WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
R-PAG contains eltrombopag, a medicine that works by stimulating a
receptor (the thrombopoietin receptor, or c-Mpl) on the surface of
platelet-producing cells in the bone marrow called megakaryocytes.
This stimulation drives the bone marrow to produce more platelets — the
tiny blood cells essential for clotting and stopping bleeding.
Eltrombopag is used for:
· chronic immune thrombocytopenia (ITP)
in adults and children — a condition where the immune system mistakenly
destroys platelets, leading to dangerously low platelet counts, bruising, and
bleeding risk;
· aplastic anaemia (AA) in adults — a
rare, serious condition where the bone marrow stops producing blood cells, used
alongside immunosuppressive therapy;
· Thrombocytopenia (low platelets)
associated with chronic hepatitis C infection — to enable interferon-based
therapy to continue (though this indication has largely been superseded by
newer hepatitis C treatments).
The 50mg tablet is the standard starting and maintenance dose for most
adults with ITP (except those of East Asian heritage or those with liver
disease, who start at 25mg). Doses can be adjusted between 25mg and 75mg based
on platelet count response.
3. HOW TO TAKE THIS MEDICINE
For chronic ITP in most adults: 50mg once daily, on an empty stomach.
Adjust based on platelet count response: increase to 75mg if the platelet count
does not reach 50 x 10⁹/L after 2 weeks on 50mg; reduce to 25mg if platelets
rise above 200 x 10⁹/L on two consecutive counts. For aplastic anaemia: higher
doses (up to 150mg daily) may be used under haematologist supervision.
Take on an empty stomach — at least 2 hours before food and 4 hours after
the last food, dairy, or mineral supplement. This fasting requirement is
identical to and equally critical as for the 25mg tablet.
All the same food, dairy, and mineral supplement timing restrictions that
apply to the 25mg tablet apply with equal importance to the 50mg tablet. This
is the most common reason for poor platelet response — taking the medicine too
close to food or supplements reduces its absorption significantly.
⚠ PATIENT TIP: Take the 50mg tablet first thing
in the morning, at least 30 minutes before breakfast, and before taking any
morning supplements. Setting a phone alarm for 6 to 7 am, then eating breakfast
30 to 60 minutes later, is a routine that works well for many patients.
Consistency of timing every day is what gives the most predictable platelet
counts.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Same as R-PAG 25mg —
see entry 159 |
Nausea, diarrhoea,
headache, upper respiratory infections, fatigue, raised liver enzymes |
|
Frequency may be
slightly higher at 50mg than 25mg |
Liver enzyme
elevations and thrombotic risk are dose-related — monitoring is equally
important at 50mg as at 25mg |
|
Serious — Same as
entry 159 |
Hepatotoxicity,
thromboembolism if platelets rise too high, cataracts with long-term use,
reticulin fibrosis |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Identical to R-PAG 25mg — see entry 159. Contraindicated in MDS, during
pregnancy, and with significant uncontrolled liver disease. Not for use in
patients with high thrombotic risk without careful monitoring.
⚠ FOOD AND SUPPLEMENT TIMING IS EQUALLY CRITICAL
AT 50MG: The absorption interaction with food, dairy, and polyvalent cation
supplements (calcium, iron, magnesium) is the same at 50mg as at 25mg.
Reinforce at every dispensing.
⚠ DOSE ADJUSTMENT BASED ON PLATELET COUNTS: Do
not assume the 50mg dose is permanently fixed — platelet counts determine the
dose. If counts rise too high (>400 x 10⁹/L), the dose is reduced or
stopped. If counts remain inadequate after 2 weeks, it is increased to 75mg.
⚠ ALL WARNINGS FROM ENTRY 159 APPLY: LFT
monitoring, thrombotic risk, cataract monitoring, reticulin fibrosis
assessment, MDS contraindication, pregnancy contraindication.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Identical to R-PAG 25mg — see entry 159. Polyvalent cation antacids,
calcium/iron/magnesium supplements, and dairy products must be separated by at
least 4 hours (post-dose) and 2 hours (pre-dose). Statin interaction
(rosuvastatin, simvastatin): dose review required. Ciclosporin reduces
absorption.
7. HOW TO STORE THIS MEDICINE
Store below 30°C in original packaging, away from moisture. Keep out of
reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (haematology) prescription required |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Take your 50mg tablet every morning on an empty stomach — before
breakfast and before any supplements. Do not take it with milk, dairy, calcium,
iron, or antacid supplements. Attend regular platelet count and liver function
blood tests. If platelets rise too high, your haematologist will adjust your
dose. Report any leg swelling, breathlessness, chest pain, or eye changes to
your haematologist promptly. All guidance in the R-PAG 25mg entry (159) applies
equally to this tablet.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
50mg is the standard
starting dose for most adults with ITP (non-East Asian, no significant liver
impairment). Fasting administration counselling is as critical here as at
25mg — reinforce at every dispensing. LFT monitoring: pre-treatment, every 2
weeks during titration, monthly when stable. Platelet monitoring: weekly
during initiation, monthly when stable. Dose adjustment algorithm: <50 x
10⁹/L after 2 weeks on 50mg → increase to 75mg; >200 x 10⁹/L on 2
consecutive counts → reduce to 25mg; >400 x 10⁹/L → reduce and if
sustained, discontinue. Statin interaction: rosuvastatin and simvastatin dose
review. Polyvalent cation supplement timing rule: separate by minimum 4 hours
post-dose. Cataract and bone marrow monitoring for long-term users. MDS
contraindication — confirm diagnosis. Pregnancy: contraindicated. |
11. FREQUENTLY ASKED QUESTIONS
Q: Do the same food restrictions apply as for the 25mg tablet?
Yes — exactly the same. The food, dairy, and supplement timing rules
apply equally at all doses. Taking it within 2 hours of food or within 4 hours
of dairy, calcium, iron, magnesium, or antacids dramatically reduces how much
of the medicine your body absorbs.
Q: How do I know if the dose needs to change?
Your haematologist will check your platelet count weekly when you first
start, and monthly once things are stable. Based on those results, they will
decide whether to increase, decrease, or maintain your current dose. Never
adjust the dose yourself — always wait for your haematologist's guidance.
Q: What happens if I accidentally take two doses in one day?
Contact your haematologist or pharmacist immediately. A double dose risks
pushing your platelet count too high, which increases clot risk. Your team may
arrange a blood test sooner than planned to check.
Q: How long will I need to take this medicine?
For chronic ITP, many patients take eltrombopag long-term, as long as it
is controlling the platelet count and side effects are manageable. Your
haematologist will review periodically whether it is still needed. Some
patients achieve a remission of their ITP and can stop; others require
ongoing treatment.