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Fc-peptide fusion protein that acts as an agonist at the thrombopoietin receptor stimulating platelet production. Indicated in chronic immune thrombocytopenic purpura (ITP) refractory to other treatments (corticosteroids, immunoglobulins). Subcutaneous administration of a weekly dose.
Amino acid sequences of romiplostim have been found in both breast milk and infant plasma, without being able to estimate the amount or concentration of romiplstim excreted in breast milk. (Labrecque 2023).
Its very high molecular weight makes the passage into milk of significant amounts very unlikely.
Of two infants born to mothers treated with romiplostim, one had moderate thrombocytosis that persisted despite discontinuation of breastfeeding (Labrecque 2023), indicating that it was not due to romiplostim; the other had no problem. (Patras 2020)
Due to its protein nature, it is inactivated in the gastrointestinal tract and is not absorbed, so its oral bioavailability is practically nil, except in premature infants and the immediate neonatal period in which there may be greater intestinal permeability.
It may be advisable to monitor hematological parameters in infants breastfed by mothers receiving romiplostim.
Translated with DeepL.com (free version)