Drug Action
Eltrombopag is a thrombopoietin receptor agonist that binds to and activates the thrombopoietin (TPO) receptor, thereby increasing platelet production.
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Drug reference
Eltrombopag is a thrombopoietin receptor agonist that binds to and activates the thrombopoietin (TPO) receptor, thereby increasing platelet production.
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Chronic immune (idiopathic) thrombocytopenic purpura in patients refractory to other treatments (such as corticosteroids or immunoglobulins) (under expert supervision) Blood and nutrition ▶BY MOUTH ▶Adult: Initially 50 mg once daily, dose to be adjusted to achieve a platelet count of 50x109/litre or more— consult product literature for dose adjustments, discontinue if inadequate response after 4 weeks treatment at maximum dose; maximum 75 mg per day ▶Adult (patients of East Asian origin): Initially 25 mg once daily, dose to be adjusted to achieve a platelet count of 50x109/litre or more—consult product literature for dose adjustments, discontinue if inadequate response after 4 weeks treatment at maximum dose; maximum 75 mg per day. Treatment of thrombocytopenia associated with chronic hepatitis C infection, where the degree of thrombocytopenia is the main factor preventing the initiation or limiting the ability to maintain optimal interferon-based therapy (under expert supervision) ▶BY MOUTH ▶Adult: Initially 25 mg once daily, dose to be adjusted to achieve a platelet count sufficient to initiate antiviral therapy then a platelet count of 50–75x109/litre during antiviral therapy—consult product literature for dose adjustments, discontinue if inadequate response after 2 weeks treatment at maximum dose; maximum 100 mg per day Acquired severe aplastic anaemia in patients either refractory to or heavily pretreated with prior immunosuppressive therapy and are unsuitable for haematopoietic stem cell transplantation (under expert supervision) ▶BY MOUTH ▶Adult: Initially 50 mg once daily, dose to be adjusted to achieve a platelet count of 50x109/litre or more— consult product literature for dose adjustments, discontinue if no haematological response after 16 weeks treatment; maximum 150 mg per day ▶Adult (patients of East Asian origin): Initially 25 mg once daily, dose to be adjusted to achieve a platelet count of 50x109/litre or more—consult product literature for dose adjustments, discontinue if no haematological response after 16 weeks treatment; maximum 150 mg per day.
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Patients of East Asian origin. risk factors for thromboembolism
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For severe aplastic anaemia, manufacturer advises do not initiate if patients have existing cytogenetic abnormalities of chromosome 7.
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NICE decisions ▶Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (updated October 2018) NICE TA293 Eltrombopag (Revolade ®) is recommended as an option for treating chronic immune (idiopathic) thrombocytopenic purpura in adults, only if: . their condition is refractory to standard active treatments and rescue therapies, or . they have severe disease and a high risk of bleeding that needs frequent courses of rescue therapies. Eltrombopag is recommended only if the manufacturer provides it with the discount agreed in the patient access scheme. Patients currently receiving eltrombopag whose disease does not meet these criteria should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta293 Scottish Medicines Consortium (SMC) decisions SMC No. 625/10 The Scottish Medicines Consortium has advised (August 2010) that eltrombopag (Revolade ®) is accepted for restricted use within NHS Scotland for the treatment of both splenectomised and non-splenectomised patients with severe symptomatic immune (idiopathic) thrombocytopenic purpura or a high risk of bleeding.
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MHRA/CHM ADVICE: ELTROMBOPAG (REVOLADE ®): REPORTS OF INTERFERENCE WITH BILIRUBIN AND CREATININE TEST RESULTS (JULY 2018) See Effect on laboratory tests.
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→Appendix 1: eltrombopag
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▶Common or very common Abnormal loss of weight. alopecia. anaemia. anxiety. appetite abnormal. arthralgia . asthenia. cataract. chest discomfort. chills. concentration impaired. confusion. constipation. cough. depression. diarrhoea. dizziness. drowsiness. dry eye. dry mouth. dysphagia. dyspnoea. eye discomfort. eye disorders. fever. gastrointestinal discomfort. gastrointestinal disorders. haemolytic anaemia. haemorrhage. headaches. hepatic disorders. hyperbilirubinaemia. hyperglycaemia. hypoglycaemia. increased risk of infection. influenza like illness. iron overload. lymphopenia. malaise. memory loss. menorrhagia. mood altered. muscle complaints. nasal complaints. nausea. neutropenia. oedema. oral disorders . oropharyngeal complaints. pain. palpitations. QT interval prolongation. sensation abnormal. skin reactions . sleep disorders. splenic infarction. sweat changes. syncope. taste altered. urine discolouration. vertigo. vision disorders. vomiting. weight decreased ▶Uncommon Anisocytosis. arrhythmias. balance impaired. cardiovascular disorder. cyanosis. ear pain. electrolyte imbalance. embolism and thrombosis. eosinophilia. eye inflammation. feeling hot. feeling jittery. food poisoning. gout. hemiparesis. increased leucocytes. lens opacity. muscle weakness. myocardial infarction. nephritis lupus. nerve disorders. rectosigmoid cancer. renal failure. retinal pigment epitheliopathy. sinus disorder. sleep apnoea. speech disorder. sunburn. thrombocytopenia. tremor. urinary disorders. urine abnormalities. vasodilation. wound inflammation
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Ensure effective contraception during treatment.
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Avoid—toxicity in animal studies.
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Manufacturer advises avoid.
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▶When used for Idiopathic thrombocytopenic purpura Manufacturer advises consider avoiding. ▶When used for Severe aplastic anaemia Manufacturer advises caution. ▶When used for Thrombocytopenia associated with chronic hepatitis C infection Manufacturer advises caution (increased risk of hepatic decompensation and thromboembolic events). Dose adjustments ▶When used for Idiopathic thrombocytopenic purpura Manufacturer advises initial dose reduction to 25 mg once daily and wait at least 3 weeks before upwards titration of dose. ▶When used for Severe aplastic anaemia Manufacturer advises initial dose reduction to 25 mg once daily and wait at least 2 weeks before upwards titration of dose. ▶When used for Thrombocytopenia associated with chronic hepatitis C infection Manufacturer advises initial dose reduction to 25 mg once daily in moderate to severe impairment and wait at least 2 weeks before upwards titration of dose.
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Use with caution.
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▶Manufacturer advises monitor liver function before treatment, every two weeks when adjusting the dose, and monthly thereafter. ▶Manufacturer advises regular ophthalmological examinations for cataract formation. ▶Manufacturer advises peripheral blood smear prior to initiation to establish baseline level of cellular morphologic abnormalities; once stabilised, full blood count with white blood cell count differential should be performed monthly. ▶For idiopathic thrombocytopenic purpura, manufacturer advises monitor full blood count including platelet count and peripheral blood smears every week during treatment until a stable platelet count is reached (50x109/litre or more for at least 4 weeks), then monthly thereafter; monitor platelet count weekly for 4 weeks following treatment discontinuation. ▶For severe aplastic anaemia, manufacturer advises bone marrow examination with aspirations for cytogenetics prior to initiation, at 3 months of treatment and 6 months thereafter. ▶For thrombocytopenia associated with chronic hepatitis C infection, manufacturer advises monitor platelet count every week before and during antiviral treatment until a stable platelet count is reached (50–75x109/litre), then monitor full blood count including platelet count and peripheral blood smears monthly thereafter. l EFFECT ON LABORATORY TESTS Eltrombopag is highly coloured and can cause serum discolouration and interference with total bilirubin and creatinine testing. If laboratory results are inconsistent with clinical observations, manufacturer advises re-testing using another method to help determine the validity of the result.
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Each dose should be taken at least 4 hours before or after any dairy products (or foods containing calcium), indigestion remedies, or medicines containing aluminium, calcium, iron, magnesium, zinc, or selenium to reduce possible interference with absorption.
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There can be variation in the licensing of different medicines containing the same drug. ▶Revolade (Novartis Pharmaceuticals UK Ltd) Eltrombopag (as Eltrombopag olamine) 25 mg Revolade 25mg tablets | 28 tablet P £770.00 DT = £770.00 Eltrombopag (as Eltrombopag olamine) 50 mg Revolade 50mg tablets | 28 tablet P £1,540.00 DT = £1,540.00 Eltrombopag (as Eltrombopag olamine) 75 mg Revolade 75mg tablets | 28 tablet P £2,310.00 DT = £2,310.00
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Patient counselling is advised on how to administer eltrombopag tablets.
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Initially 50 mg once daily, dose to be adjusted to
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25 mg once
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25 mg once daily, dose to be adjusted to
First-line fragment. Read the complete Indications and Dose section above.
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Initially 50 mg once daily, dose to be adjusted to
First-line fragment. Read the complete Indications and Dose section above.
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Initially 25 mg once
First-line fragment. Read the complete Indications and Dose section above.
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