Eltrombopag Avansor: Uses, Dosage & Side Effects
An oral thrombopoietin receptor agonist that stimulates platelet production for the treatment of chronic immune thrombocytopenia, severe aplastic anemia, and hepatitis C–associated thrombocytopenia
Eltrombopag Avansor is a prescription oral thrombopoietin (TPO) receptor agonist containing the active substance eltrombopag. It works by stimulating the bone marrow to produce more platelets – blood cells essential for normal blood clotting. Eltrombopag Avansor is indicated for adults and children (aged 1 year and older) with chronic immune thrombocytopenia (ITP) who have not responded adequately to other treatments, for adults with severe aplastic anemia who are refractory or insufficiently responsive to immunosuppressive therapy, and for adults with chronic hepatitis C virus (HCV) infection and thrombocytopenia where low platelet counts prevent the initiation or maintenance of interferon-based antiviral therapy. The medication is available as 25 mg film-coated tablets and must be taken on an empty stomach due to significant food and mineral interactions that reduce its absorption.
Quick Facts: Eltrombopag Avansor
Key Takeaways
- Eltrombopag Avansor is an oral thrombopoietin receptor agonist that stimulates the bone marrow to produce more platelets, used in chronic immune thrombocytopenia (ITP), severe aplastic anemia, and hepatitis C–associated thrombocytopenia.
- The medication must be taken on an empty stomach, at least 2 hours before or 4 hours after dairy products, antacids, or mineral supplements, because polyvalent cations significantly reduce its absorption.
- Regular monitoring of liver function tests and complete blood counts is essential, as eltrombopag can cause hepatotoxicity, thromboembolic events, and bone marrow fibrosis.
- Dosing is individualized based on platelet count response, typically starting at 50 mg once daily for ITP in adults (25 mg in patients of East Asian ancestry due to increased exposure), with adjustments every 2 weeks.
- Clinical trials (RAISE, EXTEND, and others) have demonstrated sustained platelet responses, reduced bleeding events, and decreased need for rescue therapies in the majority of patients treated with eltrombopag.
What Is Eltrombopag Avansor and What Is It Used For?
Eltrombopag Avansor contains the active substance eltrombopag (as eltrombopag olamine), a small-molecule, non-peptide thrombopoietin (TPO) receptor agonist. Platelets are small blood cells produced in the bone marrow by large cells called megakaryocytes. They play a critical role in hemostasis – the process by which the body stops bleeding after an injury to a blood vessel. When platelet counts fall below certain thresholds, patients become at risk for spontaneous bleeding, which can range from mild bruising and petechiae (small red or purple spots on the skin) to life-threatening hemorrhages in the brain, gastrointestinal tract, or other vital organs.
Thrombopoietin (TPO) is the primary endogenous cytokine responsible for regulating platelet production. It binds to the TPO receptor (also known as c-Mpl or MPL) on the surface of megakaryocyte progenitor cells in the bone marrow, triggering intracellular signaling cascades that promote the proliferation, differentiation, and maturation of megakaryocytes. Each mature megakaryocyte can release thousands of platelets into the circulation. Eltrombopag mimics the action of endogenous TPO by binding to the transmembrane domain of the TPO receptor at a site distinct from the natural TPO binding site. This unique binding mechanism means that eltrombopag and endogenous TPO can activate the receptor simultaneously and additively, without competing for the same binding site.
Upon binding to the TPO receptor, eltrombopag initiates downstream signaling primarily through the Janus kinase–signal transducer and activator of transcription (JAK-STAT) pathway and the mitogen-activated protein kinase (MAPK) pathway. These signaling cascades drive increased megakaryocyte proliferation and differentiation from hematopoietic stem cells, enhanced megakaryocyte maturation and polyploidization (the process by which megakaryocytes increase their DNA content to support efficient platelet production), and ultimately increased release of functional platelets into the peripheral blood. Clinical studies have confirmed that eltrombopag raises platelet counts in a dose-dependent manner, with responses typically observed within 1 to 2 weeks of initiating therapy.
In addition to its effects on the TPO receptor, research has revealed that eltrombopag possesses iron-chelating properties due to its ability to bind polyvalent metal cations. While this characteristic is primarily relevant to its pharmacokinetic interactions with food and mineral supplements, preclinical evidence suggests that this iron-chelating activity may contribute to the drug’s beneficial effects in severe aplastic anemia by reducing intracellular iron overload in hematopoietic stem cells, potentially promoting their expansion and differentiation beyond the megakaryocyte lineage alone.
Approved Indications
Eltrombopag Avansor is approved for the following indications:
- Chronic immune thrombocytopenia (ITP): For adult patients who have had chronic ITP for at least 6 months from diagnosis and who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy, and for pediatric patients aged 1 year and older with chronic ITP lasting at least 6 months who have had an insufficient response to prior therapies. ITP is an autoimmune disorder in which the immune system produces antibodies that target and destroy the patient’s own platelets, while also suppressing platelet production in the bone marrow. The pivotal RAISE trial demonstrated that eltrombopag achieved a platelet count of 50–400 × 109/L in 79% of patients versus 28% on placebo during the 6-month treatment period.
- Severe aplastic anemia (SAA): For adult patients with severe aplastic anemia who have had an insufficient response to at least one prior course of immunosuppressive therapy (IST). Aplastic anemia is a rare and serious condition in which the bone marrow fails to produce enough blood cells, including platelets, red blood cells, and white blood cells. In clinical studies, eltrombopag combined with standard IST (horse antithymocyte globulin plus ciclosporin) produced overall hematologic response rates of approximately 85–94% at 6 months, significantly higher than historical rates with IST alone.
- Chronic hepatitis C–associated thrombocytopenia: For adult patients with thrombocytopenia related to chronic HCV infection, where the degree of thrombocytopenia is the main factor preventing the initiation or limiting the ability to maintain optimal interferon-based antiviral therapy. The ENABLE 1 and ENABLE 2 trials demonstrated that eltrombopag enabled significantly more patients to initiate and maintain antiviral therapy and achieve sustained virologic response.
A normal platelet count ranges from 150 to 400 × 109/L. Patients with ITP often have counts below 30 × 109/L, putting them at risk for bleeding. The goal of eltrombopag therapy is to raise and maintain the platelet count above 50 × 109/L – the threshold generally considered sufficient to prevent clinically significant bleeding – rather than to normalize the platelet count completely. Overtreatment that pushes platelets too high can paradoxically increase the risk of blood clots (thrombosis).
What Should You Know Before Taking Eltrombopag Avansor?
Contraindications
The only absolute contraindication to Eltrombopag Avansor is hypersensitivity to eltrombopag or to any of the excipients contained in the formulation. Allergic reactions, including skin rash, urticaria, and angioedema, have been reported in post-marketing surveillance. If you develop signs of an allergic reaction, discontinue the medication and seek medical attention immediately.
Eltrombopag should not be used as a treatment for thrombocytopenia resulting from myelodysplastic syndromes (MDS) or other conditions of abnormal bone marrow function outside of its approved indications, as stimulating platelet production in these settings may theoretically promote the expansion of abnormal bone marrow clones. In clinical studies of MDS patients, eltrombopag did not show a net clinical benefit and was associated with a higher rate of progression to acute myeloid leukemia in certain subgroups.
Warnings and Precautions
Eltrombopag can cause serious and potentially life-threatening liver injury. Liver function tests (ALT, AST, bilirubin) must be checked before starting treatment, every 2 weeks during dose adjustment, and then monthly during maintenance therapy. If liver enzyme levels rise to more than 3 times the upper limit of normal and are progressive, persistent, or accompanied by increased direct bilirubin or clinical symptoms of liver injury, treatment must be discontinued.
- Hepatotoxicity: Elevated liver enzymes (ALT and AST) are among the most important adverse effects of eltrombopag. In clinical trials, clinically significant hepatotoxicity (ALT ≥ 3× upper limit of normal) was observed in approximately 10–13% of ITP patients and up to 7% of SAA patients. The risk is higher in patients with pre-existing liver disease, particularly those with chronic hepatitis C. Liver function must be monitored before treatment, every two weeks during dose titration, and at least monthly thereafter. If liver enzyme elevations are progressive, persistent for more than 4 weeks, accompanied by increased direct bilirubin, or associated with clinical signs of liver injury, eltrombopag must be discontinued immediately.
- Thromboembolic events: Raising platelet counts with eltrombopag may increase the risk of thromboembolic complications, including deep vein thrombosis (DVT), pulmonary embolism (PE), transient ischemic attacks, myocardial infarction, and portal vein thrombosis. The risk is particularly elevated in patients with chronic liver disease who may have pre-existing coagulation abnormalities. Eltrombopag should be used with caution in patients with known risk factors for thromboembolism, and the dose should be carefully titrated to maintain the lowest platelet count sufficient to prevent bleeding, rather than to normalize the platelet count.
- Bone marrow reticulin fibrosis: Thrombopoietin receptor agonists, including eltrombopag, have been associated with an increase in reticulin fiber deposition in the bone marrow. In clinical studies, reticulin fibrosis was observed in some patients after long-term treatment. While most cases involve mild (grade 1–2) reticulin without clinical sequelae, progressive fibrosis could potentially impair normal hematopoiesis. A peripheral blood smear should be evaluated before starting treatment and periodically thereafter to look for morphological abnormalities (such as teardrop cells, nucleated red blood cells, or immature white blood cells) that might suggest bone marrow fibrosis. If significant abnormalities are detected, a bone marrow biopsy should be considered.
- Cataracts: Lens opacities (cataracts) were observed in preclinical toxicology studies with eltrombopag in rodents at exposures lower than the clinical human exposure. In clinical trials in adults with ITP, new cataracts or worsening of pre-existing cataracts were reported. Regular ophthalmological examinations are recommended, particularly in pediatric patients, both before starting treatment and at regular intervals during therapy.
- Rebound thrombocytopenia: After discontinuation of eltrombopag, platelet counts typically fall back to pre-treatment levels within 1 to 2 weeks and may temporarily drop below baseline, potentially increasing the risk of bleeding. Patients should be closely monitored for at least 4 weeks after discontinuation, with regular platelet count checks.
Patients of East Asian Ancestry
Pharmacokinetic studies have shown that patients of East Asian ancestry (including Chinese, Japanese, Korean, and Taiwanese patients) have approximately 50% higher plasma exposure to eltrombopag compared with non-East Asian patients at the same dose. This difference is thought to be related to genetic variations in drug-metabolizing enzymes and transporters. For this reason, the recommended starting dose of eltrombopag for ITP in patients of East Asian ancestry is 25 mg once daily (compared with 50 mg once daily for other patients). Dose adjustments are then made based on individual platelet count response, following the same titration principles used for all patients.
Pregnancy and Breastfeeding
There are limited data on the use of eltrombopag in pregnant women. Animal reproductive studies have shown adverse developmental effects, including embryo-fetal lethality and reduced fetal body weight at clinically relevant doses. Eltrombopag should not be used during pregnancy unless the potential benefit to the mother clearly outweighs the potential risk to the fetus. Women of childbearing potential should use effective contraception during treatment and for at least 7 days after the last dose.
It is not known whether eltrombopag or its metabolites are excreted in human breast milk. In animal studies, eltrombopag was detected in the milk of lactating rats. A risk to the breastfed infant cannot be excluded. The decision to continue or discontinue breastfeeding during eltrombopag treatment should be made in consultation with a healthcare provider, taking into account the benefit of breastfeeding for the infant and the benefit of treatment for the mother.
Children and Adolescents
Eltrombopag is approved for use in pediatric patients aged 1 year and older with chronic ITP lasting at least 6 months who have had an insufficient response to other treatments. The safety and efficacy in this population were established in the PETIT and PETIT 2 clinical trials, which demonstrated platelet responses similar to those observed in adults. The recommended starting dose in pediatric patients aged 1 to 5 years is 25 mg once daily, and in those aged 6 to 17 years, it is 50 mg once daily (25 mg for patients of East Asian ancestry). Eltrombopag is not approved for use in children younger than 1 year of age. Regular ophthalmological monitoring for cataracts is particularly important in the pediatric population.
How Does Eltrombopag Avansor Interact with Other Drugs?
Eltrombopag has several clinically important drug interactions that patients and healthcare providers must be aware of. These interactions can be broadly categorized into pharmacokinetic interactions affecting eltrombopag’s absorption, interactions where eltrombopag affects the levels of other drugs, and pharmacodynamic interactions related to its mechanism of action.
Major Interactions
| Interacting Substance | Effect | Recommendation |
|---|---|---|
| Polyvalent cations (Ca, Fe, Mg, Al, Zn, Se) | Chelation reduces eltrombopag absorption by up to 70% | Take eltrombopag ≥2 hours before or ≥4 hours after these products |
| Dairy products, calcium-fortified foods | Calcium chelation significantly reduces bioavailability | Avoid dairy for ≥2 hours before and ≥4 hours after dosing |
| Antacids (aluminium/magnesium hydroxide) | Chelation reduces absorption; AUC reduced by ~70% | Separate administration by ≥4 hours |
| Rosuvastatin (OATP1B1/BCRP substrate) | Eltrombopag increases rosuvastatin AUC by 55% and Cmax by 103% | Consider dose reduction of rosuvastatin; monitor for statin-related adverse effects |
| Ciclosporin (cyclosporine) | Ciclosporin may decrease eltrombopag exposure by 25–38% via BCRP/OATP1B1 inhibition | Monitor platelet counts closely; dose adjustment may be needed |
The most critical interaction involves polyvalent cations. Eltrombopag possesses a chelating moiety within its molecular structure that binds strongly to metal ions such as calcium (Ca2+), iron (Fe2+/Fe3+), magnesium (Mg2+), aluminium (Al3+), zinc (Zn2+), and selenium (Se2+). When eltrombopag is taken at the same time as, or within a short time window of, products containing these metals – including dairy products, calcium-fortified juices, antacids, and multivitamin or mineral supplements – the resulting chelate complex is poorly absorbed from the gastrointestinal tract. Pharmacokinetic studies have demonstrated reductions in eltrombopag exposure (AUC) of approximately 59% when co-administered with calcium carbonate antacids and approximately 70% when taken with a dairy-containing meal.
Eltrombopag is an inhibitor of several drug transporters, including organic anion transporting polypeptide 1B1 (OATP1B1) and breast cancer resistance protein (BCRP). By inhibiting these transporters, eltrombopag can increase the plasma concentrations of drugs that rely on them for hepatic uptake and elimination. The most clinically relevant example is rosuvastatin, an HMG-CoA reductase inhibitor (statin) that is a substrate of both OATP1B1 and BCRP. Co-administration of eltrombopag with rosuvastatin resulted in a 55% increase in rosuvastatin AUC and a 103% increase in Cmax in healthy volunteers. Patients taking rosuvastatin or other OATP1B1/BCRP substrates (such as pravastatin, methotrexate, or topotecan) concurrently with eltrombopag should be monitored for potential toxicity, and dose reductions of these medications should be considered.
Other Interactions
| Interacting Drug/Class | Effect | Clinical Significance |
|---|---|---|
| Lopinavir/ritonavir | Reduces eltrombopag Cmax by 17% and AUC by 17% | Monitor platelet counts; dose adjustment may be needed |
| Methotrexate (BCRP substrate) | Potential increase in methotrexate levels | Monitor for methotrexate toxicity when used concomitantly |
| Anticoagulants/Antiplatelet agents | No direct pharmacokinetic interaction but altered bleeding/clotting risk balance | Reassess need as platelet count rises; clinical judgement required |
| CYP1A2 and CYP2C8 substrates | Eltrombopag is a weak inhibitor of CYP1A2 and CYP2C8 in vitro | Low clinical relevance at therapeutic doses; monitor if narrow therapeutic index |
Eltrombopag is metabolized primarily through oxidation (CYP1A2, CYP2C8), conjugation with glucuronic acid (UGT1A1, UGT1A3), and cleavage. It is a substrate of BCRP but not of P-glycoprotein. Eltrombopag does not induce or significantly inhibit major CYP enzymes at therapeutic concentrations, so interactions via CYP-mediated metabolism with most commonly prescribed medications are not expected to be clinically significant. However, caution should be exercised with narrow therapeutic index drugs that are CYP1A2 substrates (such as theophylline) or CYP2C8 substrates (such as repaglinide), particularly in patients who may be slow metabolizers of these enzymes.
What Is the Correct Dosage of Eltrombopag Avansor?
Eltrombopag dosing is highly individualized and must be guided by regular platelet count monitoring. The goal is to achieve and maintain the lowest dose of eltrombopag that produces a platelet count sufficient to reduce the risk of bleeding, not to normalize platelet counts. The maximum recommended dose is 75 mg once daily for all indications. Tablets should be taken once daily on an empty stomach (at least 2 hours before or 4 hours after dairy, antacids, or mineral supplements) and swallowed whole with water.
Adults – Chronic Immune Thrombocytopenia (ITP)
ITP – Standard Starting Dose
Starting dose: 50 mg once daily (25 mg for patients of East Asian ancestry)
Dose titration: Adjust dose by 25 mg every 2 weeks to achieve target platelet count ≥50 × 109/L
Maximum dose: 75 mg once daily
Target: Platelet count 50–150 × 109/L (lowest effective count to reduce bleeding risk)
| Platelet Count | Action |
|---|---|
| <50 × 109/L after ≥2 weeks | Increase dose by 25 mg (max 75 mg/day) |
| 50–150 × 109/L | Maintain current dose |
| 150–250 × 109/L | Decrease dose by 25 mg; reassess after 2 weeks |
| >250 × 109/L | Stop eltrombopag; increase platelet count monitoring; restart at reduced dose when <100 × 109/L |
Adults – Severe Aplastic Anemia (SAA)
SAA – In Combination with Standard Immunosuppressive Therapy
Starting dose: 50 mg once daily (25 mg for patients of East Asian ancestry)
Dose titration: Assess response at 2-week intervals; increase by 25 mg up to maximum of 150 mg/day
Note: A maximum dose of 150 mg daily is permitted for SAA (higher than ITP). Titration should be guided by platelet count and clinical response across all blood cell lineages.
In the context of severe aplastic anemia, eltrombopag is typically used as part of a combination regimen with standard immunosuppressive therapy (horse antithymocyte globulin and ciclosporin). The landmark NIH studies demonstrated that adding eltrombopag to standard IST substantially improved overall hematologic response rates, complete response rates, and event-free survival compared with historical IST-alone controls. The optimal timing of eltrombopag initiation (simultaneously with IST on day 1, or delayed until day 14) is an area of ongoing research, with current practice often favoring early initiation.
Children – Chronic ITP
Pediatric Dosing for ITP
Ages 1–5 years: 25 mg once daily as starting dose
Ages 6–17 years: 50 mg once daily (25 mg for East Asian ancestry)
Maximum dose: 75 mg once daily
Dose adjustments: Same platelet count–based titration as adults, with assessments every 2 weeks
Adults – Hepatitis C–Associated Thrombocytopenia
HCV Thrombocytopenia Dosing
Starting dose: 25 mg once daily
Dose titration: Increase by 25 mg every 2 weeks as needed to achieve target platelet count for starting antiviral therapy
Maximum dose: 75 mg once daily
Note: Eltrombopag should be discontinued when antiviral therapy is stopped. Hepatic function monitoring is especially critical in this population.
Missed Dose
If you miss a dose of Eltrombopag Avansor, take it as soon as you remember, provided it is still within the same day and you can maintain the required separation from food and mineral products. Do not take two doses on the same day to make up for a missed dose. If it is already the next day, skip the missed dose and resume your normal dosing schedule. If you frequently forget to take your medication, discuss strategies with your pharmacist or healthcare provider to help you establish a consistent routine.
Overdose
In clinical studies, eltrombopag has been administered at doses up to 150 mg daily for aplastic anemia. In cases of overdose with ITP or HCV indications (where the maximum recommended dose is 75 mg), platelet counts may rise excessively, increasing the risk of thromboembolic complications. There is no specific antidote for eltrombopag overdose. Eltrombopag is not significantly removed by hemodialysis due to its high protein binding (>99%). If overdose is suspected, platelet counts should be monitored closely, and supportive care should be provided. Temporary withdrawal of eltrombopag may be necessary, with platelet counts checked at least every other day until they return to an acceptable range.
What Are the Side Effects of Eltrombopag Avansor?
Like all medications, Eltrombopag Avansor can cause side effects, although not everyone will experience them. The side effects listed below are based on data from clinical trials involving thousands of patients with ITP, severe aplastic anemia, and hepatitis C–associated thrombocytopenia, as well as post-marketing surveillance reports. The frequency categories used follow the international standard convention.
Very Common
- Headache
- Nausea
- Diarrhea
- Elevated liver enzymes (ALT, AST)
- Upper respiratory tract infection (cold-like symptoms)
- Fatigue
Common
- Nasopharyngitis (sore throat, runny nose)
- Urinary tract infection
- Vomiting
- Abdominal pain
- Musculoskeletal pain (muscle aches, joint pain, back pain)
- Decreased appetite
- Paresthesia (tingling or numbness)
- Rash, alopecia (hair loss)
- Elevated bilirubin
- Cough
- Oropharyngeal pain
- Insomnia
- Dizziness
- Pruritus (itching)
- Dry mouth
Uncommon
- Thromboembolic events (DVT, pulmonary embolism, stroke, portal vein thrombosis)
- Cataracts (lens opacity)
- Reticulin fibrosis of the bone marrow
- Hepatotoxicity with jaundice
- Skin discoloration (hyperpigmentation)
- Increased blood creatinine
- Menorrhagia (heavy menstrual bleeding)
- Thrombocytosis (excessive platelet count)
Rare
- Severe hepatotoxicity (hepatic failure)
- Severe hypersensitivity/anaphylaxis
- Bone marrow collagen fibrosis
- Acute myocardial infarction
- Severe skin reactions
Contact your doctor immediately or go to the nearest emergency department if you experience: yellowing of the skin or eyes (jaundice), unusually dark urine, right-sided abdominal pain (which could indicate liver damage), sudden onset of leg swelling, chest pain, or difficulty breathing (which could indicate a blood clot), sudden severe headache, weakness on one side of the body, or difficulty speaking (which could indicate a stroke), or signs of a severe allergic reaction such as difficulty breathing, swelling of the face, lips, or throat.
The hepatotoxicity associated with eltrombopag deserves particular attention. In the EXTEND long-term extension study in ITP, approximately 10% of patients experienced ALT elevations of grade 3 or higher at some point during treatment. In most cases, these elevations were transient, reversible upon dose reduction or interruption, and did not recur upon rechallenge. However, rare cases of severe hepatic decompensation have been reported, particularly in patients with underlying chronic liver disease. The mechanism of eltrombopag-induced hepatotoxicity is not fully understood but may involve idiosyncratic drug-induced liver injury or interference with hepatic bilirubin and bile acid transport.
Thromboembolic events represent another serious concern. In a pooled analysis of ITP clinical trials, thromboembolic events occurred in approximately 4–6% of eltrombopag-treated patients compared with 2–3% of placebo-treated patients. The risk is highest in patients with additional prothrombotic risk factors (such as Factor V Leiden mutation, antiphospholipid antibodies, advanced age, prolonged immobilization, or concurrent use of estrogen-containing contraceptives). Portal vein thrombosis has been particularly noted in patients with chronic liver disease, including those with hepatitis C–associated thrombocytopenia.
Regarding cataracts, the preclinical finding of lens opacities in rodents led to the requirement for ophthalmological monitoring in clinical trials and in clinical practice. In the EXTEND study, new or worsened cataracts were reported in approximately 15% of patients, though many of these were in older patients in whom cataracts develop naturally. A causal relationship has not been definitively established, but regular eye examinations remain recommended.
How Should You Store Eltrombopag Avansor?
Eltrombopag Avansor film-coated tablets should be stored at temperatures not exceeding 30°C (86°F). The tablets should be kept in their original blister packaging until use to protect them from moisture and light. Do not remove tablets from the blister strip in advance for storage in pill organizers unless used within a short period, as this may compromise the integrity and stability of the medication.
Keep this medication out of the sight and reach of children. Children are particularly vulnerable to accidental ingestion, and eltrombopag can cause significant hematologic effects even in small doses. Store the medication in a secure location, preferably in a locked medicine cabinet.
Do not use Eltrombopag Avansor after the expiry date stated on the blister and carton. The expiry date refers to the last day of the stated month. Do not dispose of medications via household waste or wastewater. Ask your pharmacist about the proper method for disposing of medications that are no longer needed or have expired. These measures help to protect the environment and prevent accidental exposure to others.
If you notice any visible changes in the appearance of the tablets, such as discoloration, crumbling, or a change in odor, do not use the medication and consult your pharmacist. While film-coated tablets are generally robust, exposure to high humidity or extreme temperatures can affect their quality.
What Does Eltrombopag Avansor Contain?
The active substance in Eltrombopag Avansor is eltrombopag, present in the form of eltrombopag olamine (the diethanolamine salt). Each 25 mg tablet contains eltrombopag olamine equivalent to 25 mg of eltrombopag free acid. Eltrombopag olamine has the molecular formula C25H22N4O4·C4H11NO2 and a molecular weight of approximately 564.6 g/mol.
The excipients (inactive ingredients) in the tablet core typically include magnesium stearate (a lubricant used in tablet manufacturing), mannitol (a sugar alcohol used as a filler), microcrystalline cellulose (a bulking and binding agent), povidone (a binding agent that helps hold the tablet together), and sodium starch glycolate (a disintegrant that helps the tablet break apart in the stomach for absorption). The film coating contains hypromellose (hydroxypropyl methylcellulose), titanium dioxide (a white colorant), and may contain additional colorants depending on the tablet strength and manufacturer. Specific coating compositions may vary by batch and should be verified on the product packaging.
It is important to note that the magnesium stearate content in the excipients is minimal and is not expected to interact significantly with eltrombopag’s chelating properties. However, patients should still observe the dietary and supplement separation guidelines described in the interactions section, as the primary source of problematic polyvalent cations comes from external sources (food, supplements, and concomitant medications) rather than from the tablet formulation itself.
Patients with known allergies or intolerances to any of these excipients should inform their healthcare provider before starting treatment. The tablets do not contain lactose, gluten, or tartrazine, making them suitable for patients with these common sensitivities. However, individual product formulations may vary, and patients should always check the patient information leaflet supplied with their specific medication batch for the most up-to-date list of excipients.
Frequently Asked Questions
Eltrombopag Avansor is an oral medication containing eltrombopag, a thrombopoietin receptor agonist. It works by mimicking the action of thrombopoietin (TPO), the body’s natural hormone that regulates platelet production. By binding to the TPO receptor on bone marrow cells, eltrombopag stimulates the growth and maturation of megakaryocytes, which are the cells that produce platelets. This leads to increased platelet production and higher platelet counts in the blood. Unlike natural TPO, eltrombopag binds to a different part of the receptor, meaning it can work alongside the body’s own TPO for an additive effect.
Eltrombopag has a chemical structure that allows it to bind very strongly to certain metal ions, including calcium, which is abundant in dairy products. When eltrombopag encounters calcium (or iron, magnesium, aluminium, zinc, or selenium), it forms a complex that cannot be properly absorbed through the gut wall into the bloodstream. Studies have shown that taking eltrombopag with dairy or mineral-containing products can reduce its absorption by as much as 70%, meaning you would only get about a third of the intended dose. To ensure you receive the full benefit of the medication, you must take it on an empty stomach at least 2 hours before or 4 hours after consuming dairy, antacids, or mineral supplements.
Most patients begin to see an increase in platelet counts within 1 to 2 weeks of starting eltrombopag treatment. However, reaching the target platelet level often takes longer, as the dose is gradually adjusted every 2 weeks based on your blood test results. Some patients may achieve their target within 2 to 4 weeks, while others may require several weeks of dose titration. If there is no meaningful increase in platelet counts after 4 weeks of treatment at the maximum recommended dose, your doctor may consider discontinuing the medication, as lack of response at this point makes a later response unlikely.
When you stop taking eltrombopag, your platelet count will typically return to its pre-treatment level within approximately 1 to 2 weeks. In some cases, the platelet count may temporarily drop below what it was before you started treatment – a phenomenon known as “rebound thrombocytopenia.” This temporary dip can potentially increase your risk of bleeding. For this reason, your doctor will monitor your platelet counts closely for at least 4 weeks after stopping eltrombopag. You should not stop taking eltrombopag without consulting your doctor, even if you are feeling well, as the underlying condition that caused your low platelet counts is still present.
Yes, regular blood tests are essential during eltrombopag treatment. Platelet counts should be checked weekly during dose titration and at least monthly once a stable dose is established. Liver function tests (ALT, AST, bilirubin) must be performed before starting treatment, every 2 weeks during dose adjustment, and then monthly during maintenance. Your doctor may also periodically examine a peripheral blood smear to check for abnormal blood cell shapes that could suggest bone marrow fibrosis. Additionally, regular eye examinations are recommended to monitor for cataracts, particularly in children and patients on long-term treatment.
Yes, eltrombopag is approved for use in children aged 1 year and older with chronic immune thrombocytopenia (ITP) who have had an insufficient response to other treatments. The dosing is adjusted according to age: children aged 1 to 5 years start at 25 mg once daily, while children aged 6 to 17 years start at 50 mg once daily (25 mg if of East Asian ancestry). The same careful monitoring of platelet counts, liver function, and eye health applies to pediatric patients. Eltrombopag is not currently approved for children under 1 year of age or for pediatric patients with severe aplastic anemia or hepatitis C–associated thrombocytopenia outside of clinical trials.
References
- European Medicines Agency (EMA). Revolade (eltrombopag) – Summary of Product Characteristics. Last updated 2025. Available at: EMA Revolade EPAR.
- U.S. Food and Drug Administration (FDA). Promacta (eltrombopag) – Prescribing Information. Novartis Pharmaceuticals Corporation. Revised 2024.
- Cheng G, Saleh MN, Marcher C, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet. 2011;377(9763):393–402. doi:10.1016/S0140-6736(10)60959-2.
- Saleh MN, Bussel JB, Cheng G, et al. Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study. Blood. 2013;121(3):537–545. doi:10.1182/blood-2012-04-425512.
- Townsley DM, Scheinberg P, Winkler T, et al. Eltrombopag Added to Standard Immunosuppression for Aplastic Anemia. N Engl J Med. 2017;376(16):1540–1550. doi:10.1056/NEJMoa1613878.
- American Society of Hematology (ASH). 2019 ASH Clinical Practice Guidelines on Immune Thrombocytopenia. Blood Adv. 2019;3(23):3829–3866. doi:10.1182/bloodadvances.2019000966.
- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829–3866.
- Afdhal NH, Giannini EG, Vaez-Zadeh N, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia (ELEVATE). N Engl J Med. 2012;367(8):716–724. doi:10.1056/NEJMoa1110709.
- British Society for Haematology (BSH). Guidelines for the diagnosis and management of adult immune thrombocytopenia. Br J Haematol. 2023;201(5):828–851.
- World Health Organization (WHO). Model List of Essential Medicines – 23rd List. 2023. Available at: WHO Essential Medicines List.
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