Interactions between Eltrombopag and Slow Fe
1 drug interaction and 13 additional warnings found for the following 2 drugs:
- eltrombopag
- Slow Fe (ferrous sulfate)
Drug interactions
Moderate drug interactions
Moderate:
ferrous sulfate eltrombopag
Applies to: Slow Fe (ferrous sulfate) and eltrombopag
Adjust dosing interval
Products containing aluminum, calcium, iron, magnesium, zinc and other polyvalent cations such as antacids or mineral supplements can significantly reduce the gastrointestinal absorption of eltrombopag due to chelation. In one clinical trial, administration of a single 75 mg dose of eltrombopag with an antacid containing 1524 mg aluminum hydroxide and 1425 mg magnesium carbonate resulted in an approximately 70% decrease in eltrombopag peak plasma concentration (Cmax) and systemic exposure (AUC).
Management
Eltrombopag should be taken on an empty stomach at least 2 hours before or 4 hours after oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution), aluminum, calcium, iron, magnesium, zinc or other polyvalent cations.
References (4)
- (2025) "Product Information. Promacta (eltrombopag)." Novartis Pharmaceuticals, FDA 41 (tablet); FDA
- (2022) "Product Information. Apo-Eltrombopag (eltrombopag)." Apotex Inc
- (2023) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals UK Ltd
- (2024) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals Australia Pty Ltd
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
ferrous sulfate Food/Lifestyle
Applies to: Slow Fe (ferrous sulfate)
Adjust dosing interval
Concomitant use of some oral medications may reduce the bioavailability of orally administered iron, and vice versa. Food taken in conjunction with oral iron supplements may reduce the bioavailability of the iron. However, in many patients intolerable gastrointestinal side effects occur necessitating administration with food.
Management
Ideally, iron products should be taken on an empty stomach (i.e., at least 1 hour before or 2 hours after meals), but if this is not possible, administer with meals and monitor the patient more closely for a subtherapeutic effect. Some studies suggest administration of iron with ascorbic acid may enhance bioavailability. In addition, administration of oral iron products and some oral medications should be separated whenever the bioavailability of either agent may be decreased. Consult the product labeling for specific separation times and monitor clinical responses as appropriate.
References (2)
- "Product Information. Feosol (ferrous sulfate)." SmithKline Beecham
- (2021) "Product Information. Accrufer (ferric maltol)." Shield Therapeutics
Moderate:
eltrombopag Food/Lifestyle
Applies to: eltrombopag
Adjust dosing interval
High-calcium foods may reduce the oral bioavailability of eltrombopag. In healthy volunteers, a standard high-fat breakfast that included dairy products significantly decreased eltrombopag peak plasma concentration (Cmax) by 65% and systemic exposure (AUC) by 59% and delayed Tmax by one hour. In another study, adult subjects administered a single 25 mg dose of eltrombopag for oral suspension with a high-calcium, moderate-fat, moderate-calorie meal exhibited a 79% decrease in Cmax and 75% decrease in AUC of eltrombopag. Administration of eltrombopag 2 hours after the high-calcium meal decreased eltrombopag Cmax by 48% and AUC by 47%, while administration 2 hours before the high-calcium meal decreased eltrombopag Cmax by 14% and AUC by 20%. Food low in calcium (< 50 mg calcium), regardless of calorie content, did not significantly impact plasma eltrombopag exposure.
Management
Eltrombopag should be taken 2 hours before or 4 hours after a meal containing high-calcium foods. Eltrombopag can be taken with a meal low in calcium (< 50 mg).
References (4)
- (2025) "Product Information. Promacta (eltrombopag)." Novartis Pharmaceuticals, FDA 41 (tablet); FDA
- (2022) "Product Information. Apo-Eltrombopag (eltrombopag)." Apotex Inc
- (2023) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals UK Ltd
- (2024) "Product Information. Revolade (eltrombopag)." Novartis Pharmaceuticals Australia Pty Ltd
Disease interactions
11 potential interactions Applies to: 11 conditions, including Peptic Ulcer, Cataract, Thrombotic/Thromboembolic Disorder, Liver Disease, and Noninfectious Colitis.
Achlorhydria
Moderate:
Slow Fe
The ferrous sulfate in Slow Fe has a moderate potential interaction with Achlorhydria.
Gastric acidity increases iron bioavailability by maintaining the ingested iron in a reduced form as ferrous ions, which are more readily absorbed than ferric ions. Therefore, when iron therapy is administered orally, higher dosages may be necessary for patients with decreased gastric acid production. Also, a liquid formulation is recommended in these patients because dissolution of the tablet coating depends on normal gastric acidity.
Blood Transfusion
Major:
Slow Fe
The ferrous sulfate in Slow Fe has a major potential interaction with Blood Transfusion.
There is no excretory mechanism for iron. Iron will correct only hemoglobin abnormalities due to iron deficiency and should not be used to treat conditions such as thalassemia, hemosiderosis, hemochromatosis, normocytic anemia (unless iron deficiency exists), or in patients receiving blood transfusions. Clinical monitoring of erythropoietic function and ferritin levels is recommended.
Cataract
Moderate:
eltrombopag
Eltrombopag has a moderate potential interaction with Cataract.
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.
Hemoglobinopathy
Major:
Slow Fe
The ferrous sulfate in Slow Fe has a major potential interaction with Hemoglobinopathy.
There is no excretory mechanism for iron. Iron will correct only hemoglobin abnormalities due to iron deficiency and should not be used to treat conditions such as thalassemia, hemosiderosis, hemochromatosis, normocytic anemia (unless iron deficiency exists), or in patients receiving blood transfusions. Clinical monitoring of erythropoietic function and ferritin levels is recommended.
History, Thrombotic/Thromboembolic Disorder
Moderate:
eltrombopag
Eltrombopag has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.
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).
Infectious Hepatitis
Major:
eltrombopag
Eltrombopag has a major potential interaction with Infectious Hepatitis.
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.
Liver Disease
Major:
eltrombopag
Eltrombopag has a major potential interaction with Liver Disease.
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.
Noninfectious Colitis
Moderate:
Slow Fe
The ferrous sulfate in Slow Fe has a moderate potential interaction with Noninfectious Colitis.
Iron can be irritating and damaging to gastrointestinal mucosa. Iron therapy should be administered cautiously in patients with peptic ulcer disease, enteritis, or ulcerative colitis.
Peptic Ulcer
Moderate:
Slow Fe
The ferrous sulfate in Slow Fe has a moderate potential interaction with Peptic Ulcer.
Iron can be irritating and damaging to gastrointestinal mucosa. Iron therapy should be administered cautiously in patients with peptic ulcer disease, enteritis, or ulcerative colitis.
Protein C Deficiency
Moderate:
eltrombopag
Eltrombopag has a moderate potential interaction with Protein C 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).
Thrombotic/Thromboembolic Disorder
Moderate:
eltrombopag
Eltrombopag has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.
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).
More resources
eltrombopag
A total of 218 drugs are known to interact with eltrombopag.
- Eltrombopag is in the drug class platelet-stimulating agents.
- Eltrombopag is used to treat the following conditions:
Slow Fe
A total of 89 drugs are known to interact with Slow Fe.
- Slow fe is in the drug class iron products.
- Slow fe is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.