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Romiplostim Side Effects

In Summary

Commonly reported side effects of romiplostim include: dizziness, abdominal pain, insomnia, myalgia, and limb pain. Other side effects include: dyspepsia, paresthesia, and shoulder pain. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to romiplostim: subcutaneous powder for solution

As well as its needed effects, romiplostim may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking romiplostim, check with your doctor or nurse immediately:

  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • difficulty with breathing
  • pain in the chest, groin, or legs, especially the calves
  • pinpoint red spots on the skin
  • severe, sudden headache
  • slurred speech
  • sudden loss of coordination
  • sudden, severe weakness or numbness in the arm or leg
  • sudden, unexplained shortness of breath
  • unusual bleeding or bruising
  • vision changes

Minor Side Effects

Some romiplostim side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Acid or sour stomach
  • belching
  • difficulty with moving
  • dizziness
  • headache
  • heartburn
  • indigestion
  • muscle aching or cramping
  • muscle pains or stiffness
  • pain in the arms or legs
  • pain in the joints
  • pain in the shoulder
  • stomach discomfort, upset, or pain
  • swollen joints
  • 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]


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]

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]


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): Nasopharyngitis (up to 26.2%), epistaxis (22.6%), upper respiratory tract infection (18.2%), cough (up to 17.3%), oropharyngeal pain (12.2%)
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): Fatigue (up to 23.3%), contusion (up to 22.5%), pyrexia (up to 11.8%)
Common (1% to 10%): Influenza-like illness, pain, asthenia, chills, injection site reaction, chest pain
Uncommon (0.1% to 1%): Injection site hemorrhage, malaise, feeling hot, feeling jittery, body temperature increased[Ref]


Very common (10% or more): Nausea (up to 19.4%), diarrhea (up to 18.7%), 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 11.3%)
Common (1% to 10%): Angioedema, pruritus, ecchymosis
Uncommon (0.1% to 1%): Alopecia, photosensitivity reaction, acne, dermatitis contact, dry skin, eczema, erythema, exfoliative rash, hair growth abnormal, prurigo, purpura, rash papular, rash pruritic, skin nodule, skin odor abnormal, urticaria, 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]


Common (1% to 10%): Antibodies to this drug, preexisting antibodies to this drug, influenza
Uncommon (0.1% to 1%): Localized infection, neutralizing antibodies
Frequency not reported: Hypersensitivity[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]


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

2. "Product Information. Nplate (romiplostim)." Amgen USA, Thousand Oaks, CA.

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

It is possible that some side effects of romiplostim may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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