Treatments for ITP

If your ITP is mild, you may not need treatment at all. Mild ITP generally means your platelet count is above 30,000, and you are having little or no bleeding. Your provider may simply watch your platelet count to be sure it does not drop too low.¹

Treatments for ITP work differently from person to person. Therefore, there is no single right treatment for immune thrombocytopenia (ITP). Treatment is a shared decision between you and your doctor, where you will discuss current recommendations, side effects, how the drug is taken, and your own preferences.

What ITP treatment is trying to do

The goal of treatment is not a perfect platelet count. Platelet-boosting drugs are not meant to bring your count back to normal. The aim is to bring your count high enough to stop any bleeding and to protect you from serious bleeding in the future.²

When treatment is needed

Guidance from the American Society of Hematology says adults with newly diagnosed ITP who have a platelet count of 30,000 per microliter or higher, and no or only minor bleeding, can be observed rather than treated. If your platelet count is below that level, or you are having more serious bleeding, it is suggested to use corticosteroids as an initial treatment.²

There are other treatment options available as well, and treatment decisions rest on your symptoms and preferences, not your count alone, and is shared between you and your doctor.³

Corticosteroids

Corticosteroids - often just called “steroids”- are usually the first treatment tried. They calm the immune system, which helps raise your platelet count. These are not the same as the “anabolic steroids” some athletes may misuse. Some examples of corticosteroids include:^1,2,4

• Prednisone – A tablet approved by the US Food and Drug Administration (FDA) to treat ITP in adults. A daily tablet which is generally taken for a few weeks, and then gradually reduced.
• Dexamethasone – Another corticosteroid used as a first treatment.

Important: Do not stop steroids suddenly. After taking steroids for a short time, your body needs them lowered slowly (tapered). Stopping suddenly can make you feel unwell. Always follow your doctor’s instructions and never stop on your own. Steroids are not for long-term use. Over time, they raise the risk of infections, cause higher blood sugar, and contribute to bone thinning.^4,5

Immune globulin and anti-D therapy

Both of these therapies are given through a vein and can raise platelet counts quickly:^6-10

• Immune globulin (IVIG) – Supplies antibodies that help stop your immune system from destroying platelets. Brands approved to treat ITP include Privigen® for chronic ITP in people age 15 and older, Octagam® 10 percent and Panzyga® for chronic ITP in adults, and Gamunex®-C for ITP in adults and children.
• Anti-D therapy – WinRho® SDF is approved for people who are Rho(D) positive and still have their spleen: children with acute or chronic ITP, adults with chronic ITP, and children and adults with ITP related to HIV.

Immune globulin products carry a boxed warning, the strictest warning from the FDA, about blood clots and kidney problems. WinRho® SDF carries a boxed warning about the destruction of red blood cells, which has led to deaths in people treated for ITP.^6-10

Drugs that help you make more platelets

These are called thrombopoietin receptor agonists. They signal your bone marrow to make more platelets. All 3 are approved for adults and children, though the ages differ:^1,11-14

• Romiplostim (Nplate®) – An injection, for adults, and for children age 1 and older with ITP for at least 6 months, when corticosteroids, immunoglobulins, or spleen removal did not work well enough.
• Eltrombopag (Promacta®, Alvaiz®) – Taken by mouth for persistent or chronic ITP after those same treatments did not work well enough. Promacta® covers adults and children age 1 and older, and Alvaiz® adults and children age 6 and older.
• Avatrombopag (Doptelet®) – Taken by mouth, for adults with chronic ITP and for children age 1 and older with persistent or chronic ITP, when a previous treatment did not work well enough.

Promacta® and Alvaiz® carry a boxed warning about severe liver injury. As a group, these drugs also carry a risk of blood clots.^11,13,14

Drugs that slow platelet destruction

Both of these drugs are approved for adults only, after a previous treatment did not work well enough:^15-17

• Fostamatinib (Tavalisse®) – Taken by mouth for chronic ITP. It blocks an enzyme called SYK, reducing the antibody-driven destruction of platelets.
• Rilzabrutinib (Wayrilz®) – Taken by mouth for persistent or chronic ITP, approved in 2025. It blocks an enzyme called BTK, which lowers antibody-driven destruction of platelets.

Rituximab, used off-label

Rituximab is given through a vein and helps stop your immune system from destroying platelets. It is not approved by the FDA to treat ITP. The American Society of Hematology lists it as a possible second-line option for adults whose ITP has lasted 3 months or longer and who depend on corticosteroids or have not responded to them.^1,2,18

All patients must be screened for Hepatitis B prior to starting Rituximab, as it can reactivate Hepatitis B infection. Infusion reactions can occur, though are generally managed easily with additional medications, and do not prevent a patient from receiving more Rituximab in the future.

Some treatments listed here are not approved by the US Food and Drug Administration to treat ITP. They may be approved for other conditions. A doctor may prescribe them “off-label” when evidence suggests they help. Talk to your doctor about what is right for you.

Surgery and emergency care

Some surgical options may be available to treat ITP, such as:^1,2,5,19

• Splenectomy – Surgery to remove the spleen, where most platelets are destroyed by mistake. It can raise counts when drugs have not worked, but it does not help everyone, and it raises your infection risk for life.
• Platelet transfusion – Used to stop or prevent serious bleeding, sometimes with steroids and immune globulin in an emergency.

What are the possible side effects?

Side effects can vary depending on the specific treatment or drug you are taking. Common ones across these treatments include headache, fever, nausea, diarrhea, joint pain, and tiredness. Some carry more specific risks, such as high blood pressure and liver enzyme changes with fostamatinib, and serious infections with rilzabrutinib.^{6,12,13,15,16}

These are not all the possible side effects of ITP treatments. Talk to your doctor about what to expect when taking an ITP treatment. You also should call your doctor if you have any changes that concern you when taking an ITP treatment.

Other things to know

Before beginning treatment for ITP, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

Ask before taking aspirin, ibuprofen, or blood thinners such as warfarin, clopidogrel, apixaban, or rivaroxaban, which raise bleeding risk, and supplements such as ginkgo biloba, Vitamin E, turmeric, or fish oil/Omega 3 fatty acids.^5,20

There is no cure for ITP. Even so, most people who have chronic ITP can stop treatment at some point and keep a healthy platelet count. Many find their counts improve with treatment, and remission is possible.^1,19,21

Talking with your doctor

Treatments work differently for each person, and the first one you try may not be the one you stay on. Ask why your doctor recommends an option, what to expect, and what comes next if it does not work well enough.