Should be used only in patients with ITP whose degree of thrombocytopenia and clinical condition increase the risk for bleeding. Should not be used in an attempt to normalize platelet counts. Increases risk for reticulin deposition within bone marrow. Discontinuation of romiplostim may result in worsened thrombocytopenia than was present prior to therapy (monitor complete blood counts including platelet counts, for at least 2 weeks following discontinuation). Excessive doses may increase platelet counts to a level that produces thrombotic/thromboembolic complications. Assess patients for the formation of neutralizing antibodies if platelet counts decrease significantly following an initial response. May increase risk for hematological malignancies, especially in patients with myelodysplastic syndrome. Monitor CBCs weekly, including platelet counts and peripheral blood smears, until a stable dose has been achieved (thereafter, monitor CBCs, including platelet counts and peripheral blood smears, at least monthly). Available only through a restricted distribution program. Discontinue romiplostim if platelet count does not increase to a level sufficient to avoid clinically important bleeding after 4 weeks of therapy at the maximum weekly dose.