Eltrombopag (Revolade) is a thrombopoietin receptor agonist. Clinically, it is mainly used for the treatment of chronic immune thrombocytopenia (ITP), chronic hepatitis C-related thrombocytopenia, and severe aplastic anemia.
How to Use Eltrombopag (Revolade)
Take on an Empty Stomach
It should be taken on an empty stomach, either 1 hour before a meal or 2 hours after a meal, to ensure optimal absorption.
Food, especially calcium-rich food (such as dairy products and calcium-fortified juices), can significantly reduce the absorption of the drug.
Avoid Drug Interactions
When taking eltrombopag, an interval of at least 2 hours should be maintained between eltrombopag and other drugs (e.g., antacids). For drugs and supplements containing polyvalent cations (e.g., iron, calcium, aluminum, magnesium, selenium, and zinc), an interval of 4 hours should be observed.
Preparation of Oral Suspension
When using the oral suspension, it must be prepared with warm water (hot water is not allowed). The prepared suspension should be taken immediately; any suspension not taken within 30 minutes should be discarded.
Guidance from professionals should be obtained before preparing and using the suspension.
Dosage Adjustment of Eltrombopag (Revolade)
Dosage Adjustment for Chronic Immune Thrombocytopenia (ITP)
Initial Dosage: For patients aged 6 years and above: usually 50 mg once daily; for children aged 1-5 years: 25 mg once daily.
For East Asian patients or patients with hepatic impairment: The initial dosage should be halved.
Principles of Dosage Adjustment: If the platelet count is < 50×10⁹/L for at least 2 weeks: increase the daily dosage by 25 mg (maximum 75 mg/day).
If the platelet count is 200-400×10⁹/L: decrease the daily dosage by 25 mg.
If the platelet count is > 400×10⁹/L: suspend the medication. Resume treatment with a lower dosage when the platelet count drops to < 150×10⁹/L.
If the platelet count remains > 400×10⁹/L even at the minimum dosage: discontinue the medication permanently.
Dosage Adjustment for Chronic Hepatitis C-Related Thrombocytopenia
Initial Dosage: 25 mg once daily for all patients.
Dosage Adjustment: If the platelet count is insufficient for at least 2 weeks: increase the dosage by 25 mg every 2 weeks (maximum 100 mg/day).
If the platelet count is 200-400×10⁹/L: decrease the daily dosage by 25 mg.
If the platelet count is > 400×10⁹/L: follow the same management principles as for ITP.
Dosage Adjustment for Severe Aplastic Anemia
Initial Dosage: 50 mg once daily for most patients; 25 mg once daily for East Asian patients or those with hepatic impairment.
Dosage Adjustment: If the therapeutic effect is insufficient for at least 2 weeks: increase the dosage by 50 mg every 2 weeks (maximum 150 mg/day).
If the platelet count is 200-400×10⁹/L: decrease the daily dosage by 50 mg.
If the platelet count is > 400×10⁹/L: suspend the medication for 1 week, then resume with a lower dosage.
Medication Use in Special Populations for Eltrombopag (Revolade)
Patients with Hepatic Impairment
For all indications: The initial dosage should be reduced by 50%.
For ITP patients: Extend the interval between dosage adjustments to 3 weeks.
East Asian patients with concurrent hepatic impairment: Consider a further dosage reduction to 12.5 mg once daily.
Enhanced monitoring of liver function is required; if signs of hepatotoxicity appear, discontinue the medication promptly.
East Asian Population
For ITP patients: The initial dosage is 25 mg once daily (for adults).
For patients with severe aplastic anemia: The initial dosage is 25 mg once daily.
East Asian patients with hepatic impairment may require an even lower initial dosage.
Pediatric Patients
Only for use in children aged 1 year and above.
For ITP children aged 1-5 years: A fixed dosage of 25 mg once daily.
For ITP children aged 6 years and above: Refer to the adult dosage adjustment plan.
Individualized dosage adjustment based on body weight and therapeutic effect is necessary.
Pregnancy and Lactation
Animal studies have shown potential fetal harm; use only when the potential benefit outweighs the risk.
During lactation, the importance of the drug to the mother should be weighed to decide whether to discontinue the drug or stop breastfeeding.
