TM Owner Shionogi
Mulpleta 3mg Tablet
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Indications & Clinical Uses
- Mulpleta 3 mg tablets contain lusutrombopag, a thrombopoietin (TPO) receptor agonist made by Shionogi.
- It is indicated for the treatment of thrombocytopenia (low platelet count) in adult patients with chronic liver disease who are scheduled to undergo an invasive procedure, to reduce the need for a platelet transfusion around the time of that procedure.
- It works by stimulating platelet production in the bone marrow.
- The same molecule was marketed in the EU as Mulpleo, but Shionogi withdrew Mulpleo's EU marketing authorisation on 14 April 2026 for commercial reasons; Mulpleta remains approved and available in the United States and Japan.
- Mulpleta is a specialist, hepatology-prescribed treatment used as a short, defined pre-procedure course rather than an ongoing medicine, and is not intended for general or long-term management of low platelet counts unrelated to a planned procedure.
Side Effects
- The most common side effect of Mulpleta, reported in around 5% of treated patients compared with 4% on placebo, is headache.
- As a thrombopoietin receptor agonist, Mulpleta carries a risk of blood clots (thrombosis), including portal vein thrombosis, particularly if the platelet count rises above the normal range during or after treatment in patients with chronic liver disease; there is no boxed warning on the current US label, but this thrombotic risk is an important safety point.
- Patients should seek urgent medical attention for sudden numbness or weakness, especially on one side of the body, swelling, pain or redness in an arm or leg, chest pain or shortness of breath, as these can signal a blood clot.
- Fever, vomiting, yellowing of the skin or eyes (jaundice), or bloody or black stools should also be reported promptly, as they may indicate worsening liver function or bleeding.
Precautions & Warnings
- Mulpleta is taken as 3 mg once daily for 7 days, starting 8 to 14 days before a scheduled procedure, with the procedure then carried out 2 to 8 days after the last dose; it is not intended for longer or repeated courses outside this pre-procedure window without specialist reassessment.
- Platelet counts must be monitored before, during and after treatment because of the risk of thrombosis if the count rises too high or overshoots after the procedure.
- It should be used with particular caution, or avoided, in patients with a personal or family history of blood clots or clotting disorders.
- Safety in pregnancy has not been established; it is not known whether lusutrombopag passes into breast milk, and breastfeeding is generally avoided during treatment and for at least 28 days after the last dose.
- Mulpleta is prescribed and monitored by a hepatology or specialist team as part of pre-procedure planning, with liver function and platelet counts checked throughout the course.
Avoid Interactions
- Lusutrombopag has a low potential to inhibit the major cytochrome P450 (CYP) enzymes, and no clinically significant interaction was seen with cyclosporine, antacids containing multivalent cations such as aluminium, magnesium or calcium, or midazolam.
- Patients should still tell their prescriber about all medicines and supplements being taken, because Mulpleta is used specifically around invasive procedures, where other medicines that affect bleeding or clotting risk - such as anticoagulants, antiplatelet drugs, or other agents that raise clotting activity - need careful coordination with the treatment and procedure schedule.
- Because of the class thrombosis risk, combining Mulpleta with other medicines or conditions that independently increase clotting risk should be flagged to the prescriber in advance.
- Mulpleta tablets may be taken with or without food, and there is no specific food interaction identified on the label; alcohol use should be discussed with the hepatology team given the underlying chronic liver disease being treated.
References
Frequently Asked Questions
Mulpleta (lusutrombopag) raises platelet counts in adults with chronic liver disease before a scheduled invasive procedure, reducing the need for a platelet transfusion. It works by stimulating the bone marrow to make more platelets and is taken as a short pre-procedure course.
Mulpleta is taken as one 3 mg tablet by mouth once daily for 7 days, starting 8 to 14 days before the scheduled procedure, with or without food. Your procedure is then done 2 to 8 days after your last dose, timed by your specialist team.
Headache is the most common side effect, in about 5% of patients. The main serious risk is a blood clot, including portal vein thrombosis, especially if platelet counts rise too high. Report sudden limb weakness, leg swelling, chest pain or breathlessness urgently.
Tell your prescriber about all medicines that affect bleeding or clotting, such as blood thinners, since these need coordinating around your procedure. Avoid unmonitored use if you have a personal or family history of blood clots, and discuss alcohol use given your liver condition.
Yes. Your platelet count is checked before, during and after the 7-day course, because Mulpleta can raise platelets too high and increase clotting risk. Liver function is also monitored throughout, since Mulpleta is used specifically in people with chronic liver disease.
No, Mulpleta is only a short 7-day course used before a specific procedure, not a long-term treatment. Safety in pregnancy is not established, so contraception and breastfeeding plans should be discussed with your prescriber; breastfeeding is generally avoided for 28 days after the last dose.
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