Eltrombopag (Revolade) is a thrombopoietin receptor agonist used for the treatment of specific types of thrombocytopenia and aplastic anemia. Although it has good therapeutic efficacy, potential side effects and precautions must be watched out for during medication.
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 infection (7%-17%), cough (9%-23%), and sore throat (8%-14%).
Influenza-like symptoms (such as fever and 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 higher in pediatric patients.
Severe Side Effects of Eltrombopag (Revolade) That Require Vigilance
Liver Damage and Hepatotoxicity
May cause elevated ALT/AST (5%-12%), and even lead to liver failure.
Management Measures: Regular monitoring of liver function is required before medication and during treatment. If ALT is ≥ 3 times the upper limit of normal value or accompanied by elevated bilirubin, the medication must be discontinued immediately.
Thrombosis and Embolism Risks
The incidence of portal vein thrombosis increases significantly (1%-3%) in patients with chronic liver disease after using this drug.
High-Risk Populations: Patients with liver cirrhosis and hereditary thrombotic tendency (such as factor V Leiden mutation) need to use this drug with caution.
Myelosuppression and Hematological 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 progression of cataracts; data in children are not yet clear.
Recommendation: Regular ophthalmological examinations are required before medication and during treatment.
Precautions for Eltrombopag (Revolade) Use
Dosage Adjustment and Administration Method
Take on an Empty Stomach: Administer 1 hour before a meal or 2 hours after a meal. Avoid taking it with calcium/iron-containing foods (an interval of 4 hours is required).
Individualized Dosage: The initial dosage for East Asian populations or patients with liver injury needs to be halved (e.g., 25 mg/day).
The maximum dosage for patients with chronic ITP should not exceed 75 mg/day.
Contraindications in Special Populations
Pregnant Women: Animal studies have shown potential fetal risks; the benefits and risks must be weighed.
Lactating Women: It is recommended to discontinue the medication or stop breastfeeding.
Children: Patients over 1 year old can use this drug, but the dosage needs to be adjusted according to age.
Drug Interactions
Avoid concurrent use with drugs containing polyvalent cations (such as antacids and iron supplements); an interval of at least 2 hours is required.
Protease inhibitors may affect the metabolism of eltrombopag, so dosage adjustment is necessary.
Indications for Discontinuation
When the platelet count is > 400×10⁹/L, suspend the medication, and resume it at a reduced dosage after the count drops to the safe range.
Permanent discontinuation is required if hepatotoxicity, thrombosis, or myelosuppression occurs.
