Classification: Antithrombin Agent
About Eltrombopag (Promacta®)
Eltrombopag is a man-made protein used to treat a low platelet count (thrombocytopenia) in adults that is caused by idiopathic thrombocytopenic purpura (also called ITP). Eltrombopag is a thrombopoietin receptor agonist that stimulates bone marrow cells to produce platelets.
How to Take Eltrombopag
Eltrombopag is given in a pill or liquid form, taken once a day. The medication should be taken on an empty stomach (1 hour before or 2 hours after eating). Take the tablets whole, do not crush, chew or break. If you are using the liquid form, you will receive instructions on how to prepare the dose.
The following compounds significantly reduce the absorption of Eltrombopag and should not be consumed for at least 4 hours before or 2 hours after taking the medication:
- Dairy products or calcium fortified juices
- Antacids (used for heartburn or as calcium supplements)
- Multivitamins or supplements that contain iron, calcium, aluminum, magnesium, selenium or zinc.
The recommended starting dose is 50mg a day. Patients of East Asian ancestry or those with liver problems will be started at a lower dose due to the risk of liver toxicity. Your platelet count will be monitored and the dose of medication changed as needed. If you miss a dose, wait and take the next scheduled dose. Do not take two doses to make up for a missed dose.
Storage and Handling
Store this medication (both pill and liquid formulations) at room temperature in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Eltrombopag is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Eltrombopag
There are a number of things you can do to manage the side effects of eltrombopag. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Your risk of developing a blood clot (DVT or PE) is higher while taking this medication, particularly when your platelet count is high. Your healthcare provider will monitor your platelet count to attempt to prevent it from getting too high. Blood clots can occur anywhere in the body. They occur most frequently in the calves (leg) or the lungs. Signs of a blood clot in the leg may include any of the following: leg pain, warmth, swelling of one leg more than the other. Signs of a blood clot in the lung could include: fever, shortness of breath that comes on you very quickly, racing heart and chest pain (that tends to be worse when you take a deep breath). If you have any of these signs or symptoms of blood clots, you will need to be seen immediately so that you can be treated with blood thinners.
This medication can cause liver toxicity, which your doctor may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, you develop swelling or pain in your abdomen, as these can be signs of liver toxicity.
Worsening of the Platelet Count After Stopping the Medication
In clinical trials, some patients experienced lower platelet counts when the medication was stopped than they had before taking the medication. This side effect is most likely to occur shortly after stopping eltrombopag and may last about 1 month. This lower platelet count increases the risk of bleeding, so precautions should be taken and any bruising or bleeding should be reported to your healthcare provider.
Eltrombopag can cause new or worsened cataracts. Your healthcare provided may check your eyes before and during treatment. Symptoms of cataracts include: cloudy, blurry or dim vision, difficulty with night vision, sensitivity to light or seeing halos around lights. Report any vision changes to your healthcare team.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.