Eltrombopag


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Idiopathic thrombocytopenic purpura In patients with inadequate response to corticosteroids and immunoglobulins or splenectomy: Initial: 50 mg once daily, adjust dose to achieve and maintain ≥50 x 109 cells/L platelet count. Max: 75 mg/day. Thrombocytopenia associated with chronic hepatitis C Initial: 25 mg once daily, adjust dose in increments of 25 mg every 2 weeks until adequate response is achieved to initiate antiviral therapy. Max: 100 mg/day. Severe aplastic anaemia In patients who are unresponsive to immunosuppressive therapy and unsuitable for haematopoietic stem cell transplantation: Initial: 50 mg once daily, adjust dose in increments of 50 mg every 2 weeks to achieve and maintain ≥50 x 109 cells/L platelet count. Max: 150 mg/day. Dose reduction, dosing interruption, or discontinuation may be required according to platelet response (refer to detailed product guideline).
Dosage Details
Oral
Idiopathic thrombocytopenic purpura
Adult: In patients with inadequate response to corticosteroids and immunoglobulins or splenectomy: Initially, 50 mg once daily, adjust dose to achieve and maintain ≥50 x 109 cells/L platelet count. Max: 75 mg daily. Dose reduction, dosing interruption, or discontinuation may be required according to platelet response (refer to detailed product guideline).
Child: 1-5 years Initially, 25 mg once daily; 6-17 years Same as adult dose.

Oral
Aplastic anaemia
Adult: In patients with severe cases, unresponsive to immunosuppressive therapy and unsuitable for haematopoietic stem cell transplantation: Initially, 50 mg once daily, adjust dose in increments of 50 mg every 2 weeks to achieve and maintain ≥50 x 109 cells/L platelet count. Max: 150 mg daily. Dose reduction, dosing interruption, or discontinuation may be required according to platelet response (refer to detailed product guideline). In patients with tri-lineage response for at least 8 weeks transfusion independence, dose may be reduced by 50%.

Oral
Thrombocytopenia associated with chronic hepatitis C
Adult: Initially, 25 mg once daily, adjust dose in increments of 25 mg every 2 weeks until adequate response is achieved to initiate antiviral therapy. Max: 100 mg daily. Dose reduction, dosing interruption, or discontinuation may be required according to platelet response (refer to detailed product guideline).
Special Patient Group
Patients of Asian ancestry (e.g. Chinese, Japanese, Taiwanese, Korean, Thai):

Idiopathic thrombocytopenic purpura: Initially, 25 mg once daily. In hepatic impairment: Initially, 12.5 mg once daily.

Aplastic anaemia: Initially, 25 mg once daily.
Hepatic Impairment
Oral
Idiopathic thrombocytopenic purpura
Initially, 25 mg once daily, adjust dose at 3 weeks interval.

Aplastic anaemia
Initially, 25 mg once daily, adjust dose at 2 weeks interval.
Special Precautions
Patient with risk factors for thromboembolism (e.g. advanced chronic liver disease, Factor V Leiden, ATIII deficiency, antiphospholipid syndrome, prolonged periods of immobilisation, malignancies, surgery/trauma, contraceptives and hormone replacement therapy, advanced age, smoking, obesity). Patients of Asian ancestry (e.g. Chinese, Koreans, Japanese, Taiwanese, Thai). Renal and hepatic impairment. Children. Pregnancy and lactation. Not intended for use to normalise platelet count.
Adverse Reactions
Significant: Thromboembolic events (e.g. portal vein thrombosis), cataract formation.
Blood and lymphatic system disorders: Anaemia, neutropenia, splenic infarction.
Cardiac disorders: Chest pain, palpitations, exertional dyspnoea.
Ear and labyrinth disorders: Vertigo.
Eye disorders: Dry eye, retinal exudates, ocular icterus, retinal haemorrhage.
Gastrointestinal disorders: Nausea, diarrhoea, mouth ulceration, vomiting, abdominal pain, flatulence, toothache, dyspepsia, dysgeusia, dry mouth, constipation, oropharyngeal pain, abdominal distension, stomatitis, GERD, haemorrhoids, abdominal discomfort, oesophageal varices, swollen tongue, gastrointestinal motility disorder.
General disorders and administration site conditions: Pyrexia, asthenia, chills, fatigue, influenza-like illness, irritability, pain, lethargy, malaise.
Hepatobiliary disorders: Hyperbilirubinaemia, hepatic neoplasm, jaundice.
Investigations: Abnormal LFT, increased ALT, AST; decreased haemoglobin, WBC, increased blood alkaline phosphatase.
Metabolism and nutrition disorders: Decreased appetite, peripheral oedema, abnormal weight loss, Fe overload.
Musculoskeletal and connective tissue disorders: Myalgia, arthralgia, muscle spasm, musculoskeletal pain, bone pain, back pain, pain in extremity.
Nervous system disorders: Paraesthesia, headache, dizziness, hepatic encephalopathy, memory impairment.
Psychiatric disorders: Insomnia, depression, anxiety, disturbance in attention.
Renal and urinary disorders: Proteinuria, thrombotic microangiopathy with renal failure, UTI, chromaturia.
Respiratory, thoracic and mediastinal disorders: Pharyngitis, influenza, tonsillitis, nasopharyngitis, upper respiratory tract infection, cough, rhinorrhea, epistaxis.
Skin and subcutaneous tissue disorders: Rash, alopecia, pruritus, petechiae, dry skin, eczema, erythema, skin discolouration, hyperhidrosis.
Vascular disorders: Syncope.
Potentially Fatal: Severe hepatotoxicity.
Patient Counseling Information
This drug may cause dizziness and lack of alertness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor CBC with differential and platelet count weekly at initiation then monthly thereafter; LFT prior to therapy, every 2 weeks during dose adjustment and monthly thereafter. Perform bone marrow examination with aspirations for cytogenetics in patients with aplastic anaemia prior to therapy then after 3 months and every 6 months thereafter. Obtain eye examination at baseline and during therapy. Monitor for signs and symptoms of cataract formation and thromboembolism.
Overdosage
Symptoms: Increased platelet counts resulting in thrombotic/thromboembolic complications; rash, transient bradycardia, elevated ALT and AST, and fatigue may also occur. Management: Administer metal cation-containing preparations (e.g. Ca, Al, Mg) to limit eltrombopag absorption. Monitor platelet counts closely.
Drug Interactions
Increased risk of hepatic decompensation in patients with chronic hepatitis C who are using or taking interferon and ribavirin. May increase the serum concentrations of HMG CoA reductase inhibitors (e.g. rosuvastatin, simvastatin). Decreased serum concentration with concomitant use of ciclosporin or lopinavir/ritonavir. Reduced absorption with polyvalent cations (e.g. Fe, Ca, Mg, Zn).
Food Interaction
Decreased plasma concentration with meals that have high Ca (e.g. dairy products) or moderate to high calorie or fat content.
Lab Interference
May discolour serum and interfere with certain laboratory tests (e.g. total bilirubin, serum creatinine).
Action
Description: Eltrombopag is a non-peptide thrombopoietin (TPO) receptor agonist. It binds to and activates the human TPO receptor and initiates signal transduction pathways which induces proliferation and differentiation from bone marrow progenitor cells thereby increasing platelet production.
Onset: Within 1-2 weeks.
Duration: 1-2 weeks after the last dose.
Pharmacokinetics:
Absorption: Absorbed from the gastrointestinal tract. Bioavailability: ≥52% (increased by 22% for oral susp). Time to peak plasma concentrations: 2-6 hours.
Distribution: Plasma protein binding: >99%.
Metabolism: Extensively metabolised in the liver by CYP1A2, CYP2C8 via oxidation and UGT1A1, UGT1A3 via glucuronidation.
Excretion: Via faeces (approx 59%, approx 20% as unchanged drug); urine (approx 31%, as metabolites). Elimination half-life: Approx 21-32 hours.
Chemical Structure

Click on icon to see table/diagram/image
Storage
Store below 30°C.
ATC Classification
B02BX05 - eltrombopag ; Belongs to the class of other systemic hemostatics. Used in the treatment of hemorrhage.
Disclaimer: This information is independently developed by MIMS based on Eltrombopag from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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