Introduction
Thrombopag 50 is a 50 mg tablet formulation of eltrombopag, an oral thrombopoietin receptor agonist (TPO-RA). It works by stimulating platelet production in the bone marrow and is used to treat chronic immune thrombocytopenia (ITP), hepatitis C-associated thrombocytopenia, and severe aplastic anemia (SAA).
Storage
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Store at 20–25°C (room temperature) in a dry place.
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Keep tablets in their original blister pack to protect from moisture.
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Do not refrigerate or freeze.
Dosage & Administration
1. Chronic ITP (Adults & Children ≥1 Year)
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Starting Dose: 50 mg once daily (for most adults).
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Asian patients or those with liver impairment: 25 mg once daily (due to increased drug exposure).
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Take on an empty stomach (1 hour before or 2 hours after food).
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Avoid calcium-rich foods/drinks (milk, antacids) for at least 4 hours after dosing.
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Adjust dose based on platelet response (target: 50–200 x 10⁹/L).
2. Hepatitis C-Associated Thrombocytopenia
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Dose: 25 mg once daily (adjust based on platelet count).
3. Severe Aplastic Anemia (SAA)
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Dose: 50 mg once daily (may increase to 75–100 mg if needed).
Clinical Significance
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Increases platelet counts, reducing bleeding risk.
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Reduces need for platelet transfusions and corticosteroids.
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Oral administration (more convenient than injectable alternatives like romiplostim).
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Effective in refractory cases where other treatments fail.
Drawbacks
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Expensive long-term therapy.
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Risk of excessive platelets → thrombosis (requires monitoring).
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Not a cure (platelets may drop after stopping).
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Food & drug interactions (must avoid calcium, iron, and antacids near dosing time).
Side Effects
Common Side Effects | Serious Side Effects |
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– Headache | – Blood clots (DVT, stroke, PE) |
– Nausea | – Liver damage (monitor LFTs) |
– Fatigue | – Bone marrow fibrosis (rare) |
– Diarrhea | – Cataracts (eye exams needed) |
– Rash | – Increased cancer risk (theoretical) |
Drug Interactions
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Antacids, calcium, iron supplements → Reduce absorption (take 4 hours apart).
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Statins (atorvastatin, rosuvastatin) → Increased risk of myopathy.
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Proton pump inhibitors (PPIs) → May reduce eltrombopag absorption.
Monitoring Requirements
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Weekly platelet counts (until stable, then monthly).
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Liver function tests (LFTs) before and during treatment.
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Regular eye exams (risk of cataracts).
Conclusion
Thrombopag 50 (eltrombopag 50 mg) is a highly effective oral treatment for ITP, hepatitis C-related thrombocytopenia, and severe aplastic anemia. While it significantly improves platelet counts, it requires careful dosing adjustments, dietary restrictions, and monitoring for liver toxicity, thrombosis, and other risks. It is a valuable second-line therapy for patients unresponsive to conventional treatments.
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