Eltrombopag (Revolade) is a thrombopoietin receptor agonist used for the treatment of chronic immune thrombocytopenia (ITP), chronic hepatitis C-related thrombocytopenia, and severe aplastic anemia. It increases platelet count by stimulating the proliferation of megakaryocytes in the bone marrow, but strict adherence to medication guidelines is required to avoid adverse reactions.

Precautions for Eltrombopag (Revolade) Use

Indications and Contraindications

Target Population: Patients with chronic ITP (adults and children aged 1 year and above) who have an inadequate response to glucocorticoids, immunoglobulins, or splenectomy.

Patients with chronic hepatitis C who cannot initiate or maintain antiviral therapy due to thrombocytopenia when combination therapy with interferon is required.

Patients with severe aplastic anemia who have an inadequate response to immunosuppressive therapy.

Contraindications: There are no absolute contraindications, but risks (such as hepatic impairment, history of thrombosis) must be carefully evaluated.

Dosage and Administration

Take on an Empty Stomach: Administer 1 hour before a meal or 2 hours after a meal. Avoid concurrent use with foods or drugs containing polyvalent cations (e.g., calcium, magnesium, iron) — an interval of at least 4 hours is required.

Dosage Adjustment:

For ITP patients: The initial dosage is 50 mg/day for adults; it is reduced to 25 mg/day for East Asian patients or those with hepatic impairment. For children (aged 1-5 years), the initial dosage is 25 mg/day. The maximum daily dosage should not exceed 75 mg.

For hepatitis C patients: The initial dosage is 25 mg/day, with a maximum of 100 mg/day.

For aplastic anemia patients: The initial dosage is 50 mg/day (25 mg/day for East Asian patients or those with hepatic impairment), with a maximum of 150 mg/day.

Medication Use in Special Populations

Patients with Hepatic Impairment: Dosage reduction is necessary, and close monitoring of liver enzymes is required.

Pregnancy/Lactation: This drug may cause fetal harm; the benefits and risks must be weighed. During lactation, it is recommended to discontinue the drug or stop breastfeeding.

East Asian Patients: Due to metabolic differences, the initial dosage needs to be reduced.

Potential Risk Warnings

Thrombosis Risk: Portal vein thrombosis may occur, especially in patients with chronic liver disease. It is necessary to avoid excessively high platelet counts (the target for ITP is ≥ 50×10⁹/L, not normalization).

Hepatotoxicity: Regular monitoring of ALT/AST is required. If ALT/AST levels are ≥ 3 times the upper limit of normal (ULN) accompanied by symptoms, the drug should be discontinued.

Cataracts: Ocular examinations are required before and during the medication period.

Monitoring During Eltrombopag (Revolade) Use

Platelet Count Monitoring

For ITP patients: Testing is performed weekly during the initial phase, and once a month after the condition stabilizes. When switching dosage forms (e.g., from tablets to oral solution), weekly monitoring is required for 2 consecutive weeks.

Adjustment Basis: Increase the dosage if the platelet count is < 50×10⁹/L; decrease the dosage if it is > 200×10⁹/L; suspend medication if it is > 400×10⁹/L.

For hepatitis C patients: Weekly monitoring is conducted during antiviral therapy to maintain the target platelet count and ensure the continuity of treatment.

Liver Function Monitoring

Test ALT, AST, and bilirubin before medication and every 2 weeks during the dosage adjustment period; after stabilization, testing is done once a month.

If abnormal liver enzymes are detected, reconfirmation is needed. If the abnormality persists for ≥ 4 weeks or is accompanied by elevated bilirubin, discontinue the drug immediately.

Adverse Reaction Monitoring

For ITP patients: Nausea, diarrhea, upper respiratory tract infection, and elevated transaminases.

For hepatitis C patients: Anemia, fever, and headache.

For aplastic anemia patients: Fatigue, cough, and muscle spasms.

Severe Reactions: Thrombotic events (e.g., abdominal pain, vomiting), symptoms of liver failure (e.g., jaundice, ascites), and vision changes (e.g., cataracts).