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Nplate Side Effects

Generic name: romiplostim

Medically reviewed by Philip Thornton, DipPharm. Last updated on Dec 30, 2022.

Note: This document contains side effect information about romiplostim. Some dosage forms listed on this page may not apply to the brand name Nplate.


Common side effects of Nplate include: abdominal pain, dizziness, insomnia, limb pain, and myalgia. Other side effects include: dyspepsia, paresthesia, and shoulder pain. Continue reading for a comprehensive list of adverse effects.

Applies to romiplostim: subcutaneous powder for solution.

Serious side effects of Nplate

Along with its needed effects, romiplostim (the active ingredient contained in Nplate) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking romiplostim:

More common

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • body aches or pain
  • change in hearing
  • chills
  • cough
  • diarrhea
  • difficulty breathing
  • ear congestion, drainage, or pain
  • fever
  • headache
  • loss of appetite
  • loss of voice
  • nausea
  • pain or tenderness around the eyes and cheekbones
  • rapid weight gain
  • sneezing
  • sore throat
  • stomach pain
  • stuffy or runny nose
  • tightness of the chest
  • tingling of the hands or feet
  • unusual tiredness or weakness
  • unusual weight gain or loss
  • upper stomach pain

Incidence not known

  • Burning pain, warmth, swelling, or redness of the hands and feet
  • fast heartbeat
  • feeling of warmth
  • hives, itching, skin rash
  • hoarseness
  • irritation
  • joint pain, stiffness, or swelling
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
  • redness of the skin
  • trouble swallowing

Other side effects of Nplate

Some side effects of romiplostim may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Acid or sour stomach
  • belching
  • bruise
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • difficulty with moving
  • dizziness
  • heartburn
  • indigestion
  • mouth or throat pain
  • muscle pains, cramps, or stiffness
  • pain in the shoulder, arms, or legs
  • stomach discomfort, upset, or pain
  • trouble sleeping

For Healthcare Professionals

Applies to romiplostim: subcutaneous powder for injection.


The most serious adverse reactions were increased bone marrow reticulin, thrombotic/thromboembolic complications, and progression of myelodysplastic syndromes (MDS) to acute myelogenous leukemia (AML).[Ref]


Serious bleeding events included any event that was fatal, life-threatening, required hospitalization or prolongation of hospitalization, caused persistent or significant disability/incapacity, congenital anomaly/birth defect, and any other significant hazard.[Ref]

Very common (10% or more): Grade 2 or higher bleeding event (15%)

Common (1% to 10%): Bone marrow reticulin formation increased 2 grades or more, bone marrow collagen fibrosis increased to grade 4, grade 4 bone marrow collagen fibrosis, bone marrow disorder, thrombocytopenia, anemia, thrombocytosis, bone marrow reticulin deposition, anemia, reticulin increased, serious bleeding event

Uncommon (0.1% to 1%): Aplastic anemia, bone marrow failure, leukocytosis, splenomegaly, thrombocythemia, platelet count increased, platelet count abnormal, blood lactate dehydrogenase increased

Frequency not reported: Marrow fibrosis with collagen[Ref]


Common (1% to 10%): Palpitations, flushing, hematoma, hypertension, peripheral ischemia, peripheral embolism

Uncommon (0.1% to 1%): Myocardial infarction, heart rate increased, deep vein thrombosis, hypotension, phlebitis, thrombophlebitis superficial, thrombosis, erythromelalgia, blood pressure increased

Frequency not reported: Congestive heart failure[Ref]


Common (1% to 10%): B-cell lymphoma

Uncommon (0.1% to 1%): Multiple myeloma, myelofibrosis

Frequency not reported: Progression of myelodysplastic syndromes (MDS) to acute myelogenous leukemia (AML), blast cell counts transiently increased[Ref]

Nervous system

Very common (10% or more): Headache (up to 36.2%), dizziness (up to 17%)

Common (1% to 10%): Paresthesia, migraine

Uncommon (0.1% to 1%): Clonus, dysgeusia, hypoesthesia, hypogeusia, neuropathy peripheral, transverse sinus thrombosis, vertigo[Ref]


Very common (10% or more): Upper respiratory tract infection (up to 31%), nasopharyngitis (up to 26.2%), oropharyngeal pain (up to 25%), epistaxis (22.6%), cough (up to 17.3%)

Common (1% to 10%): Pulmonary embolism, sinusitis, bronchitis, dyspnea, nasal congestion, rhinorrhea

Uncommon (0.1% to 1%): Dry throat, painful respiration

Frequency not reported: Upper respiratory tract infection, pneumonia[Ref]


Very common (10% or more): Arthralgia (up to 26%), back pain (up to 15.8%), pain in extremity (up to 15.6%), myalgia (up to 14%)

Common (1% to 10%): Shoulder pain, muscle spasms, bone pain, musculoskeletal pain

Uncommon (0.1% to 1%): Muscle tightness, muscle weakness, muscle twitching[Ref]


Very common (10% or more): Contusion (up to 41%), pyrexia (up to 24%), fatigue (up to 23.3%)

Common (1% to 10%): Influenza-like illness, pain, asthenia, chills, injection site reaction, chest pain, peripheral swelling

Uncommon (0.1% to 1%): Injection site hemorrhage, malaise, feeling hot, feeling jittery, body temperature increased[Ref]


Very common (10% or more): Diarrhea (up to 20%), nausea (up to 19.4%), upper abdominal pain (14%), abdominal pain (up to 11%), vomiting (up to 10.5%)

Common (1% to 10%): Dyspepsia, gastroenteritis, constipation, gingival bleeding, mouth hemorrhage, upper abdominal pain, toothache

Uncommon (0.1% to 1%): Rectal hemorrhage, breath odor, dysphagia, gastroesophageal reflux disease, hematochezia, stomach discomfort, stomatitis, tooth discoloration[Ref]


Very common (10% or more): Petechiae (18.6%), rash (up to 15%)

Common (1% to 10%): Angioedema, pruritus, ecchymosis, purpura, urticaria

Uncommon (0.1% to 1%): Alopecia, photosensitivity reaction, acne, dermatitis contact, dry skin, eczema, erythema, exfoliative rash, hair growth abnormal, prurigo, rash papular, rash pruritic, skin nodule, skin odor abnormal, face edema[Ref]


Very common (10% or more): Insomnia (up to 16%)

Common (1% to 10%): Anxiety

Uncommon (0.1% to 1%): Depression, abnormal dreams, irritability[Ref]


Very common (10% or more): Peripheral edema (up to 12.5%)

Common (1% to 10%): Hypokalemia

Uncommon (0.1% to 1%): Alcohol intolerance, anorexia, appetite decreased, dehydration, gout, weight decreased, weight increased[Ref]


Very common (10% or more): Antibodies to this drug (up to 16%)

Common (1% to 10%): Preexisting antibodies to this drug, influenza, ear infection

Uncommon (0.1% to 1%): Localized infection, neutralizing antibodies

Frequency not reported: Hypersensitivity reactions including angioedema and anaphylaxis (postmarketing reports)[Ref]


Common (1% to 10%): Urinary tract infection

Uncommon (0.1% to 1%): Protein urine present, vaginal hemorrhage[Ref]


Uncommon (0.1% to 1%): Conjunctival hemorrhage, accommodation disorder, blindness, eye disorder, eye pruritus, lacrimation increased, papilledema, visual disturbances[Ref]


Uncommon (0.1% to 1%): Portal vein thrombosis, transaminase increased[Ref]

Frequently asked questions


1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. "Product Information. Nplate (romiplostim)." Amgen USA (2008):

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.