Eltrombopag

What Is Eltrombopag?

Eltrombopag is a prescription medicine that belongs to a drug class called thrombopoietin receptor agonists (TPO-RAs). It is taken by mouth and helps the body make more platelets. Platelets are the blood cells that help blood clot. Eltrombopag is sold under brand names such as Promacta and Alvaiz, and generic versions may also be available.

Approved Uses

In the United States, eltrombopag is FDA-approved to treat:

• Persistent or chronic immune thrombocytopenia (ITP) in adults and children 1 year and older, when other treatments (such as corticosteroids, immunoglobulins, or spleen removal) have not worked well enough
• Low platelet counts in people with chronic hepatitis C infection, to allow them to start and stay on interferon-based treatment
• Severe aplastic anemia, a condition in which the bone marrow does not make enough blood cells. It is used together with standard immune-suppressing treatment as first-line therapy in adults and children 2 years and older, and in people who did not respond enough to immune-suppressing treatment alone.

Eltrombopag is not approved to treat myelodysplastic syndromes (MDS), and it is not used to make platelet counts normal.

Other Prescribed Uses

Specialists may occasionally prescribe eltrombopag for conditions that are not listed on the FDA label. This guide does not recommend use for any condition that is not FDA-approved.

Available Formulations and Strengths

• Oral tablets: multiple strengths depending on the product (Eltrombopag 25mg, Eltrombopag 50mg)
• Powder for oral suspension: single-use packets, available for some products, for people who cannot swallow tablets

Different eltrombopag products may not be interchangeable milligram for milligram. Do not switch brands or forms unless your specialist or pharmacist tells you to.

What Is the Recommended Dosage of Eltrombopag?

There is no single dose that fits everyone. Your specialist chooses the starting dose and adjusts it over time based on:

• The condition being treated
• Platelet counts, which are checked often, especially at the start of treatment
• Age and body size, particularly for children
• Liver function: people with liver problems usually start on a lower dose
• Ancestry: people of East or Southeast Asian ancestry are often started on a lower dose because their bodies may absorb more of the medicine
• Other medicines being taken

Available Dosage Forms

Eltrombopag is usually taken by mouth once a day as a tablet or as a liquid made from the powder packet. It should be taken on an empty stomach, generally at least 1 hour before or 2 hours after a meal, and away from calcium-rich foods and certain minerals (see the drug interactions section).

Follow Your Specialist’s Instructions

Doses may be raised, lowered, or paused based on blood test results. Take eltrombopag exactly as prescribed. Do not change your dose or stop the medicine on your own. If you use the powder packets, follow the mixing directions provided with your prescription and use the mixture right away.

How Eltrombopag Works

Platelets are made in the bone marrow, and the body uses a natural signal (thrombopoietin) to tell the marrow to make them. Eltrombopag attaches to the receptor for that signal and switches it on. This helps the bone marrow produce more platelets, and in aplastic anemia it may also help the marrow produce more of other blood cells.

• In ITP, it helps raise platelet counts in people whose bodies are destroying platelets or not making enough.
• In chronic hepatitis C, it raises platelet counts so that antiviral treatment can proceed. It does not treat the virus.
• In severe aplastic anemia, it is used with immune-suppressing treatment to help the marrow recover.

Eltrombopag helps manage low platelet counts. It does not cure ITP, aplastic anemia, or hepatitis C. Platelet counts may fall again if the medicine is stopped.

Is a Prescription Required to Buy Eltrombopag Online?

Yes. Eltrombopag is a prescription-only medicine. It should be started and monitored by a licensed medical specialist, such as:

• A hematologist (blood specialist), for ITP and aplastic anemia
• A hepatologist, gastroenterologist, or infectious disease specialist, for low platelets related to chronic hepatitis C, together with a hematologist when needed

Buying Medicine Safely

• Use only licensed pharmacies that require a valid prescription.
• Be cautious of websites that sell eltrombopag without a prescription or at prices that seem unrealistic. These products may be counterfeit, expired, contaminated, or the wrong strength.
• Do not use veterinary products or products from unverified sellers.
• If you are unsure whether a pharmacy is legitimate, ask your specialist, your local pharmacist, or your country’s pharmacy regulator.

Side Effects of Eltrombopag

Not everyone has side effects. Tell your care team about any new or bothersome symptoms.

Common Side Effects

• Nausea or vomiting
• Diarrhea
• Headache
• Tiredness
• Muscle aches or back pain
• Cough or sore throat
• Upper respiratory infections, such as colds
• Urinary tract infections
• Fever
• Skin rash
• Tingling or numbness
• Abnormal liver blood tests (often found only on lab work)

Side effects can differ by condition. For example, people with chronic hepatitis C may also have other symptoms related to their antiviral treatment.

Serious Side Effects

• Liver injury: signs include yellowing of the skin or eyes, dark urine, right-sided abdominal pain, or unusual tiredness.
• Liver decompensation in people with chronic hepatitis C who take eltrombopag with interferon and ribavirin
• Blood clots: including clots in the veins of the legs, lungs, or the portal vein in the liver, especially in people with chronic liver disease
• Cataracts: clouding of the eye lens that can affect vision
• Bleeding after stopping the medicine: platelet counts can drop below where they were before treatment and increase bleeding risk.
• Worsening of certain blood cancers or abnormal bone marrow changes, particularly in people with myelodysplastic syndromes
• New or worsening bone marrow changes in people with aplastic anemia, which may need monitoring
• Severe allergic reaction

When to Get Medical Help Right Away

Contact your specialist or seek emergency care if you have:

• Yellow skin or eyes, or dark brown urine
• Swelling, pain, warmth, or redness in one leg
• Chest pain or sudden shortness of breath
• Sudden weakness on one side, trouble speaking, vision changes, or severe headache
• Severe belly pain or swelling
• Unusual bleeding, black stools, or a bleeding episode that will not stop
• Swelling of the face, lips, or throat, or trouble breathing

Drug Interactions

Some medicines and foods can change how well eltrombopag works or raise the risk of side effects.

Major Interaction Categories

• Products containing calcium, iron, magnesium, aluminum, zinc, or selenium: These bind to eltrombopag in the stomach and reduce absorption. This includes antacids, dairy foods, calcium-fortified foods, and mineral supplements. Eltrombopag is generally taken at least 2 hours before or 4 hours after these products, as directed by your pharmacist or specialist.
• Cholesterol-lowering medicines (statins): Eltrombopag can raise statin levels, so lower statin doses may be needed. Rosuvastatin is one example.
• Some HIV and transplant medicines: Cyclosporine and the combination lopinavir/ritonavir may lower eltrombopag levels. Dose adjustments or extra monitoring may be needed.
• Medicines cleared by certain transporters in the body: Eltrombopag may raise levels of some medicines, such as methotrexate and topotecan.
• Interferon and ribavirin: These are used in some hepatitis C regimens and carry their own risks when combined with eltrombopag.
• Other platelet-raising medicines: Do not combine eltrombopag with other TPO-RA medicines unless a specialist directs it.
• Blood thinners and antiplatelet medicines: These can raise bleeding risk when platelet counts are low, and may need careful management.

Over-the-Counter Medicines

Ask a pharmacist or specialist before using OTC products. Antacids and mineral-containing products are especially important to time correctly. Pain relievers such as aspirin and ibuprofen can raise bleeding risk and should be used only if your specialist approves.

Supplements and Herbal Products

Multivitamins with minerals, calcium supplements, and iron products can interfere with absorption. Some herbal products may affect the liver or bleeding risk. Do not start them without checking first.

Share a Full Medication List

Give your licensed medical specialist a complete list of everything you take, including prescription medicines, OTC medicines, supplements, and herbal products. Update the list whenever anything changes.

Safety & Important Considerations

Boxed Warning from the FDA

Eltrombopag’s labeling includes a boxed warning, the FDA’s most serious type of warning, about:

• Risk of liver decompensation in people with chronic hepatitis C when eltrombopag is used with interferon and ribavirin
• Risk of liver injury (hepatotoxicity)

Liver Precautions

Liver blood tests are checked before starting, regularly while the dose is being adjusted, and then monthly or as directed. Eltrombopag may not be appropriate, or may require a lower starting dose, for people with existing liver disease.

Kidney Considerations

People with kidney problems are generally monitored for side effects. Your specialist will decide if any changes are needed.

Eye Monitoring

Cataracts have been reported. Eye exams may be recommended before treatment and during treatment.

Blood Clot Precautions

Tell your specialist about a history of clots, stroke, heart disease, chronic liver disease, smoking, or other clot risk factors. Report any signs of clots right away.

Pregnancy and Breastfeeding

Information on use in pregnancy is limited. Tell your specialist if you are pregnant, planning to become pregnant, or become pregnant during treatment. If eltrombopag is used together with ribavirin, ribavirin carries strict pregnancy warnings. It is not known whether eltrombopag passes into breast milk. Discuss breastfeeding with your specialist before starting treatment.

Children and Older Adults

• Children: Eltrombopag is approved for certain conditions in children 1 year and older (ITP) and 2 years and older (severe aplastic anemia). Doses are usually based on age, weight, and platelet counts.
• Older adults: They may be more likely to have liver, kidney, or heart problems and may need closer monitoring.

Monitoring

Expect regular blood tests. For ITP, platelet counts (complete blood counts) are often checked weekly at the start of treatment or after a dose change, and then monthly. Liver tests are checked as directed. In aplastic anemia, bone marrow tests may be needed. Do not skip these visits, and do not stop the medicine suddenly.

Goal of Treatment

Eltrombopag is used to raise platelet counts enough to lower bleeding risk. It is not used to bring platelet counts to normal levels, and unusually high counts can raise clot risk.

Who This Medication Is For

Eltrombopag is prescribed for people who have low platelet counts or low blood counts from a condition that a specialist has decided it can help manage.

• FDA-approved indications: Persistent or chronic ITP, low platelets in chronic hepatitis C before and during interferon-based therapy, and severe aplastic anemia (in combination with immune-suppressing treatment, or after an insufficient response to it).
• Whether it is right for a particular person depends on their diagnosis, previous treatments, liver health, other conditions, and lab results.

Who Should Not Take Eltrombopag

Eltrombopag is not right for everyone. Talk with your specialist before starting if any of the following apply.

• Allergy: You have had an allergic reaction to eltrombopag or any ingredient in the medicine.
• Chronic liver disease: It may raise the risk of liver problems and clots, and a lower starting dose or closer monitoring may be needed. It is not meant to raise platelets before procedures in people with chronic liver disease.
• Chronic hepatitis C treated with interferon and ribavirin: The risk of liver decompensation is higher, and treatment should be stopped if the antiviral treatment is stopped.
• Myelodysplastic syndromes (MDS): Eltrombopag is not approved for MDS and may raise the risk of progression.
• History of blood clots, stroke, or heart disease: Extra caution is needed.
• Cataracts or eye conditions: Eye monitoring is advised.
• Pregnancy or breastfeeding: Discuss the risks and benefits with your specialist.

Your specialist will review the full list of precautions in the current FDA labeling for your specific product.

What to Do If You Miss a Dose

• If you miss a dose, take your next dose at your regular time.
• Do not take two doses at the same time to make up for a missed one.
• If you are unsure what to do, or you miss more than one dose, contact your licensed medical specialist or pharmacist for guidance.
• Missing doses or stopping the medicine may cause platelet counts to fall. Report any unusual bruising or bleeding.
• Use reminders or a dose log to help stay on schedule.

Related medications to Eltrombopag

The right alternative depends on the condition being treated. Examples of options that may be used in similar situations include:

• Other thrombopoietin receptor agonists: Romiplostim (given by injection under the skin) and avatrombopag. Lusutrombopag is used for low platelets before certain procedures in chronic liver disease.
• For ITP: Corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, rituximab, fostamatinib, and spleen removal.
• For severe aplastic anemia: Immune-suppressing treatment (such as antithymocyte globulin with cyclosporine) and stem cell (bone marrow) transplant.
• For chronic hepatitis C: Modern antiviral medicines that do not depend on interferon.

These options differ in how they work, their side effects, and their monitoring needs. Do not switch or stop treatment on your own. Any change should be made only after talking with your licensed medical specialist.

Storage Instructions

• Temperature: Store tablets and powder packets at room temperature, generally between 68°F and 77°F (20°C to 25°C), unless the label says otherwise.
• Moisture and light: Keep tablets in the original container, tightly closed, away from moisture (avoid bathrooms) and direct light. Keep packets in their original carton until use.
• Prepared liquid: If you use the powder packets, prepare the liquid just before use as directed, and discard any that is left over.
• Child safety: Keep all medicines locked or out of reach and sight of children and pets. Use child-resistant caps.
• Disposal: Ask your pharmacist about safe disposal of expired or unused medicine.

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed medical specialist, such as a hematologist or, for hepatitis C–related low platelets, a hepatologist or gastroenterologist, before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist. If you think you are having a medical emergency, call your local emergency number right away.