Description
DK
Dr. Daria Kwaśniewska
ESMO Certified Consultant Medical Oncologist
Reviewed June 2026
⚠ Prescription required. For informational purposes only. Meds For Cancer is a Named Patient Program facilitator — not a retail pharmacy. A valid physician prescription is mandatory before any order is processed. Avatrombopag is not approved for dengue-related thrombocytopenia.
Is Avalet 20 mg right for your situation?
Review these criteria with your doctor before enquiring✔ You may be a candidate if
- ✓Chronic immune thrombocytopenia (ITP) with inadequate response to prior therapy
- ✓Thrombocytopenia in adults with chronic liver disease scheduled for a procedure
- ✓Need a generic alternative to Doptelet® (Swedish Orphan Biovitrum) without dietary chelation restrictions
- ✓Hold a valid physician prescription
✖ May NOT be suitable if
- ✗Thrombocytopenia from dengue or other non-approved causes — not an established indication
- ✗History of arterial or venous thromboembolism, especially in chronic liver disease setting
- ✗Pregnant, planning pregnancy, or breastfeeding
- ✗Scheduled procedure within less than 5 days of starting (requires specific pre-procedure dosing window)
Check Availability & Pricing
Prescription required · Named Patient Program · Worldwide shipping
🛡 WHO-GMP Certified · Prescription verified · Express dispatch
What is Avalet 20 mg?
Avalet 20 mg is a generic formulation of Avatrombopag — an oral thrombopoietin (TPO) receptor agonist — manufactured by Drug International Ltd. under WHO-GMP certified conditions in Bangladesh. Each tablet contains 20 mg of avatrombopag, the same active molecule found in Doptelet® (Swedish Orphan Biovitrum), and is dispensed under the Named Patient Program for patients requiring an affordable, quality-assured alternative.
A key practical advantage of avatrombopag over eltrombopag is that it can be taken with food and has no dietary chelation restrictions — no need to avoid dairy, antacids, or mineral supplements around dosing time.
| Generic name | Avatrombopag |
| Reference brand | Doptelet® (Swedish Orphan Biovitrum) |
| Manufacturer | Drug International Ltd. |
| Standard | WHO-GMP Certified |
| Drug class | Thrombopoietin (TPO) Receptor Agonist |
| Dosage form | Tablet — 20 mg |
| Pack size | 28 tablets per pack |
| Route | Oral · once daily, with food |
| Prescription | Required — physician only |
How Avatrombopag Works
Platelets are produced by bone marrow megakaryocytes under the regulation of thrombopoietin (TPO). In conditions like ITP and chronic liver disease, platelet production is insufficient, leading to dangerously low counts and bleeding risk.
Avatrombopag binds to and activates the TPO receptor on megakaryocyte precursors, stimulating platelet production through the same receptor pathway as the body’s natural hormone. Unlike eltrombopag — which chelates with polyvalent cations and must be taken fasting — avatrombopag does not bind metal ions and can be taken with food, simplifying the dosing routine. In the ADAPT-1 and ADAPT-2 trials for chronic liver disease, avatrombopag significantly increased platelets above 50,000/μL in the majority of patients prior to procedures, reducing the need for platelet transfusions.
What to Expect: First 30 Days
The dosing pattern differs significantly between the two approved indications — understanding which applies to you is essential.
- For chronic ITP: Treatment is continuous — 20 mg once daily ongoing, with platelet counts checked regularly and dose adjusted between 20 mg and 40 mg based on response. Most patients begin to see platelet increases within 1–2 weeks.
- For chronic liver disease (pre-procedure): A short 5-day course starting 10–13 days before the scheduled procedure. Dose depends on pre-treatment platelet count — 60 mg daily for platelets below 40,000/μL, or 40 mg daily for platelets 40,000–50,000/μL. This is a time-limited, procedure-specific regimen.
- Week 4 onwards (ITP): If platelet counts are stable and well-tolerated, dose adjustments and monitoring frequency settle into a routine. Blood counts continue throughout.
Side Effects
Avatrombopag is generally well tolerated, but blood clot risk — particularly in patients with chronic liver disease — requires awareness and monitoring.
Common · Usually Manageable
- Headache
- Fatigue
- Nausea
- Easy bruising (from underlying thrombocytopenia)
- Upper respiratory infections
- Joint pain
Serious · Report Immediately
- Thrombotic events (blood clots) — DVT, PE, portal vein thrombosis
- Excessive platelet response (thrombocytosis)
- Severe abdominal pain (possible portal/splenic vein thrombosis in liver disease)
⚠ Call your doctor immediately if you experience:
- Sudden leg swelling, pain, or redness (possible DVT)
- Breathlessness or chest pain (possible pulmonary embolism)
- Severe or sudden abdominal pain (possible portal/splenic vein thrombosis)
How to Take Avalet 20 mg
Dose depends on indication — chronic ITP: 20 mg once daily (adjusted 20–40 mg by response) · chronic liver disease pre-procedure: 60 mg or 40 mg once daily for 5 days (dose selected by pre-treatment platelet count). Follow your physician’s exact prescription.
- 1Take with food — avatrombopag absorption is not significantly affected by food, and no dairy/calcium separation is needed (unlike eltrombopag).
- 2Same time each day — consistency helps maintain stable drug levels and makes it easier to track the dosing schedule.
- 3Swallow tablets whole with water. Do not chew or crush.
- 4If you miss a dose, take it as soon as you remember the same day. If a full day has passed, skip it and continue your normal schedule.
- 5Storage: below 30°C, protected from moisture and light, out of reach of children.
Caregiver Guidance
- ♥Watch for blood clot warning signs — leg swelling/pain, breathlessness, or sudden severe abdominal pain are urgent warning signs, especially in patients with chronic liver disease where portal vein thrombosis risk is elevated.
- ♥For the liver disease indication, track the 5-day course carefully — this is a very specific short regimen timed to a procedure date. Help ensure the course starts and ends on the prescribed days.
- ♥Track platelet monitoring appointments — dose adjustments in the ITP setting are made based on platelet counts, so regular blood tests are essential for safe dosing.
If the Medicine Stops Working
If platelet counts fail to respond adequately to avatrombopag after an adequate trial at the maximum dose, your physician will typically discontinue treatment and consider alternative TPO receptor agonists (such as eltrombopag or romiplostim) or other ITP management strategies including rituximab or immunomodulatory therapy. For the chronic liver disease indication, the pre-procedure regimen is not designed to be repeated indefinitely — long-term management of the liver disease itself should be addressed with your hepatologist.
Frequently Asked Questions
How is Avalet different from Elbonix or Elopag (eltrombopag)?
Both are oral TPO receptor agonists that stimulate platelet production, but they are different molecules with different characteristics. Avatrombopag (Avalet) can be taken with food and has no dietary chelation restrictions — you can eat dairy, take antacids, and take mineral supplements normally. Eltrombopag (Elbonix/Elopag) must be taken fasting and separated from dairy, antacids, and mineral supplements by at least 4 hours, due to chelation with polyvalent cations. Avatrombopag also has a distinct indication for chronic liver disease pre-procedure use that eltrombopag does not share.
Is Avalet used for dengue fever thrombocytopenia?
No. Avatrombopag is not approved for dengue-related thrombocytopenia. Its approved indications are chronic ITP and thrombocytopenia in adults with chronic liver disease preparing for a procedure. Dengue-related platelet drops should be managed according to your treating physician’s specific protocol — not with TPO receptor agonists outside of physician-supervised, informed clinical decisions.
Who manufactures Avalet?
Avalet is manufactured by Drug International Ltd. — one of Bangladesh’s largest pharmaceutical companies with WHO-GMP certification and a broad oncology and specialty medicine portfolio. Drug International exports to multiple markets across Asia and Africa under Named Patient Program frameworks.
How long does it take to work?
For chronic ITP, platelet counts typically begin rising within 1–2 weeks of starting treatment. Clinical trials showed that a meaningful proportion of patients achieved platelet counts above 50,000/μL within 8 days of starting treatment. For chronic liver disease, the 5-day course is timed so that peak platelet response aligns with the procedure date, usually around Day 10–13.
Do I need to avoid dairy or antacids with Avalet?
No — this is one of avatrombopag’s advantages over eltrombopag. Avatrombopag does not chelate with polyvalent cations (calcium, iron, magnesium, etc.), so no special timing around dairy, antacids, or mineral supplements is required. Simply take it with food at the same time each day.
How do I order Avalet through Meds For Cancer?
Contact us via WhatsApp (+880 130 449 8958) or email (info@medsforcancer.com) with your physician’s prescription specifying your diagnosis and the prescribed dose. Our team will verify the prescription, confirm availability and pricing, and arrange secure international shipping under the Named Patient Program.
🛡 Named Patient Program — Regulatory Framework
Meds For Cancer operates as a Named Patient Program (NPP) facilitator. Under this framework, WHO-GMP certified medicines are made available to individual patients with a confirmed medical need and a valid prescription, in countries where the branded product is unavailable or unaffordable.
This service does not constitute retail pharmacy dispensing. A prescription review is mandatory before any order is processed.
Clinical References
- Terrault N, et al. Avatrombopag before procedures in patients with chronic liver disease and thrombocytopenia (ADAPT-1 and ADAPT-2). Lancet 2018;391:2163–2173.
- Jurczak W, et al. Avatrombopag in the treatment of ITP. Eur J Haematol 2018;101:415–422.
- FDA Prescribing Information: Doptelet (avatrombopag). Swedish Orphan Biovitrum, 2022.
- NCCN Clinical Practice Guidelines in Oncology: Hematopoietic Growth Factors. V2.2026.
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