Eltrombopag (Promacta®)

How to Take Eltrombopag

Eltrombopag is given in a pill or liquid form, taken once a day. You can take this medication without a meal, or with a meal that is low in calcium (less than 50mg total). Check nutrition labels for the amount of calcium. Take the tablets whole, do not crush, chew or break. If you are using the liquid form, you will receive instructions on how to prepare the dose. If you miss a dose, only take your next scheduled dose. Do not take two doses to make up for a missed dose.

It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.

Take eltrombopag without a meal or with a meal low in calcium. Certain foods and supplements can affect how your body absorbs eltrombopag and should not be eaten or taken for at least 2 hours before or 4 hours after taking the medication:

• Dairy products or calcium-fortified juices.
• Antacids (used for heartburn or as calcium supplements).
• Multivitamins or supplements that contain iron, calcium, aluminum, magnesium, selenium, or zinc.

Patients of East Asian ancestry or those with liver problems will be started at a lower dose due to the risk of liver toxicity. You will have lab work regularly to monitor your blood counts and liver function.

Tell your care team if you have a history of myelodysplastic syndrome (MDS).

Storage and Handling

Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw it in the trash.

Where do I get this medication?

This medication is available through a limited-access program. It is only available through registered pharmacies. Your care team will work to identify where you can fill this prescription.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources if they are available.

Possible Side Effects of Eltrombopag

There are a number of things you can do to manage the side effects of eltrombopag. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Liver Toxicity

This medication can cause liver toxicity, which your provider may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, you develop swelling or pain in your abdomen (belly), as these can be signs of liver toxicity.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole-grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Worsening of Platelet Count After Stopping the Medication

In clinical trials, some patients had lower platelet counts when the medication was stopped than they had before taking the medication. This side effect is most likely to happen shortly after stopping eltrombopag and may last about 1 month. This lower platelet count increases the risk of bleeding, so precautions should be taken, and any bruising or bleeding should be reported to your healthcare provider.

Vision Changes

Eltrombopag can cause new or worsened cataracts. Your healthcare provider may check your eyes before and during treatment. Symptoms of cataracts include cloudy, blurry, or dim vision, having a hard time seeing at night, sensitivity to light, or seeing halos around lights. Report any vision changes to your healthcare team.

Blood Clots

Your risk of developing a blood clot (DVT or PE) is higher while taking this medication. Symptoms can include swelling, redness or pain in an extremity (arm or leg) or shortness of breath. If you have any of these symptoms, call your provider right away or call 911.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Cough/Upper Respiratory Infection (URI)

This medication can cause a new or worsening cough and, at times, upper respiratory infections. An upper respiratory infection causes swelling or irritation in your upper airways. It can cause a runny nose, cough, and sore throat. Call your provider if you have any of these symptoms and for ways to manage a URI.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for 7 days after treatment is complete. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication and for 7 days after the last dose.