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Eltrombopag: Comprehensive Guide to Thrombocytopenia Treatment
Summary or Key Points
Eltrombopag is a prescription medication used to treat low platelet counts in conditions such as chronic immune thrombocytopenic purpura (ITP), aplastic anemia, and thrombocytopenia related to hepatitis C or liver disease. It works by stimulating the production of platelets in the bone marrow. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist with any questions or concerns you may have.
Names of Medication
US Brand Name: Promacta
Generic Name: Eltrombopag
The generic name refers to the chemical name of the active ingredient in the medication. It is typically listed in parentheses next to the brand name.
Pharmacologic Category
Thrombopoietin Receptor Agonists
Other medications in this category include Romiplostim (Nplate).
Eltrombopag Dosage
Eltrombopag is prescribed for various conditions related to low platelet counts. The dosage will depend on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with us for further guidance.
Idiopathic Thrombocytopenic Purpura (ITP) or Chronic Immune Thrombocytopenic Purpura
Starting Dose: 50 mg once daily
Adjustments: Based on platelet response, the dose may be increased by 25 mg every 2 weeks, up to a maximum of 75 mg daily.
Length of Treatment: The duration of treatment varies depending on platelet counts and clinical response.
Aplastic Anemia
Starting Dose: 50 mg once daily
Adjustments: Dose adjustments are made based on platelet response, up to a maximum of 150 mg daily.
Length of Treatment: Treatment is typically long-term, depending on the patient’s response.
Thrombocytopenia Due to Hepatitis C
Starting Dose: 25 mg once daily
Adjustments: The dose may be increased by 25 mg every 2 weeks, up to a maximum of 100 mg daily, depending on platelet counts.
Length of Treatment: Treatment continues as long as the patient is undergoing antiviral therapy for hepatitis C.
Thrombocytopenia Due to Liver Disease
Starting Dose: 25 mg once daily
Adjustments: The dose may be increased by 25 mg every 2 weeks, up to a maximum of 100 mg daily, based on platelet counts.
Length of Treatment: The duration of treatment depends on the patient’s clinical response.
Myelodysplastic Syndromes and Bone Marrow Disorders
Starting Dose: 50 mg once daily
Adjustments: Dose adjustments are made based on platelet response, up to a maximum of 150 mg daily.
Length of Treatment: Long-term treatment may be necessary depending on the condition.
Chemotherapy-Induced Thrombocytopenia
Starting Dose: 50 mg once daily
Adjustments: Dose adjustments are made based on platelet response, up to a maximum of 150 mg daily.
Length of Treatment: The duration of treatment depends on the chemotherapy cycle and platelet response.
Dosage Forms and Strengths
Tablets: 12.5 mg, 25 mg, 50 mg, 75 mg, 100 mg
Oral Suspension: 12.5 mg, 25 mg
Administration Instructions for Eltrombopag
Eltrombopag should be taken on an empty stomach, either 1 hour before or 2 hours after a meal. Avoid consuming dairy products, calcium-fortified juices, or supplements containing calcium, iron, magnesium, or aluminum within 4 hours of taking Eltrombopag, as these can interfere with absorption. Always follow your healthcare provider’s instructions. If you have any questions about how to take your medication, our telemedicine providers are available to assist you.
Eltrombopag Side Effects and Adverse Reactions
Like all medications, Eltrombopag can cause side effects. Some are more common, while others are rare but potentially serious. Always report any side effects to your healthcare provider, and seek medical attention if you experience severe reactions.
Common Side Effects of Eltrombopag
Nausea: Feeling queasy or experiencing an upset stomach.
Headache: Mild to moderate headaches may occur.
Fatigue: Feeling unusually tired or weak.
Less Common but Serious Side Effects
Liver Problems: Eltrombopag can cause liver damage. Symptoms may include yellowing of the skin or eyes, dark urine, and pain in the upper right side of the abdomen.
Blood Clots: In rare cases, Eltrombopag can increase the risk of blood clots, particularly in patients with liver disease.
Bone Marrow Changes: Long-term use may lead to changes in the bone marrow, potentially affecting blood cell production.
Contraindications for Eltrombopag
A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. If you have any of the following conditions, Eltrombopag may not be safe for you. Always discuss your medical history with your healthcare provider before starting a new medication.
Allergy to Eltrombopag: If you have had an allergic reaction to Eltrombopag or any of its ingredients, you should not take this medication. Allergic reactions can include symptoms such as rash, itching, swelling, or difficulty breathing.
Severe liver disease: Eltrombopag can increase liver enzyme levels and may worsen liver function in individuals with severe liver disease. If you have a history of liver problems, your doctor may recommend alternative treatments.
Thromboembolic events: Eltrombopag may increase the risk of blood clots, especially in patients with known risk factors for clotting disorders. If you have a history of blood clots, this medication may not be appropriate for you.
Drug to Drug Interactions
Eltrombopag can interact with other medications, potentially altering its effectiveness or increasing the likelihood of side effects. It’s important to inform your healthcare provider about all the medications you are currently taking, including over-the-counter drugs and supplements.
Atorvastatin (Lipitor): Eltrombopag may increase the levels of atorvastatin in your bloodstream, which could raise the risk of side effects such as muscle pain or liver damage.
Cyclosporine (Neoral, Gengraf, Sandimmune): Taking cyclosporine alongside Eltrombopag may elevate the risk of liver complications and other adverse effects.
Rifampin (Rifadin, Rimactane): Rifampin can reduce the effectiveness of Eltrombopag by speeding up its breakdown in the body.
Antacids (containing aluminum, calcium, or magnesium): These antacids can interfere with the absorption of Eltrombopag, making it less effective. It’s recommended to take Eltrombopag at least two hours before or four hours after using antacids.
Eltrombopag in Pregnancy
Is it Safe to Take Eltrombopag When Pregnant?
There is limited information regarding the safety of Eltrombopag during pregnancy. While animal studies suggest potential risks to the fetus, there are no well-controlled studies in humans. If you are pregnant or planning to become pregnant, it’s essential to discuss the potential risks and benefits of Eltrombopag with your healthcare provider. Together, you can make an informed decision that prioritizes both your health and your baby’s well-being.
Eltrombopag While Breastfeeding
Is it Safe to Take Eltrombopag While Breastfeeding?
It is not known whether Eltrombopag passes into breast milk. Due to this uncertainty, breastfeeding mothers are generally advised to avoid Eltrombopag or consult their healthcare provider to explore alternative treatments. If you are breastfeeding, it’s important to have a conversation with your doctor to determine the best course of action for both you and your baby.
Estimated Cost of Eltrombopag
The cost of a 30-day supply of Eltrombopag without insurance can vary. With a GoodRx coupon, the estimated price for a 30-day supply of Eltrombopag (Promacta) ranges from $11,000 to $12,000, depending on the dosage and the pharmacy. Prices may fluctuate, so it’s a good idea to check with your pharmacy and explore available discount programs.
Possible Alternatives to Eltrombopag
If Eltrombopag is not the right option for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options.
- Idiopathic thrombocytopenic purpura (ITP): Alternatives include corticosteroids (e.g., prednisone), intravenous immunoglobulin (IVIG), or splenectomy (surgical removal of the spleen). Rituximab (Rituxan) may also be considered in certain cases.
- Chronic immune thrombocytopenic purpura: Similar to ITP, treatments may involve corticosteroids, IVIG, or rituximab. Thrombopoietin receptor agonists like romiplostim (Nplate) may also be used as an alternative to Eltrombopag.
- Aplastic anemia: Immunosuppressive therapy with medications such as cyclosporine or antithymocyte globulin (ATG) is often used. In severe cases, a bone marrow transplant may be considered.
- Thrombocytopenia: Treatment depends on the underlying cause and may involve platelet transfusions, corticosteroids, or addressing the root condition (e.g., discontinuing a medication that is causing low platelet counts).
- Hepatitis C-related thrombocytopenia: Managing the underlying hepatitis C infection with antiviral medications may help improve platelet counts. In some cases, platelet transfusions or other medications may be necessary.
- Myelodysplastic syndromes (MDS): Treatment options include blood transfusions, erythropoiesis-stimulating agents (ESAs), or chemotherapy. In some cases, a bone marrow transplant may be considered.
- Bone marrow disorders: Treatment depends on the specific disorder but may include medications to stimulate blood cell production, blood transfusions, or bone marrow transplants.
- Chemotherapy-induced thrombocytopenia: Reducing the chemotherapy dose or delaying treatment may help. In some cases, platelet transfusions or medications like romiplostim (Nplate) may be used.
- Thrombocytopenia due to liver disease: Managing the underlying liver condition is crucial. In some cases, platelet transfusions or medications to increase platelet production may be considered.
Recent Updates on Eltrombopag Research
Recent studies on Eltrombopag are exploring its potential use in treating additional conditions beyond its current indications. Researchers are investigating its role in managing thrombocytopenia in patients with other bone marrow disorders, as well as its long-term safety profile. Ongoing clinical trials are also examining the use of Eltrombopag in combination with other therapies for aplastic anemia and myelodysplastic syndromes. As research continues, more data will become available to guide treatment decisions. Stay in touch with your healthcare provider to stay informed about any new developments that may impact your treatment plan.
