What are the important precautions when taking Eltrombopag (Revlan)?

While taking Eltrombopag (Eltrombopag), patients need to pay special attention to medication methods, interactions, organ function monitoring and potential risk management, because although this drug can effectively increase platelet levels, its pharmacokinetics are highly sensitive, and improper use may lead to reduced efficacy or increased side effects. First of all, the most important things to note with eltrombopag are the medication time and dietary restrictions. Because it is highly bound to foods containing metal ions and will significantly affect absorption, patients must strictly abide by the "taking on an empty stomach" principle: 2 hours before taking the drug and 4 hours after taking the drug. Avoid dairy products, mineral supplements such as calcium, iron, magnesium, zinc, and foods containing high calcium (such as milk, cheese, yogurt), fortified cereals, and vitamin-mineral products. If iron or calcium supplements are necessary, they should be separated from eltrombopag by at least 4 hours. In addition, citrus fruits such as grapefruit and orange juice may also affect metabolism and are not recommended to be taken at the same time as medicine. When taking the medicine, swallow the tablet whole and do not crush it to ensure stable absorption and avoid insufficient platelet elevation due to incorrect administration.

The second most important thing to note is regular monitoring of liver function and platelet levels. Eltrombopag may cause elevated liver enzymes or even liver damage, so it is necessary to test ALT, AST, and bilirubin before use, in the first few weeks of treatment, and regularly (usually monthly) thereafter. Once obvious liver function abnormalities occur (such as transaminases exceeding the upper limit of normal 3 times), doctors may need to suspend or adjust the dose. Another key monitoring item is platelet count, because eltrombopag is strong and improper dosage may cause excessive elevation of platelets, thereby increasing the risk of thrombosis. Clinically, the dose will be dynamically adjusted based on changes in platelets, rather than fixed doses for long-term use. Patients are not allowed to add or subtract medications at will; even if the platelets recover, the medication cannot be stopped immediately and must be gradually adjusted under the guidance of a doctor, otherwise a rebound drop in platelets may occur. In addition, if the patient develops leg swelling, chest pain, difficulty breathing, headache, nervous system abnormalities, etc., he or she needs to seek medical attention immediately to rule out the possibility of blood clots.

Third, patients should pay attention to the interactions with other diseases and drugs and the risks for special populations. Eltrombopag is mainly metabolized by the liver by UGT1A1, UGT1A3 and CYP1A2 , so co-use with certain drugs may change its blood concentration, such as some antiviral drugs, anti-allergic drugs, anti-tuberculosis drugs and other effects CYP Enzyme system drugs. Patients should inform their doctor about all medicines, health products, and herbal supplements before use to avoid interactions. In addition, eltrombopag may further increase the risk of portal vein thrombosis in patients with chronic liver disease, so extra caution is required. If the patient himself suffers from liver fibrosis, hepatitis, a history of thrombosis, cardiovascular disease, diseases with a higher risk of bleeding, etc., he also needs to use it with caution after a doctor's evaluation. For children, pregnant women, and lactating women, the safety of eltrombopag has not been fully confirmed, and it is generally necessary to strictly follow medical advice; especially during pregnancy, use is usually avoided unless the benefits clearly outweigh the risks. If medication is necessary, close monitoring of the fetus is required.

Finally, patients taking eltrombopag for a long time should pay special attention to potential long-term risks and usage misunderstandings. Although eltrombopag can effectively increase platelets, it cannot cure the underlying disease, such as primary immune thrombocytopenia (ITP). Therefore, patients cannot expect to rely on this drug to completely stop taking the drug. Long-term follow-up and evaluation of disease progression are required. Long-term use may lead to the risk of myelofibrosis, so peripheral blood smears need to be checked regularly during use, and bone marrow evaluation should be performed if necessary. In addition, patients should avoid the misunderstandings of "blindly increasing activity" or "unauthorized discontinuation of medication" due to elevated platelets. Even if the platelets recover, it does not mean that the condition has completely improved. Sudden discontinuation of the drug can cause a sudden rebound platelet drop and cause severe bleeding. In daily life, patients should avoid operations that are prone to bleeding, such as strenuous exercise, tooth extraction, nose picking, excessive drinking, and the use of drugs that affect blood coagulation (such as aspirin, ibuprofen) unless permitted by the doctor. In short, although eltrombopag is a key therapeutic drug for increasing platelets, its use requires strict and monitoring is important. Only under standardized management can the efficacy be maximized and risks reduced.

Reference materials:https://www.nlm.nih.gov/

xa0