eltrombopag olamine: clinical use

Prescribing considerations

• Treatment should be initiated and supervised by a clinician experienced in haematological disease or relevant hepatitis C complications.
• Confirm the cause of thrombocytopenia and aim to reduce bleeding risk rather than normalise the platelet count.
• Assess hepatic disease and thrombotic risk before treatment; advanced chronic liver disease carries additional risks.
• Review food, antacid, mineral and transporter-mediated interactions.
• After discontinuation, anticipate falling platelet counts and monitor for bleeding.
• Use particular caution in hepatic impairment, people with thromboembolic risk factors and older adults.
• Eltrombopag is not established for thrombocytopenia caused by myelodysplastic syndromes and should not be used for this outside clinical studies.

Contraindications and cautions

• Hypersensitivity to eltrombopag or any product excipient.

Monitoring

• Platelet count and full blood count, with peripheral blood-film review where indicated.
• ALT, AST and bilirubin before and during treatment; promptly investigate progressive or symptomatic abnormalities.
• Consider marrow assessment if new cytopenias, dysplastic cells or loss of response develops.
• For severe aplastic anaemia, assess marrow cytogenetics because clonal abnormalities and progression to myelodysplastic syndrome or acute myeloid leukaemia have been reported.
• The medicine's colour can interfere with some bilirubin and creatinine assays; request an alternative method if results conflict with the clinical picture.

Clinical pharmacology

Eltrombopag is an oral, small-molecule thrombopoietin-receptor agonist. It binds the receptor's transmembrane domain, stimulating proliferation and differentiation of bone-marrow progenitor cells. It is highly protein-bound, extensively metabolised through several pathways and predominantly eliminated in faeces.

Formulation and product differences

• Selected products include film-coated tablets and powder reconstituted as an oral suspension.
• The oral suspension can produce higher exposure than tablets; switching formulation requires additional platelet monitoring.
• Prepare the suspension with water using the supplied bottle and a new single-use syringe, then administer it promptly.
• The selected oral-suspension licence includes acquired severe aplastic anaemia; the selected tablet licence does not.

Tablet

Route: Oral

Strengths: 25 mg, 50 mg, 75 mg