Michael R. Cohen ScD, MS, RPH

December 2011 
Volume 41  Number 12
Pages 14 - 14
  PDF Version Available!

Nplate (romiPLOStim) is a thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura who've had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. The drug is available as a lyophilized powder in both 250 and 500 mcg vials. As you can see on the carton label below, 250 mcg is printed in a large red circle. Vials are similarly labeled. One might logically conclude that each vial contains 250 mcg of drug. But on closer inspection, the label indicates that the vial actually contains 375 mcg and must be diluted with 0.72 mL of sterile water, which provides a large overfill. The solution has a final concentration of 500 mcg/mL (with a total vial content of 375 mcg), or 250 mcg in 0.5 mL.The final concentration is noted elsewhere on the carton, but is easily missed if your eye is drawn to the red circle. A clinician who didn't read the package insert might be misled into adding 0.5 mL of

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