Drug Interactions between Copper and eltrombopag

Foods that are high in calcium may reduce the absorption and blood levels of eltrombopag. You should take eltrombopag 2 hours before or 4 hours after a meal containing high-calcium foods. Eltrombopag may be taken with meals that are low in calcium (< 50 mg calcium), including fruit, lean ham, beef and unfortified (no added calcium, magnesium, or iron) fruit juice, unfortified soy milk, and unfortified grain. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Eltrombopag has shown to increase the risk of hepatic decompensation in patients with chronic hepatitis C in treatment with interferon and ribavirin. Clinical trials reported that ascites and encephalopathy occurred more frequently on these patients than in the placebo arm. Patients with chronic hepatitis and receiving antiviral treatment should be closely monitored. The manufacturers also recommend to discontinue eltrombopag if the antiviral therapy is discontinued.

Eltrombopag can cause liver enzyme elevations. Monitor ALT, AST and bilirubin prior to treatment initiation, and every 2 weeks during dose adjustment phase and then monthly. If abnormalities are confirmed, monitor serum liver tests weekly until resolved or stabilized. Treatment should be discontinued if ALT levels increase to greater than or equal to 3 x ULN in patients with normal liver function, or greater or equal to 3 x baseline in patients with pretreatment transaminase elevations that are progressively increasing, persist for 4 weeks or more, also have an increase in bilirubin, or also have clinical symptoms of liver injury or hepatic decompensation.

Hepatic impairment influences the exposure to eltrombopag. The initial dose should be reduced in patients with chronic ITP or severe aplastic anemia who have hepatic impairment. No dose adjustment is required on patients with chronic hepatitis C and hepatic impairment.

The trace elements, copper and manganese, are excreted in the bile. Copper and manganese doses may need to be adjusted, reduced, or omitted in patients with liver disease or biliary obstruction.

In clinical trials, eltrombopag developed or worsened cataracts in 7% of the patients receiving treatment. A baseline ocular examination prior to administration of eltrombopag is recommended, and regular monitoring for signs and symptoms of cataracts should be performed regularly during treatment.

Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).

The trace elements, copper and manganese, are excreted in the bile. Copper and manganese doses may need to be adjusted, reduced, or omitted in patients with liver disease or biliary obstruction.

The trace metals manganese, chromium, copper, selenium, and zinc are absorbed in the GI tract from dietary sources and following administration of oral supplements. GI absorption may be decreased in patients with malabsorption syndromes. Therefore, larger dosages may be required when these supplements are given orally. Parenteral administration may be appropriate.

Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).

Thromboembolic complications may result from increases in platelet counts with TPO receptor agonists such as avatrombopag, lusutrombopag, and eltrombopag. Consider the potential for increased risk of thromboembolism when administering these medications to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210 A, Antithrombin deficiency or Protein C or S deficiency).