Eltrombopag

Antihaemorrhagic/Antihemophilic · Thromboprotein receptor agonist

Indications

Chronic immune thrombocytopenic purpura in splenectomised patients refractory to other treatments. Second line treatment for non-splenectomised patients where surgery is contraindicated. Treatment of thrombocytopaenia associated with chronic hepatitis C infection, where the degree of thrombocytopaenia is the main factor preventing the initiation or limiting the ability to maintain optimal interferon-based therapy. Acquired severe aplastic anaemia in patients either refractory to or heavily pretreated with prior immunosuppressive therapy and are unsuitable for haematopoietic stem cell transplantation.

Dosage

Adults: Immune thrombocytopenic purpura: Initially 50 mg once daily, then adjusted to achieve and maintain platelet count > 50,000/mm3 according to platelet count; max dose 75 mg daily. Dosage adjustment recommendations based on platelet response: Platelet count < 50,000/mm3 after at least 2 wk increase daily dose by 25 mg daily. If previously taking 12.5 mg once daily, increase dose to 25 mg once daily then increase the dose amount by 25 mg/day, max dose 75 mg/day. Platelet count at any time > 200,000/mm3 and < 400,000/ mm3: Reduce daily dose by 25 mg; reassess in 2 wk. Platelet count > 400,000/mm3 and < 400,000/ mm3: Withhold dose, assess plate count twice weekly. When platelet count < 150,000/mm3, start with the daily dose reduced by 25 mg. If taking 25 mg once daily, start with 12.5 mg once daily. Platelet count > 400,000/mm3 after 2 wk at the lowest dose, discontinue…

Adverse Effects

Insomnia, headache, paraesthesia, cataract, dry eye, GI upset, altered LFTs, skin reactions, alopecia, arthralgia, myalgia, muscle spasm, bone pain, fatigue, peripheral oedema, thrombotic/thromboembolic complications, syncope, agitation, palpitations, confusion, anxiety, attention disturbance, impaired memory, depression, irritability, pyrexia, visual disturbances, infections, wt loss, dysgeusia, dry mouth, stomatitis, toothache, oesophageal varices, mouth ulcers, haemorrhoids, ascites, blood dyscrasias, splenic infarction, haemochromatosis, changes in blood sugar and appetite, skin and inj site reactions, menorrhagia, cough, dyspnoea, epistaxis, fatigue, flu like symptoms, oedema, hepatic neoplasm, hepatic encephalopathy, hepatic failure, jaundice, chromaturia, QT prolongation, increased INR, APTT and creatine kinase, reduced blood albumin. Cytogenetic abnormalities and haematological…

Risk Factor (Pregnancy/Lactation)

Lactation: Contraindicated or not recommended. Contraindications: Ensure adequate contraception in childbearing women. Precautions: Moderate to severe hepatic impairment (Child-Pugh score more or equal to 7). Risk factors for thromboembolism, chronic liver disease. Obtain peripheral blood smear and complete blood count, serum ALT, AST and bilirubin before and during treatment. East Asian patients, elderly. Cirrhosis; monitor for hepatic decompensation.

Interactions

Methotrexate, statins, topotecan, antacids, dairy products, mineral supplement, lopinavir, ritonavir, corticosteroids, danazol, azathioprine, IV immunoglobulins, cyclosporin, fluvoxamine, rifampicin.

Advice to Patient

Take without meals. Swallow with a full glass of water. Do not take within 4 hours of antacid, dairy products or other calcium containing food products or mineral supplements containing iron and vitamins. Take medication at the same time every day. Keep all appointments for blood work and follow-up.

Pharmacokinetics

Onset of action: Platelet count increase: Within 1-2 wks. Duration: Platelets return to baseline: 1-2 wks after last dose. Metabolism: Extensive hepatic metabolism. Bioavailability: Adults: At least 52%. Half-life elimination: Healthy persons: Approx. 21-32 hrs. ITP patients: Approx. 26-35 hrs. Time to peak, plasma: 2-6 hrs. Excretion: Faeces (Approx. 59%). Urine (31%).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.