Eltrombopag (Revolade) is a thrombopoietin receptor agonist used to treat specific types of thrombocytopenia and aplastic anemia. Although it has good efficacy, potential side effects and precautions must be watched for during medication use.
What Are the Side Effects of Eltrombopag (Revolade)
Gastrointestinal Reactions
Nausea (9%-33%), diarrhea (9%-21%), vomiting (6%), and decreased appetite (18%).
Patients with chronic liver disease may experience abnormal liver function (elevated ALT/AST).
Infections and Respiratory Symptoms
Upper respiratory tract infections (7%-17%), cough (9%-23%), and sore throat (8%-14%).
Flu-like symptoms (such as fever, fatigue) are more common in patients with hepatitis.
Other Common Reactions
Headache (10%-21%), muscle pain (5%-12%), and rash (3%-5%).
The incidence of nasopharyngitis (12%) and fever (9%) is relatively high in pediatric patients.
Severe Side Effects of Eltrombopag (Revolade) to Watch For
Liver Damage and Hepatotoxicity
It may cause elevated ALT/AST (5%-12%), and even lead to liver failure.
Management Measures: Regular liver function monitoring is required before medication use and during treatment. If ALT is ≥3 times the upper limit of normal or accompanied by elevated bilirubin, the medication must be discontinued immediately.
Thrombosis and Embolism Risk
The incidence of portal vein thrombosis increases significantly (1%-3%) in patients with chronic liver disease after using this drug.
High-Risk Groups: Patients with cirrhosis and hereditary thrombotic tendency (such as factor V Leiden) need to use it with caution.
Myelosuppression and Blood Abnormalities
Patients with severe aplastic anemia may experience cytopenia (e.g., neutrophils <0.5×10⁹/L).
Monitoring Requirements: Platelet count should be tested weekly until stable, and excessive elevation of platelets (>400×10⁹/L) should be avoided.
Cataract Risk
Approximately 7% of adult patients experience cataract progression; data in children is not yet clear.
Recommendation: Regular ophthalmic examinations are required before medication use and during treatment.
Precautions for Eltrombopag (Revolade) Use
Dosage Adjustment and Administration Method
Fasting Administration: Take 1 hour before meals or 2 hours after meals. Avoid taking with calcium/iron-containing foods (with an interval of 4 hours).
Individualized Dosage: The initial dose for East Asian populations or patients with liver damage needs to be halved (e.g., 25mg/day).
The maximum dose for patients with chronic ITP should not exceed 75mg/day.
Contraindications for Special Populations
Pregnant Women: Animal studies show potential fetal risks; the pros and cons must be weighed.
Lactating Women: It is recommended to discontinue the medication or stop breastfeeding.
Children: Patients over 1 year old can use it, but the dosage needs to be adjusted according to age.
Drug Interactions
Avoid concurrent use with polyvalent cation-containing drugs (such as antacids, iron supplements); an interval of at least 2 hours is required.
Protease inhibitors may affect the metabolism of eltrombopag, requiring dosage adjustment.
Discontinuation Indications
Suspend the medication when the platelet count is >400×10⁹/L; reduce the dose and restart after the count drops to the safe range.
Permanent discontinuation is required if hepatotoxicity, thrombosis, or myelosuppression occurs.
