicine is doing its job, not that the immune attack has ended. Stopping suddenly can drop the count fast. Any reduction is planned by your haematologist with close blood tests.
"These are chemotherapy, so ITP must be a kind of cancer."
They are not chemotherapy, and ITP is not cancer. They do not kill cells. They send a growth signal to the marrow, the same kind of signal your body makes itself.
"A higher count is always safer, so a bigger dose is better."
A count pushed too high can raise the chance of a clot. Your team aims for a safe range, not the highest number, which is why the dose is adjusted so carefully.
"If it has not worked in the first week, it will never work."
A rise often takes a few weeks while the dose is adjusted. Give your team time to judge it, and share every count report so they can see the trend.
Questions we are asked
Common questions about eltrombopag and romiplostim
How long will it take for my platelet count to rise?
Many people see a rise within a few weeks, but it varies. The dose is usually started low and adjusted according to your counts, so the early weeks can feel slow. Keep every blood test appointment. Your haematologist judges the medicine on the trend across several results, not on one report.
Will I have to take this medicine for life?
Not always. Some people take it for a long time, while others are slowly tapered off when their ITP becomes quieter. Nobody can predict which group you will be in at the start. Any decision to reduce or stop is made by your haematologist, with close counts, never on your own.
What side effects are common?
Headache, tiredness, joint or muscle aches and an upset stomach are among the more common ones. With eltrombopag, changes in liver tests can appear, which is why they are checked. Clots are uncommon but serious. Report any new symptom to your team rather than deciding yourself whether it matters.
Can I take my other medicines and supplements alongside?
Tell your team about everything, including calcium, iron, multivitamins, antacids and herbal or Ayurvedic products. Some stop eltrombopag being absorbed. Painkillers such as aspirin and ibuprofen can make bleeding worse with a low count. Ask before you start anything new, and do not stop an existing medicine without advice.
Can I get pregnant while taking one of these?
These medicines are generally avoided in pregnancy because there is not enough safety information. If you are planning a pregnancy or think you may be pregnant, talk to your haematologist early. They can plan a switch to treatments with more experience behind them. Do not stop the medicine suddenly before that conversation.
Are they covered by Aarogyasri or insurance?
Cover varies and changes over time. Cashless insurance, CGHS, ECHS, EHS, Aarogyasri or PM-JAY may help with part of the cost, depending on your policy and the current scheme rules. Long-term medicines can be expensive, so check your own cover before starting, and ask whether a generic version is available.
Is one of them simply better than the other?
Neither wins for everyone. A tablet suits people who cannot travel weekly, while an injection suits people who struggle with meal timing or have liver concerns. Your haematologist weighs your liver tests, routine, other illnesses and what you can obtain, then explains why one fits you more closely.
How can CION help if I am already on one?
CION's haematology team can review your reports, your counts over time and how you are coping, and discuss your case at a tumour board if needed. Bring every count report, your prescription and a list of all medicines. We will explain what the trend shows and which questions to ask next.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Patient stories
Hear it from people we have treated
Every story is a video, in the patient's own words. Nothing here is a written testimonial.
Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
Warangal
Vizag
Sources
- NHS — Immune thrombocytopenia (ITP)
- National Heart, Lung, and Blood Institute — Immune thrombocytopenia: treatment
- NICE — Eltrombopag for treating chronic immune thrombocytopenia (TA293)
- NICE — Romiplostim for the treatment of chronic immune thrombocytopenia (TA221)
- National Health Mission — National Health Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Steroids for ITP and Their Side EffectsThe treatment most people try firstSplenectomy for ITPThe surgical option when medicines are not enoughChronic ITP: Living With It Long TermPlanning life around long-lasting ITPPlatelet Thresholds: When Treatment StartsWhat your count means for treatmentITP and Low PlateletsThe full guide to low platelet counts
Talk to us
On treatment for ITP and unsure what your counts mean?
Share your reports with us. CION's haematology team will explain the trend and what to ask your treating doctor. One helpline serves every CION centre.