Thrombopoietin receptor agonist (TPO-R)
ATC code: B02BX05 (Eltrombopag)
Brand names
Revolade, Promacta, Eltrombopag Cipla
A small-molecule non-peptide thrombopoietin receptor (TPO-R) agonist – binds the receptor transmembrane domain, unlike endogenous thrombopoietin (extracellular domain). Activates JAK/STAT signaling in bone marrow megakaryocytes, stimulating proliferation and differentiation into platelets. Compared with peptide TPO agonists (romiplostim, injections), available orally – daily administration.
Second line
Second-line for chronic immune thrombocytopenia in adults and children over 1 year after steroid and splenectomy failure or splenectomy contraindication per ASH 2019 and the Spanish SEHH 2023. Adult starting dose 50 mg once daily, titrated to 75 mg daily. RAISE and the EXTEND long-term extension maintained platelets above 50×10⁹/L in 60–80% of patients.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Eltrombopag is a thrombopoietin receptor agonist. It is prescribed for chronic immune thrombocytopenia, aplastic anemia, and thrombocytopenia associated with chronic hepatitis C (AEMPS Ficha Técnica). In alt-anti-aging circles, eltrombopag is occasionally promoted for general platelet boost and immunity in healthy people. In healthy adults, no clinical studies of such use exist. The drug has serious risks: hepatotoxicity (requires regular liver enzyme monitoring), thromboembolic events (paradoxically, with excessive platelet elevation), cataract, and myelodysplastic changes in some patients. If eltrombopag was recommended to a healthy person, seek a second opinion immediately.
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Boxed warning
FDA boxed warning: hepatotoxicity, sometimes fatal. Monitor liver enzymes and bilirubin before start, every 2 weeks for the first month, then monthly.
Contraindicated. Reliable contraception is required in women of reproductive age.
Contraindicated during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Eltrombopag is evaluated for the following indications with varying evidence strength: Immune thrombocytopenia (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Eltrombopag (≥ 1 in 100): Headache, Nausea, Diarrhea, Fatigue, Elevated ALT and bilirubin. See the Safety section for uncommon and serious reactions.
FDA category C. Contraindicated. Reliable contraception is required in women of reproductive age.
Contraindicated during lactation.
Eltrombopag is contraindicated in: Eltrombopag hypersensitivity; Severe hepatic impairment; Pregnancy and lactation; Age under 1. Full list in the Safety section.
FDA boxed warning: hepatotoxicity, sometimes fatal. Monitor liver enzymes and bilirubin before start, every 2 weeks for the first month, then monthly.