Alvaiz (eltrombopag) is a thrombopoietin receptor agonist used to raise low platelet counts in people with persistent or chronic immune thrombocytopenia (ITP). Like all medicines, it can cause side effects. Alvaiz also has a boxed warning, the FDA’s strongest type of warning, about the risk of liver damage. This article covers the common and serious side effects reported in Alvaiz clinical studies, along with practical tips for managing them and knowing when to call your health care provider.
This isn’t a complete list of every possible side effect. Tell your health care provider about any symptom that concerns you or doesn’t go away, even if it’s not listed here.
Common Side Effects of Alvaiz
- Nausea
- Diarrhea
- Headache
- Fatigue or tiredness
- Muscle or joint aches
- Low red blood cell count (anemia)
- Abnormal liver blood test results
- Fever
- Cough
Serious Side Effects of Alvaiz
- Liver damage
- Blood clots
- New or worsening cataracts
- A drop in platelet count and higher bleeding risk after stopping Alvaiz
If you have symptoms that feel serious or life-threatening, seek medical care right away.
How to Manage Alvaiz Side Effects
Liver problems
Alvaiz carries a boxed warning that it may increase the risk of severe, potentially life-threatening liver damage (hepatotoxicity). In clinical studies of people with ITP, about 1 in 100 people treated with eltrombopag developed drug-induced liver injury, and liver blood test changes (usually mild to moderate) were reported in about 11% of adults on eltrombopag, compared with 7% on a placebo.
Signs of a possible liver problem include:
- Yellowing of your skin or the whites of your eyes (jaundice)
- Unusually dark urine
- Unusual tiredness
- Pain in the upper right area of your stomach
- Confusion
- Swelling in your stomach area
Your health care provider will check your liver health with blood tests before you start Alvaiz, every two weeks while your dose is being adjusted, and monthly once your dose is stable. Keep every one of these appointments, even if you feel fine, because liver changes don’t always cause symptoms early on. Contact your health care provider right away if you notice any of the signs above. Depending on your results, they may order repeat testing, adjust your dose, or pause or stop Alvaiz. If your liver tests improve after stopping the medicine, your provider may consider carefully restarting Alvaiz at a later time, with closer monitoring, but liver problems can happen again if you restart.
Blood clots (thrombotic or thromboembolic events)
Raising your platelet count can raise your risk of a blood clot, including clots in your legs (deep vein thrombosis), the lungs (pulmonary embolism), or the veins around your liver (portal vein thrombosis), as well as clots that can lead to a heart attack or stroke. This risk isn’t limited to people with very high platelet counts; clots have also occurred in people with normal or even low platelet counts while on eltrombopag. In clinical studies across several eltrombopag ITP trials, thromboembolic events were reported in about 6% of people treated with eltrombopag but in none of the people on a placebo.
Watch for:
- Swelling, pain, redness, or warmth in one leg
- Sudden shortness of breath or chest pain
- Sudden numbness or weakness on one side of your body, trouble speaking, or vision changes
- Stomach pain, nausea, vomiting, or diarrhea (possible signs of a clot in the veins around your liver)
If you have any of these symptoms, get medical care right away. To help lower your risk, your health care provider will use the lowest Alvaiz dose that keeps your platelets in a safe range, rather than trying to get your platelet count all the way to normal. Tell your health care provider if you have a personal or family history of blood clots or clotting disorders because they may need to watch you more closely.
New or worsening cataracts
A cataract is a clouding of the lens in your eye that can blur your vision. In the main placebo-controlled ITP studies, cataracts developed or got worse in 7% of adults treated with eltrombopag, about the same rate as those on a placebo (also 7%). Nearly all of the people who developed cataracts already had other risk factors, most often long-term corticosteroid use, which many people with ITP also take.
Your health care provider will check your eyes before you start Alvaiz and monitor them regularly during treatment. Tell your health care provider if you notice blurry vision, glare or halos around lights, or any other change in your eyesight. They can check whether it’s related to a cataract and decide if any changes to your treatment are needed.
Bleeding risk if you stop Alvaiz
Alvaiz doesn’t cure ITP; it helps manage the low platelet count while you’re taking it. If you stop taking Alvaiz, your platelet count can drop back down, and your bleeding risk can go up again, generally within one to two weeks. This risk is higher if you’re also taking a blood thinner or an antiplatelet medicine when you stop.
Don’t stop taking Alvaiz on your own, even if you’re feeling well or your platelet count looks good. If your health care provider does have you stop, they’ll likely want to check your blood counts weekly for at least four weeks afterward. During that time, avoid activities or medicines (such as aspirin or NSAIDs) that could raise your bleeding risk, unless your provider says otherwise, and let them know right away about any new or unusual bruising or bleeding.
Nausea, diarrhea, and vomiting
Digestive symptoms such as nausea, diarrhea, and vomiting are among the most commonly reported side effects of Alvaiz in clinical studies. Nausea is the feeling that you might throw up, though it doesn’t always lead to vomiting, and diarrhea means looser or more frequent stools than usual.
Mild symptoms often improve as your body adjusts to the medicine. These tips may help:
- Eat smaller, more frequent meals instead of a few large ones.
- Choose bland foods such as crackers, rice, toast, or bananas.
- Avoid greasy, spicy, or high-fat foods, and limit caffeine and alcohol.
- Sip water or another clear liquid throughout the day to help prevent dehydration.
- Ask your health care provider or pharmacist whether an over-the-counter (OTC) anti-nausea or antidiarrheal medicine is safe for you to try.
Call your health care provider if these symptoms are severe or don’t improve or you notice signs of dehydration, such as a very dry mouth, dizziness, or dark urine.
Headache and fatigue
Headache and fatigue (feeling unusually tired or weak) were among the most common side effects reported by adults taking eltrombopag long-term for ITP, affecting roughly 1 in 10 or more participants in the open-label extension study.
To help manage headaches:
- Rest in a quiet, dark room if needed.
- Stay well hydrated, and try to keep a regular sleep schedule.
- Ask your health care provider or pharmacist if an OTC pain reliever is safe for you before taking one.
To help manage fatigue:
- Keep a regular sleep schedule, and get plenty of rest.
- Stay physically active with light activity, such as walking, when your health care provider says it’s safe.
- Plan more demanding tasks for times of day when your energy tends to be higher.
Tell your health care provider if headaches or fatigue are severe, don’t improve, or start to interfere with your daily life.
If you notice a side effect that isn’t listed here or that feels severe or doesn’t go away, contact your health care provider. They may be able to suggest ways to manage it or, if needed, adjust your Alvaiz dose or treatment plan.