• Monitor for unusual bleeding and bruising, thromboembolic events (deep vein thrombosis, pulmonary embolus, stroke, myocardial infarction) and signs of hepatotoxicity during therapy. If thromboembolic events occur, discontinue eltrombopag but continue horse antithymocyte globulin (h-ATG) and cyclosporine.
• Monitor for signs and symptoms of cataracts. Perform baseline ocular examination prior to administration and periodically during therapy.

Lab Test Considerations:

• For Chronic Immune Thrombocytopenia: Monitor CBC with differential and platelet count weekly until platelet count is stable. Goal is platelet count ≥50 × 10⁹/L. Modify dose based on platelet count. If platelet count <50 × 10⁹/L following at least 2 wk of therapy, ↑ daily dose by 25 mg; maximum 75 mg/day. For patients taking 12.5 mg once daily, ↑ dose to 25 mg daily before ↑ dose by 25 mg. If platelet count is ≥200 × 10⁹/L to ≤400 × 10⁹/L,↓ dose by 25 mg. For patients taking 25 mg/day, ↓ dose to 12.5 mg/day. Wait 2 wk to assess effects of dose adjustment. If platelet count >400 × 10⁹/L, stop eltrombopag, ↑ monitoring of platelet to twice weekly. Once platelet count is <150 × 10⁹/L, reinitiate therapy at dose reduced by 25 mg/day. For patients taking 25 mg/day, reinitiate at dose of 12.5 mg/day.If platelet count >400 × 10⁹/L after 2 wk of therapy at lowest dose, permanently discontinue eltrombopag. Discontinue eltrombopag if platelet count does not ↑ to a level sufficient to avoid clinically important bleeding after 4 wk of therapy at maximum daily dose of 75 mg.

  • Chronic Hepatitis C-Associated Thrombocytopenia

    Monitor platelet counts every wk prior to starting antiviral therapy. Goal is to achieve and maintain platelet count necessary to initiate and maintain antiviral therapy with pegylated interferon and ribavirin. Modify dose based on platelet count. Adjust dose in 25-mg increments every 2 wks as necessary for target platelet count required to initiate antiviral therapy. During antiviral therapy, adjust dose to avoid dose reductions of peginterferon. Monitor CBC with differentials, including platelet counts, weekly during antiviral therapy until stable platelet count is achieved. Monitor platelet counts monthly thereafter. If platelet count <50 × 10⁹/L following at least 2 wk of therapy, ↑ daily dose by 25 mg; maximum 100 mg/day. If platelet count is ≥200 × 10⁹/L to ≤400 × 10⁹/L,↓ dose by 25 mg. Wait 2 wk to assess effects of dose adjustment. If platelet count >400 × 10⁹/L, stop eltrombopag, ↑ monitoring of platelet to twice weekly. Once platelet count is <150 × 10⁹/L, reinitiate therapy at dose reduced by 25 mg/day. For patients taking 25 mg/day, reinitiate at dose of 12.5 mg/day.If platelet count >400 × 10⁹/L after 2 wk of therapy at lowest dose, permanently discontinue eltrombopag. Discontinue eltrombopag when antiviral therapy is discontinued.

  • Aplastic Anemia

    Goal is platelet count >50 × 10⁹/L. Modify dose based on platelet count. If platelet count <50 × 10⁹/L following at least 2 wk of therapy, ↑ daily dose by 50 mg. If patient taking 25 mg/day, ↑ dose to 50 mg before increasing by 50 mg; maximum 150 mg/day. If platelet count is ≥200 × 10⁹/L to ≤400 × 10⁹/L,↓ dose by 50 mg. Wait 2 wk to assess effects of dose adjustment. If platelet count >400 × 10⁹/L, stop eltrombopag, for 1 wk. Once platelet count is <150 × 10⁹/L, reinititate therapy at dose ↓ by 50 mg/day. If platelet count >400 × 10⁹/L after 2 wk of therapy at lowest dose, permanently discontinue eltrombopag. If no hematologic response after 16 wks of therapy, discontinue therapy.
  • When switching between oral suspension and tablet, assess platelet counts weekly for 2 wks, then follow standard monthly monitoring.
  • Monitor AST, ALT, and serum bilirubin prior to therapy, every 2 wk during dose adjustment, and monthly following stable dose. If bilirubin is ↑, perform fractionation. Evaluate abnormal liver tests with repeat testing in 3–5 days. If abnormalities are confirmed, monitor serum liver tests weekly until resolved, stabilize, or return to baseline. Discontinue eltrombopag if ALT levels ≥3× upper limit of normal (ULN) in patients with normal liver function or ≥3× baseline or >5× ULN and progressively increasing, or persistent for ≥4 wk, or accompanied by ↑ direct bilirubin, or accompanied by symptoms of liver injury or hepatic decompensation.

  • First line treatment of aplastic anemia

    Measure ALT, AST, and bilirubin before starting therapy, every other day while hospitalized for hATG therapy, and then every 2 wks during therapy. Do not start eltrombopag if AST or ALT levels ≥6 × upper limit of normal (ULN). If <5 × ULN, restart at same dose. If AST and ALT >6 × ULN after restarting, discontinue therapy and monitor ALT or AST at least every 3 to 4 days. If ALT or AST < 5 × ULN, restart eltrombopag at dose reduced from previous dose by 25 mg daily. If AST or ALT >6 × ULN with reduced dose, reduce dose by 25 mg until AST or ALT <5 × ULN. In pediatric patients under 12 yrs, reduce daily dose by ≥15% to nearest dose that can be administered.