(el-trom-bo-pag) ,


(trade name),


(trade name)


Therapeutic: antithrombocytopenics
Pharmacologic: thrombopoietin receptor agonists
Pregnancy Category: C


Treatment of chronic immune (idiopathic) thrombocytopenic purpura in patients who have had an inadequate response to corticosteroids, immunoglobulins or splenectomy (should only be used in patients with an ↑ risk of bleeding).Treatment of thrombocytopenia in patients with chronic hepatitis C to allow the initiation and maintenance of interferon-based therapy


Increases platelet production by initiating proliferation and differentiation of megakaryocytes from bone marrow progenitor cells.

Therapeutic effects

Increased platelet count with reduced risk of bleeding.


Absorption: 52% absorbed following oral administration.
Distribution: Unknown.
Protein Binding: >99%.
Metabolism and Excretion: Extensively metabolized; 59% eliminated in feces, 20% as unchanged drug; 31% excreted in urine as metabolites.
Half-life: 21–35 hr.

Time/action profile (effect on platelet count)

PO1 wk2 wk1 wk


Contraindicated in: Lactation: Lactation.
Use Cautiously in: Myelodysplastic syndromes (may ↑ risk of hematologic malignancy); Hepatic impairment (lower initial dose required); genetic implication Patients of East Asian ancestry (may require lower doses); Geriatric: May be more sensitive to drug effects; ↑ dose cautiously, consider age-related ↓ in renal and hepatic function, concurrent disease states and drug therapy; Obstetric: Use only when potential maternal benefit outweighs potential risk to fetus.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • development/worsening of cataracts


  • thromboembolism (life-threatening)


  • hepatotoxicity (life-threatening)


  • bone marrow changes


Drug-Drug interaction

↓ availability and absorption of iron, calcium, aluminum, magnesium, selenium and zinc by chelation; do not administer within 4 hr of medications containing these and other polyvalent cations.↓ availability and absorption of iron, calcium, aluminum, magnesium, selenium, and zinc by chelation; do not administer within 4 hr of foods containing these and other polyvalent cations.


Chronic Immune (Idiopathic) Thrombocytopenia

Oral (Adults) 50 mg once daily, may be ↑ to achieve a platelet count of ≥50 x 109/L (not to exceed 75 mg/day); genetic implication Patients of East Asian ancestry— 25 mg once daily initially, may be ↑ to achieve a platelet count of ≥50 x 109/L (not to exceed 75 mg/day);.

Hepatic Impairment

(Adults) Mild, moderate, or severe hepatic impairment (Child Pugh Class A, B, C)—25 mg once daily initially, may be ↑ to achieve a platelet count of ≥50 x 109/L (not to exceed 75 mg/day);genetic implication Patients of East Asian ancestry with mild, moderate, or severe hepatic impairment (Child Pugh Class A, B, C)— 12.5 mg once daily initially, may be ↑ to achieve a platelet count of ≥50 x 109/L (not to exceed 75 mg/day)

Chronic Hepatitis C-Associated Thrombocytopenia

Oral (Adults) 25 mg once daily; may be ↑ by 25 mg every 2 wk to achieve the target platelet count required to initiate antiviral therapy; during antiviral therapy, adjust dose to avoid dose ↓ of peginterferon (not to exceed 100 mg/day)


Tablets: 12.5 mg, 25 mg, 50 mg, 75 mg

Nursing implications

Nursing assessment

  • Monitor for unusual bleeding and bruising and signs of hepatotoxicity during therapy.
  • Monitor for signs and symptoms of cataracts. Perform baseline ocular examination prior to administration and periodically during therapy.
  • Lab Test Considerations: Modify dose based on platelet count. If platelet count <50 x 109/L following at least 2 wk of therapy, increase daily dose by 25 mg. If platelet count is ≥200 x 109/L to ≤400 x 109/L, decrease dose by 25 mg. Wait 2 wk to assess effects of dose adjustment. If platelet count >400 x 109/L, stop eltrombopag, increase monitoring of platelet monitoring to 2x/wk. Once platelet count is <150 x 109/L, reinititate therapy at dose reduced by 25 mg/day. If platelet count >400 x 109/L after 2 wk of therapy at lowest dose, permanently discontinue eltrombopag. Discontinue eltrombopag if platelet count does not ↑ to a level sufficient to avoid clinically important bleeding after 4 wk of therapy at maximum daily dose of 75 mg.
    • Monitor liver tests and CBC, including platelet counts and peripheral blood smears, prior to and throughout therapy. Monitor AST, ALT, and serum bilirubin prior to therapy, every 2 wk during dose adjustment, and monthly following stable dose. If bilirubin is ↑, perform fractionation. Evaluate abnormal liver tests with repeat testing in 3–5 days. If abnormalities are confirmed, monitor serum liver tests weekly until resolved, stabilize, or return to baseline. Discontinue eltrombopag if ALT levels ↑ to ≥3 x upper limit of normal and are progressive, persistent for ≥4 wk, or accompanied by ↑ direct bilirubin, or accompanied by clinical symptoms of liver injury or evidence of hepatic decompensation. Monitor CBC including platelet count, for at least 4 wk following discontinuation of therapy; may cause worsening thrombocytopenia.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)


  • Oral: Administer on an empty stomach, 1 hr before or 2 hr after a meal. Allow at least 4 hr between eltrombopag and other medications (antacids), calcium-rich foods (dairy and calcium-fortified juices), and supplements containing iron, calcium, aluminum, magnesium, zinc, and selenium.

Patient/Family Teaching

  • Explain purpose, risks and benefits of therapy to patient. Risks or long term therapy are unknown.
  • Instruct patient to avoid taking eltrombopag within 4 hr of foods, mineral supplements, and antacids containing iron, calcium, aluminum, magnesium, zinc, and selenium.
  • Advise patients to avoid activities that may increase risk of bleeding.
  • Instruct patient to notify health care professional if symptoms of liver problems (yellowing of skin or whites of eyes, unusual darkening of urine, unusual tiredness, pain in right upper stomach) occur.
  • Advise female patients to notify health care professional promptly if pregnancy is planned or suspected or if breastfeeding. A pregnancy registry has been established to collect information about eltrombopag effects during pregnancy. Enrollment is by calling 1-888-825-5249.
  • Emphasize the importance of routine lab tests to determine effectiveness and monitor for side effects.

Evaluation/Desired Outcomes

  • Increased platelet counts and decreased risk of bleeding. Platelet counts usually increase within 1–2 wk of starting and decrease within 1–2 wk of discontinuing therapy.
Mentioned in ?
References in periodicals archive ?
One such novel agent is thrombopoietin receptor agonists like eltrombopag, romiplostim with promising results and lesser potential for immunogenicity.
In the September 2013 issue, Cardamone et al (1) reported that serum samples from 4 patients receiving 200 or 300 mg of eltrombopag (Promacta, GlaxoSmithKline, Research Triangle Park, North Carolina) in a clinical trial for treatment of acute myelogenous leukemia were deep brownish red in color and that total bilirubin concentrations for these patients were lower than 0.
Within 8 weeks of initiation of AVT - Eltrombopag, followed by IFN dose reduction, if needed.
Detailed review of the donor's medical history revealed a diagnosis of severe idiopathic thrombocytopenic purpura, refractory to treatment by corticosteroids, IV immunoglobulins, splenectomy (performed six months before organ harvesting), eltrombopag, and romiplostim.
Treatment with the thrombopoietin receptor agonist eltrombopag led to a sustained platelet response in 40% of children and adolescents with chronic immune thrombocytopenia, compared with only 3% of the placebo group, according to a randomized trial published online in The Lancet.
More recently, recognising that platelet underproduction and megakaryocyte dysfunction play a substantial role in the pathophysiology of ITP, TPO receptor agonists such as romiplostim and eltrombopag have become available.
There are several second-line therapies: spelenectomy, rituximab, danazol, azathioprine, and thrombopoietin agonists such as eltrombopag and romiplostim.
Consideration in the management of hepatitis C virus related thrombocytopenia with Eltrombopag.
e results from the Phase III PETIT2 study which evaluated its drug eltrombopag in pediatric patients with low platelet count showed the main objective was met.
Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomized, phase 3 study.
A non-protein TPO agonist, Eltrombopag, was shown to increase patients' platelet counts and decrease bleeding incidence while receiving the medication when compared with patients on placebo.