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Thrombopoietin Receptor Agonist (TPO-RA) Pregnancy: C

Eltrombopag

Brand names: Revolade

Adult dose

Dose: 50 mg once daily (ITP); 25 mg in East/South-East Asian patients or hepatic impairment
Route: oral
Frequency: once daily
Max: 75 mg/day
Take 2h before or 4h after antacids, dairy, calcium-rich foods (chelation); titrate every 2 weeks; target platelet count 50–200 × 10⁹/L

Paediatric dose

Route: oral
Frequency: once daily
Max: 75 mg/day
Concentration: 12.5 mg, 25 mg, 50 mg, 75 mg tablets mg/ml
Age ≥1 year: 1–5 years: 25 mg OD; 6–17 years: 50 mg OD; reduce by 50% in East Asian descent

Dose adjustments

Renal

No dose adjustment required

Hepatic

Start at 25 mg/day in moderate/severe hepatic impairment

Clinical pearls

  • RAISE trial: maintained platelet response after 6 months in chronic ITP
  • Must perform peripheral blood smear for morphological abnormalities before and periodically during treatment
  • Used also in aplastic anaemia (with immunosuppression) and hepatitis C thrombocytopaenia

Contraindications

  • Bone marrow fibrosis (absolute — causes reticulin deposition)
  • Hepatic impairment with high-grade fibrosis

Side effects

  • Hepatotoxicity (check LFTs)
  • Cataracts
  • Thromboembolism
  • Bone marrow fibrosis (reticulin)
  • QT prolongation
  • GI upset

Interactions

  • Polyvalent cations (antacids, iron, dairy — chelation, reduce absorption)
  • CYP1A2/2C8 substrates (inhibits)

Monitoring

  • Platelet count weekly until stable, then monthly
  • LFTs every 2 weeks
  • Peripheral blood smear
  • Ophthalmology review (cataracts)

Reference: BNFc; BNF 86; NICE TA221; RAISE trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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