Eltrombopag

How it works

It stimulates the thrombopoietin receptor on megakaryocytes and their precursors, increasing platelet production.

Prescribing in practice

• It can cause hepatotoxicity and increase the risk of thromboembolism, so liver function must be checked and the platelet count must not be allowed to rise excessively.
• Absorption is reduced by polyvalent cations, so it should be separated in time from antacids, dairy products and mineral supplements.
• The dose is titrated to the platelet response rather than to normalise the count, and excessive platelet rises should prompt a dose reduction.

Monitoring

Monitor the full blood count including platelets regularly, and check liver function before and during treatment.

Counselling the patient

• Take the medicine away from dairy, antacids and iron or calcium supplements as advised.
• Report signs of a clot or of liver problems such as yellowing of the skin or eyes.

Evidence & guidelines

Thrombopoietin receptor agonists are recommended for chronic immune thrombocytopenia by NICE and used in aplastic anaemia within established practice.