Select a medication above to begin.
Promacta
eltrombopag
Black Box Warnings .
Hepatic Decompensation Risk
use w/ interferon and ribavirin may incr. risk of hepatic decompensation in chronic hepatitis C pts
Hepatotoxicity
incr. risk of severe and potentially life-threatening hepatotoxicity; in pts w/ persistent or chronic ITP, chronic HCV-associated thrombocytopenia, and refractory severe aplastic anemia, monitor ALT, AST, bilirubin at baseline, q2wk during dose adjustments until stable dose established, then qmo; if bilirubin elevated, perform fractionation and repeat LFTs w/in 3-5 days, if abnormalities confirmed, monitor LFTs qwk until resolved or stabilized; in pts w/ baseline normal liver function, D/C tx if ALT >3x ULN; in pts w/ baseline elevated ALT/AST, D/C tx if ALT >3x baseline or >5x ULN (whichever is lower) and are progressively increasing, persistent >4wk, or accompanied by incr. direct bilirubin or clinical s/sx of hepatic injury/hepatic decompensation; in pts w/ tx-naive severe aplastic anemia, monitor ALT, AST, bilirubin at baseline, qod while hospitalized for antithymocyte globulin tx, then q2wk during tx; if ALT or AST >6x ULN, hold tx until ALT or AST <5x ULN
Adult Dosing .
Dosage forms: TAB: 12.5 mg, 25 mg, 50 mg, 75 mg; SUSP: 12.5 mg per packet, 25 mg per packet
Special Note
- [formulation clarification]
- Info: not interchangeable w/ other eltrombopag products; do not substitute on a mg to mg basis
ITP, persistent or chronic
- [50-75 mg PO qd]
- Start: 50 mg PO qd; Max: 75 mg/day; Info: for pts w/ risk of bleeding who had insufficient response to corticosteroids, immunoglobulins, or splenectomy; give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use lowest effective dose to maintain Plt >50,000; see pkg insert for dose adjustments; D/C if no incr. in Plt after 4wk at max dose; start 25 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
thrombocytopenia, chronic hepatitis C-associated
- [25-100 mg PO qd]
- Start: 25 mg PO qd; Max: 100 mg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; incr. dose q2wk to the lowest effective dose to maintain Plt necessary to initiate and maintain interferon-based antiviral tx; see pkg insert for dose adjustments; D/C when antiviral tx D/C
aplastic anemia, severe
- [first-line tx]
- Dose: 150 mg PO qd x6mo; Max: 150 mg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use w/ standard immunosuppressants; see pkg insert for dose adjustments; start 75 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
- [refractory dz]
- Dose: 50-150 mg PO qd; Start: 50 mg PO qd; Max: 150 mg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; incr. dose q2wk to the lowest effective dose to maintain Plt >50,000; see pkg insert for dose adjustments; D/C if no hematologic response after 16wk; start 25 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [persistent or chronic ITP]
- Child-Pugh Class A, B, or C: start 25 mg qd; start 12.5 mg qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels); Info: may incr. dose no more frequently than q3wk
- [chronic hepatitis C-associated thrombocytopenia]
- hepatic impairment: no adjustment
- [severe aplastic anemia, first-line tx]
- Child-Pugh Class A, B, or C: 75 mg qd; ALT or AST >6x ULN: avoid use
- [severe aplastic anemia, refractory dz]
- Child-Pugh Class A, B, or C: start 25 mg qd
Peds Dosing .
- Dosage forms: TAB: 12.5 mg, 25 mg, 50 mg, 75 mg; SUSP: 12.5 mg per packet, 25 mg per packet
Special Note
- [formulation clarification]
- Info: not interchangeable w/ other eltrombopag products; do not substitute on a mg to mg basis
ITP, persistent or chronic
- [1-5 yo]
- Dose: 25-75 mg PO qd; Start: 25 mg PO qd; Max: 75 mg/day; Info: for pts w/ risk of bleeding who had insufficient response to corticosteroids, immunoglobulins, or splenectomy; give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use lowest effective dose to maintain Plt >50,000; see pkg insert for dose adjustments; D/C if no incr. in Plt after 4wk at max dose
- [6 yo and older]
- Dose: 50-75 mg PO qd; Start: 50 mg PO qd; Max: 75 mg/day; Info: for pts w/ risk of bleeding who had insufficient response to corticosteroids, immunoglobulins, or splenectomy; give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use lowest effective dose to maintain Plt >50,000; see pkg insert for dose adjustments; D/C if no incr. in Plt after 4wk at max dose; start 25 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
aplastic anemia, severe
- [first-line tx, 2-5 yo]
- Dose: 2.5 mg/kg/dose PO qd x6mo; Max: 2.5 mg/kg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use w/ standard immunosuppressants; see pkg insert for dose adjustments; start 1.25 mg/kg/dose PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
- [first-line tx, 6-11 yo]
- Dose: 75 mg PO qd x6mo; Max: 75 mg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use w/ standard immunosuppressants; see pkg insert for dose adjustments; start 37.5 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
- [first-line tx, 12 yo and older]
- Dose: 150 mg PO qd x6mo; Max: 150 mg/day; Info: give on empty stomach or w/ low calcium meal, give 2h before or 4h after calcium-rich foods; do not cut/crush/chew tab; use w/ standard immunosuppressants; see pkg insert for dose adjustments; start 75 mg PO qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels)
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [persistent or chronic ITP, 1-5 yo]
- hepatic impairment: decr. usual dose, amount not defined
- [persistent or chronic ITP, 6 yo and older]
- Child-Pugh Class A, B, or C: start 25 mg qd; start 12.5 mg qd in pts of East/Southeast Asian ancestry (risk of incr. drug levels); Info: may incr. dose no more frequently than q3wk
- [severe aplastic anemia]
- Child-Pugh Class A, B, or C: decr. usual start dose by 50%; ALT or AST >6x ULN: avoid use