Eltrombopag/Eltrombopag Dosage Guidelines and Dosage Adjustments

The timing of taking Eltrombopag is very critical, and it is usually recommended to take it before meals or with low-calcium foods (calcium content≤50mg). If you need to take other medications, such as antacids, or consume high-calcium foods (such as dairy products, calcium-fortified juices, and certain fruits and vegetables containing >50 mg of calcium) and supplements containing polyvalent cations (such as iron, calcium, aluminum, magnesium, selenium, and zinc), you should do so at least 2 hours before or at least 4 hours after taking eltrombopag. Regarding dosage adjustments, the following are detailed recommendations:

1. Persistent or chronic immune thrombocytopenia (ITP):

Pediatric patients 1 to 5 years: 25 mg once daily. Adults and children with ITP 6 years and older: 50 mg once daily. Patients with ITP and mild, moderate, or severe hepatic impairment (Child-Pugh classes A, B, C): Initial dose is 25 mg once daily. For patients with ITP of East/Southeast Asian ancestry and those who also have mild, moderate, or severe hepatic impairment, the initial dose is 12.5 mg once daily.

Research suggests that after initiating eltrombopag, dose adjustments may be needed to achieve and maintain platelet counts≥50*10^9/L, thereby reducing the risk of bleeding. The maximum daily dose is not to exceed 75 mg. Platelet counts usually increase within 1 to 2 weeks after starting treatment and decrease within 1 to 2 weeks after stopping treatment. If, after 4 weeks of treatment with eltrombopag at a maximum daily dose of 75 mg, platelet counts have not increased to a level sufficient to avoid clinically important bleeding, the drug should be discontinued.

2. Chronic hepatitis C-related thrombocytopenia (ITP):

Patients were initiated at a dose of 25 mg once daily followed by increases of 25 mg every 2 weeks to achieve target platelet counts required to initiate antiviral therapy. Platelet counts should be monitored weekly before starting antiviral therapy. Daily dose does not exceed 100mg. Eltrombopag should also be discontinued when antiviral therapy is discontinued.

3. Severe aplastic anemia (AA):

First-line heavy duty AA: Initiate eltrombopag concurrently with standard immunosuppressive therapy at a dose of 2.5 mg/kg in pediatric patients 2 to 5 years of age; 75 mg in pediatric patients 6 to 11 years of age; and 150 mg in patients 12 years and older, both once daily for 6 months. For patients with severe AA of East Asian/Southeast Asian ancestry or those with mild, moderate, or severe hepatic impairment, the first-line treatment dose is reduced by 50%.

Refractory Severe AA AA: Initial dose is 50 mg once daily, or 25 mg once daily in patients with severe AA of East/Southeast Asian ancestry or patients with mild, moderate, or severe hepatic impairment. Then increase by 50 mg every 2 weeks to achieve a platelet count ≥50*10^9/L. Do not exceed daily dose 150mg.

If there is no hematological response after 16 weeks of treatment with eltrombopag, or if new cytogenetic abnormalities develop, or if there is an exaggerated platelet count response or significant liver test abnormalities, treatment should be discontinued.