Why is it recommended to use Eltrombopag (Revlan) as little as possible and why?

Eltrombopag is an oral thrombopoietin receptor agonist (TPO-RA), mainly used to treat chronic immune thrombocytopenia (ITP), aplastic anemia and some liver disease-related thrombocytopenia. Its mechanism of action is to activate platelet precursor cells in the bone marrow and promote platelet production, thereby improving the risk of bleeding caused by platelet deficiency. Although the efficacy is significant, it is generally recommended to use the lowest effective dose in clinical practice to achieve a balance between safety and efficacy.

Overstimulation of platelet production may lead to an increased risk of thrombosis. While Eltrombopag increases platelet count, if the dose is too high or platelets rise rapidly, it may cause venous or arterial thrombotic events, including deep vein thrombosis, pulmonary embolism and even cardiovascular and cerebrovascular accidents. Therefore, using the minimum effective dose can reduce the risk of thrombosis while maintaining the safety range of platelets, which is a key clinical consideration.

Long-term high-dose use may cause liver function abnormalities and drug accumulation. Eltrombopag is mainly metabolized by the liver. High-dose or long-term overdose may lead to elevated liver enzymes or even liver damage. At the same time, elevated blood concentration may also increase the risk of other adverse reactions, such as headache, joint pain, or gastrointestinal discomfort. By using as low a dose as possible, the burden on the liver can be reduced and long-term patient tolerance can be improved.

The dose of eltrombopag can be dynamically adjusted based on platelet count. Clinically, we usually start with a small dose and gradually increase it according to the platelet level until it reaches a safe range that can control bleeding without causing excessive increase. This personalized dosing strategy not only improves safety but also reduces unnecessary drug exposure, thereby balancing efficacy and long-term health.

Reference:https://reference.medscape.com/

xa0