Eltrombopag Can Be Given During Active Infection
Yes, eltrombopag can be administered to patients with active infection, as infection is not listed as a contraindication in clinical guidelines, and upper respiratory tract infections and urinary tract infections were among the most common adverse events observed in clinical trials without requiring treatment discontinuation. 1
Evidence from Clinical Trials
The safety profile of eltrombopag in large clinical trials demonstrates that infections occurred commonly but were manageable:
- Upper respiratory tract infection and urinary tract infection were among the most frequent adverse events (≥5% and greater than placebo) in adult ITP patients treated with eltrombopag 1
- These infections did not lead to systematic treatment discontinuation or represent contraindications to therapy 1
- The occurrence of infections during eltrombopag treatment was documented without special warnings against initiating or continuing therapy in infected patients 1
Key Safety Considerations That Actually Matter
While infection itself is not a contraindication, you must monitor for these serious risks:
Hepatotoxicity Risk
- Eltrombopag definitively causes hepatobiliary laboratory abnormalities and hepatotoxicity, with increased ALT occurring in approximately 5-13% of patients 2
- Use with extreme caution in patients with preexisting liver disease, requiring close monitoring of liver function tests 1, 2
- This is particularly relevant if the infection involves hepatitis or if the patient has underlying liver disease 1, 2
Thrombotic Risk
- Thrombosis is a treatment-related serious adverse event that requires monitoring for signs of thromboembolism 3
- Exercise caution in patients with preexisting thrombotic risk factors 1
- The risk of portal vein thrombosis has been specifically noted with eltrombopag 1
Practical Monitoring Algorithm
Weekly platelet monitoring until counts stabilize 1
Regular liver function test monitoring throughout therapy 3, 2
Clinical surveillance for thrombotic events, especially in high-risk patients 1, 3
Clinical Context Matters
The decision to use eltrombopag during infection depends on the underlying indication:
- For ITP patients requiring platelet support during infection, continue or initiate eltrombopag as clinically indicated 1
- For hepatitis C-associated thrombocytopenia, eltrombopag is specifically approved to enable antiviral therapy initiation 1, 4, 5
- For severe aplastic anemia refractory to immunosuppressive therapy, add eltrombopag to supportive care with response rates of 40-48% 3
Common Pitfall to Avoid
Do not confuse the occurrence of infections as adverse events in clinical trials with infections being contraindications to therapy. The fact that respiratory and urinary tract infections were documented adverse events means they occurred during treatment but did not preclude eltrombopag use 1. The actual contraindications relate to hepatotoxicity risk in liver disease patients and thrombotic risk in predisposed individuals 1, 2.