Eltrombopag (Revolade) is a thrombopoietin receptor agonist used to treat chronic immune thrombocytopenia (ITP), chronic hepatitis C-associated 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 older) 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 liver dysfunction, history of thrombosis) must be carefully evaluated.
Dosage and Administration
Fasting Administration: Take 1 hour before meals or 2 hours after meals. Avoid concurrent use with foods or medications containing polyvalent cations (e.g., calcium, magnesium, iron) (an interval of at least 4 hours is required).
Dosage Adjustment:
ITP Patients: The initial dose is 50mg/day for adults; it is reduced to 25mg/day for East Asian patients or those with liver impairment. For children (1-5 years old), the initial dose is 25mg/day. The maximum dose should not exceed 75mg/day.
Hepatitis C Patients: The initial dose is 25mg/day, with a maximum of 100mg/day.
Aplastic Anemia Patients: The initial dose is 50mg/day (25mg/day for East Asian patients or those with liver impairment), with a maximum of 150mg/day.
Medication for Special Populations
Liver Dysfunction: Dosage reduction is required, and liver enzymes must be closely monitored.
Pregnancy/Lactation: It may cause harm to the fetus, so the pros and cons must be weighed. During lactation, it is recommended to discontinue the medication or stop breastfeeding.
East Asian Patients: Due to metabolic differences, the initial dose 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: Regularly monitor ALT/AST. If levels are ≥3 times the upper limit of normal (ULN) accompanied by symptoms, discontinue the medication.
Cataracts: Ophthalmic examinations are required before and during medication use.
Medication Monitoring for Eltrombopag (Revolade)
Platelet Count Monitoring
ITP Patients: Monitor weekly during the initial phase, once a month after stabilization, and weekly for 2 consecutive weeks when switching dosage forms (e.g., from tablets to oral solution).
Adjustment Basis: Increase the dose when platelets <50×10⁹/L, reduce the dose when platelets >200×10⁹/L, and suspend medication when platelets >400×10⁹/L.
Hepatitis C Patients: Monitor weekly during antiviral therapy, and maintain the target platelet count to ensure the continuity of treatment.
Liver Function Monitoring
Test ALT/AST/bilirubin before medication use and every 2 weeks during the dosage adjustment period; test once a month after stabilization.
If abnormal liver enzymes occur, reconfirmation is required. If abnormalities persist for ≥4 weeks or are accompanied by elevated bilirubin, discontinue the medication immediately.
Adverse Reaction Monitoring
ITP Patients: Nausea, diarrhea, upper respiratory tract infection, and elevated transaminases.
Hepatitis C Patients: Anemia, fever, and headache.
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).
