1. Definition & Mechanism
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Generic Name: Eltrombopag
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Brand Name: Revolade (also marketed as Promacta in some regions)
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Class: Thrombopoietin receptor agonist (TPO-RA) (oral small-molecule)
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Mechanism: Binds to the TPO receptor on megakaryocytes → stimulates platelet production
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Half-life: ~21–32 hours (allows once-daily dosing)
2. Indications & Importance
✅ FDA/EMA-Approved Uses:
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Chronic Immune Thrombocytopenia (ITP) (adults & children ≥1 year) – 2nd-line therapy
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Severe Aplastic Anemia (SAA) (in combination with immunosuppressants)
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Hepatitis C-associated Thrombocytopenia (to permit antiviral therapy)
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Chemotherapy-Induced Thrombocytopenia (under investigation)
⚠️ Not for use in:
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Myelodysplastic syndromes (MDS) (↑ risk of leukemic progression)
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Patients with normal platelet counts
3. Dosage & Administration
Standard Dosing Guidelines
Indication | Starting Dose | Dose Adjustment | Max Dose |
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ITP (Adults) | 50 mg once daily | Adjust by 25 mg every 2 weeks | 75 mg/day |
ITP (Children 1-5 yrs) | 25 mg once daily | Adjust by 12.5–25 mg | 75 mg/day |
SAA | 150 mg once daily | Reduce if platelets >200,000/μL | 150 mg/day |
HCV Thrombocytopenia | 25 mg once daily | Titrate weekly | 100 mg/day |
Key Administration Points:
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Take on an empty stomach (1 hr before or 2 hrs after food)
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Avoid calcium-rich foods/drugs (dairy, antacids – separate by ≥4 hrs)
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Do not crush tablets (film-coated)
4. Side Effects & Toxicity
Common (≥10%)
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Headache (20%)
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Nausea, diarrhea (15%)
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Fatigue (12%)
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Mild liver enzyme elevation (ALT/AST ↑)
Serious (Monitor Closely)
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Hepatotoxicity (rare but severe)
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Thrombosis (arterial/venous – especially if platelets >400,000/μL)
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Bone Marrow Fibrosis (long-term use)
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Cataracts (ophthalmic exams recommended)
5. Storage & Handling
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Store at 20–25°C (room temperature)
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Keep in original blister pack (protects from moisture)
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Do not freeze
6. Contraindications & Warnings
❌ Absolute Contraindications:
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Hypersensitivity to eltrombopag
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Severe hepatic impairment (Child-Pugh C)
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Active thrombosis
⚠️ Black Box Warnings (FDA):
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Risk of hepatotoxicity (monitor LFTs every 2 weeks initially)
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Risk of bone marrow fibrosis (check reticulin staining if long-term use)
7. Drug Interactions
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Polyvalent cations (Ca²⁺, Mg²⁺, Fe²⁺): ↓ Absorption (separate doses by 4 hrs)
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CYP1A2/CYP2C8 inhibitors (fluvoxamine, gemfibrozil): ↑ Eltrombopag levels
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Statins: May ↑ risk of myopathy
8. Monitoring Requirements
Parameter | Frequency | Action Threshold |
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Platelet count | Weekly until stable, then monthly | >150,000/μL → reduce dose |
Liver enzymes | Every 2 weeks ×3 months, then monthly | ALT >3× ULN → interrupt |
Bone marrow biopsy | Annually (if long-term use) | Reticulin fibrosis → reconsider therapy |
9. Cost & Alternatives
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Price: ~$5,000–$7,000/month (brand)
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Alternatives:
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Romiplostim (Nplate) (subcutaneous TPO-RA)
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Avatrombopag (Doptelet) (alternative oral TPO-RA)
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10. Conclusion
REVOLADE 50 mg is a potent oral thrombopoietin agonist for ITP, SAA, and HCV-related thrombocytopenia.
Key Takeaways:
✔ Effective in refractory ITP (60–80% response rate)
✔ Convenient oral dosing (vs. injectable alternatives)
✔ Requires strict monitoring (liver, platelets, bone marrow)
Clinical Pearls:
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Start low, go slow (especially in elderly)
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Discontinue if no response after 4 weeks
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Consider thromboprophylaxis if platelets >400,000/μL
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