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DrugMulpleta®  (lusutrombopag) [Shionogi Inc]

June 2019

Therapeutic area - Thrombopoiesis Stimulating Proteins

Initial approval criteria

Patient must:

  • Be ≥ 18 years old AND
  • Have diagnosis of chronic liver disease (CLD) AND
  • Have a platelet count of < 50 x 109/L AND
  • NOT have Child-Pugh class C liver disease, absence of hepatopetal blood flow, a prothrombotic condition other than CLD or a history of splenectomy, partial splenic embolization, or thrombosis AND
  • Have an invasive procedure scheduled AND
  • Have lusutrombopag scheduled to begin 8 to 14 days prior to the procedure, with the procedure occurring 2 to 8 days following the last dose of lusutrombopag AND
  • NOT be taking Doptelet
  • NOT be scheduled for a thoracotomy, laparotomy, open-heart surgery, craniotomy, or organ resection 


  • Date of procedure must be submitted at time of request

Quantity limits

  • 7 tablets/7 days


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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