Eltrombopag/eltrombopag dose reduction and discontinuation criteria

Eltrombopag/Eltrombopag is an oral drug mainly used to treat immune thrombocytopenia, aplastic anemia and thrombocytopenia related to chronic hepatitis C infection. Eltrombopag is used to correct thrombocytopenia caused by various diseases. It can stimulate the bone marrow to produce platelets, which may help control the disease, but it will not cure it. The dose of eltrombopag can be adjusted based on the patient's response to treatment.

Eltrombopag is usually started at a low dose of 12.5 mg or 25 mg daily The dose is gradually increased to maintain a platelet count of at least>50,000/mm to prevent bleeding. The dose of eltrombopag is adjusted as follows: if the patient's platelet count is <50,000/mm, the dose should be gradually increased to achieve a minimum count of 50,000/mm (maximum dose is 75 mg per day). If the patient's platelet count is between 50,000/mm and 200,000/mm, the dose should be maintained. If the patient's platelet count is between 200,000/mm and 400,000/mm, the dose should be reduced by 25 mg per day (if the patient is taking 25 mg, the dose should be reduced to 12.5 mg per day). Finally, if the patient's platelet count is >400,000/mm3, stop the patient's dose, monitor the platelet count twice weekly, and when the platelet count is <150,000/mm3, resume the patient's daily dose but reduce it by 25 mg (if the patient is taking 25 mg daily, resume 12.5 mg daily). These modifications are based on the increase in platelet counts that results directly from the use of eltrombopag.

In clinical practice, some patients already taking eltrombopag may experience increased platelet counts for conditions other than its effects. This situation poses a challenge for physicians to make appropriate dose adjustments, especially in patients stable on long-term fixed doses, without knowing the impact of discontinuing eltrombopag on overall safety, including the risk of bleeding.