A complete analysis of the detailed instructions and precautions for Eltrombopag (Revlan)

Eltrombopag is an oral thrombopoietin receptor agonist (TPO-RA), mainly used to treat thrombocytopenic diseases such as chronic immune thrombocytopenic purpura (ITP), chronic liver disease-related thrombocytopenia, and aplastic anemia. By simulating the effect of thrombopoietin (TPO), it activates bone marrow megakaryocyte receptors and promotes platelet production, thereby improving the number of platelets and reducing the risk of bleeding. The following is a complete analysis of Eltrombopag’s detailed instructions and precautions for use.

Indications, usage and dosage

Eltrombopag is indicated for adults and children (≥1 years old) with chronic immune thrombocytopenic purpura, especially those who have had an inadequate response to glucocorticoids, immunosuppressants, or splenectomy therapy. In addition, for patients with chronic liver disease before undergoing invasive procedures, eltrombopag can temporarily increase platelet levels and reduce the risk of bleeding. It is usually administered orally once a day. The starting dose for adults is 25-50 mg. The dose is adjusted according to the platelet count, up to a maximum of 75 mg per day. The dosage for pediatric patients must be calculated based on body surface area or weight and strictly follow the doctor's advice. The drug should be taken on an empty stomach or with water. Avoid taking it with calcium-containing foods to avoid affecting absorption.

Main adverse reactions and management

Adverse effects of eltrombopag include hematologic and liver function abnormalities, gastrointestinal effects, and a rare risk of myelofibrosis. In terms of blood system, some patients may experience excessive elevation of platelets or fluctuations in platelet levels. Blood pictures should be monitored regularly and the dose should be adjusted as necessary. Abnormal liver function is manifested by an increase in serum aminotransferase or bilirubin, which is mostly mild to moderate. The medication can be continued under monitoring or the dose can be temporarily reduced. Gastrointestinal reactions such as nausea, diarrhea, and abdominal pain are generally mild and can be alleviated through dietary adjustments and symptomatic treatment. Long-term use also requires attention to the risk of myelofibrosis and thrombosis, especially patients with significantly elevated platelets, who should undergo regular bone marrow or imaging evaluations.

Medication precautions

Patients should be assessed for platelet levels, liver function, and past medical history before using eltrombopag. Patients should avoid taking the drug with calcium-rich foods, dairy products or mineral supplements to avoid affecting absorption. For patients with hepatic impairment or who are receiving other hepatotoxic drugs, it should be used with caution and liver function indicators should be closely monitored. When platelet levels are too low or too high, the dose should be adjusted promptly to prevent bleeding or thrombotic events. Pregnant and lactating women need to weigh the pros and cons and proceed under the guidance of a doctor. Patients should follow the doctor's instructions to regularly review their blood and liver function, and seek medical attention promptly if any abnormalities are found.

Drug Interactions and Precautions

Eltrombopag is metabolized by the liver and may interact withCYP1A2, CYP2C8 and glucuronidation pathway drug interactions. When using accompanying drugs such as antacids, calcium tablets, iron, etc., they should be taken at least 2 hours apart to avoid affecting drug absorption. Caution should be used when combined with other platelet-promoting or anticoagulant drugs to prevent an increased risk of thrombosis. Patients should inform their doctors of all prescription drugs, over-the-counter drugs and health care products they are using so that the dosage and medication regimen can be adjusted appropriately.

Patient management and follow-up

Long-term use of eltrombopag requires the establishment of dynamic platelet monitoring and adverse reaction follow-up mechanisms. Patients should maintain regular review of blood count, liver function and necessary bone marrow examination to evaluate efficacy and safety. At the same time, patients should be educated to understand common adverse reactions and warning symptoms, such as severe bleeding, persistent abdominal pain, jaundice or abnormal fatigue, and seek medical treatment promptly. Through regular monitoring, individualized dose adjustment and symptomatic treatment, the vast majority of patients can use eltrombopag safely and long-term to achieve effective management of platelet levels and disease control.

In conclusion, eltrombopag, as a thrombopoietin receptor agonist, provides an oral, long-term, controllable treatment option for patients with chronic thrombocytopenia. Rational use of drugs, strict monitoring of blood and liver function, and individualized dosage adjustment according to doctor's instructions are key measures to ensure efficacy and safety. Through comprehensive patient education and follow-up management, eltrombopag can effectively increase platelet levels, reduce bleeding risks, and significantly improve patients' quality of life.

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