Specialty Pharmacy Services

Eltrombopag (Promacta)

Oral Tablet · Once Daily · Low-Calcium Meal or Empty Stomach

Promacta (eltrombopag) is a specialty thrombopoietin receptor agonist (TPO-RA) used to stimulate platelet production in patients with chronic immune thrombocytopenia (ITP), severe aplastic anemia (SAA), and thrombocytopenia associated with chronic hepatitis C. Accord Specialty Pharmacy provides Promacta with prior authorization support, copay assistance coordination, and doorstep delivery.

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Drug at a Glance

Drug Class Thrombopoietin Receptor Agonist (TPO-RA)
Generic Name Eltrombopag
Brand Name Promacta®
Route Oral tablet, once daily
Manufacturer Novartis (brand Promacta) / Teva (Alvaiz, generic)

Clinically Reviewed By · Accord Clinical Team, PharmD, RPh

Eltrombopag (Promacta) at a Glance

Feature	Eltrombopag (Promacta)
Generic Name	Eltrombopag
Brand Name	Promacta®
Drug Class	Thrombopoietin Receptor Agonist (TPO-RA)
FDA Approved For	Chronic ITP, severe aplastic anemia, hepatitis C thrombocytopenia
FDA Approved (Year)	2008 (chronic ITP) · 2012 (hepatitis C) · 2014 (severe aplastic anemia)
Approved Population	Adults · pediatric 1+ years (ITP) · pediatric 2+ years (SAA)
Dosage Form	Tablet, oral suspension
Administration	Once daily, without food or with a low-calcium meal
Available Generic	Yes (Teva Alvaiz)
Specialty Pharmacy Required	Often required by insurance
Prior Authorization	Frequently required
Copay Assistance Available	Yes, for eligible commercially insured patients
Home Delivery	Available through Accord Specialty Pharmacy

FDA-Approved Uses

What Is Promacta Approved to Treat?

Promacta (eltrombopag) is FDA-approved for three distinct indications involving low platelet counts from different underlying causes.

Immune Thrombocytopenia

ITP

Chronic ITP is an autoimmune condition in which the immune system destroys platelets, leading to low platelet counts and an increased risk of bleeding. Promacta is approved for adults and children 1 year and older with chronic ITP who have had an insufficient response to other therapies.^1,2

Chronic immune-mediated destruction of platelets
Approved for adults and pediatric patients (age 1+)
For patients with insufficient response to prior treatment

Severe Aplastic Anemia

SAA

Severe aplastic anemia is a rare, life-threatening condition in which the bone marrow fails to produce enough blood cells. Promacta is approved in combination with standard immunosuppressive therapy (IST) as a first-line treatment, and as a single agent for patients with refractory or relapsed SAA.^1,3

Bone marrow failure resulting in low blood cell counts
First-line use: in combination with immunosuppressive therapy (adults and pediatric patients 2 years and older who have not previously received IST)
Also approved for refractory or relapsed SAA as a single agent

Thrombocytopenia in Hepatitis C

HCV

Chronic hepatitis C infection can suppress platelet production, and low platelet counts can prevent patients from receiving antiviral treatment. Promacta is approved to raise platelet counts in adults with chronic hepatitis C and thrombocytopenia, allowing initiation or maintenance of interferon-based therapy.^1,4

Low platelets caused by chronic hepatitis C infection
Enables patients to begin or continue antiviral therapy
Used with peginterferon and ribavirin-based regimens

Your prescriber is the right person to discuss which diagnosis applies to your situation and whether Promacta is appropriate for you. Learn more about immune thrombocytopenia (ITP) from MedlinePlus ↗, or read about Oncology specialty pharmacy services →

How Promacta Works

Promacta works by binding to the thrombopoietin (TPO) receptor on platelet precursor cells in the bone marrow, triggering them to mature and divide. Unlike IV therapies such as IVIg or platelet transfusions, Promacta addresses low platelet counts from within the body's own production system.

In chronic ITP, the immune system mistakenly destroys platelets. Rather than directly suppressing this immune response, Promacta compensates by stimulating the bone marrow to produce more platelets. This makes it useful as a second-line option when other treatments have not provided adequate control.

In severe aplastic anemia, eltrombopag appears to stimulate hematopoietic stem cells more broadly — not just megakaryocytes (platelet-producing cells). This helps restore production of red and white blood cells as well as platelets, which is why it is used alongside immunosuppressive therapy in first-line SAA treatment.

An important practical note: calcium, dairy foods, iron, zinc, and antacids can bind eltrombopag in the gut and significantly reduce absorption. Take Promacta at least 2 hours before or 4 hours after any of these, and take your dose at a consistent time each day.² Oncology specialty pharmacy services →

Promacta Side Effects and Monitoring

Like all medications, Promacta can cause side effects, and which effects are most relevant can depend on which condition it is treating — the side effect profile reported in clinical trials differs somewhat between chronic ITP, severe aplastic anemia, and hepatitis C-associated thrombocytopenia. The information below covers commonly reported effects and important safety considerations, but it is not a complete list. Review the full prescribing information with your care team.

Promacta carries an FDA Boxed Warning, the agency's most serious safety warning, for the risk of severe liver injury. This is covered in detail below. If anything concerns you while taking Promacta, call Accord's pharmacy team at 1-855-222-6730.

Most Common

Commonly Reported Effects^2,3

Nausea — Often mild; taking Promacta at a consistent time each day may help.
Headache — Reported frequently in clinical trials, particularly during the first few weeks of treatment.
Diarrhea — Usually mild. Stay well hydrated. Let your care team know if it is severe or persistent.
Fatigue — Discuss with your prescriber if tiredness affects daily activities.
Upper respiratory infection — Cold-like symptoms have been reported in clinical studies.
Increased platelet count (thrombocytosis) — Regular monitoring helps your care team adjust the dose as needed.

FDA Boxed Warning

Hepatotoxicity²

Liver injury (hepatotoxicity) — Promacta carries an FDA Boxed Warning, the agency's most serious warning category, for the risk of severe and potentially life-threatening liver injury. Liver function tests are checked before starting and monitored regularly. Tell your prescriber right away if you notice yellowing of the skin or eyes, dark urine, or right-sided abdominal pain.
Hepatic decompensation in hepatitis C — This is also part of the FDA Boxed Warning. In patients with hepatitis C taking Promacta alongside interferon and ribavirin, liver function must be monitored especially closely, as this combination can increase the risk of serious liver complications.

Monitoring Required

Vision and Lab Monitoring^2,3

Cataracts — A baseline eye exam is recommended before starting Promacta, with regular follow-up exams during therapy to monitor for cataracts.
Increased bilirubin — Elevated bilirubin levels have been observed. Typically caught through routine lab monitoring, alongside liver function testing.

Serious Warnings

Other Serious Warnings²

Blood clots (thromboembolism) — Seek emergency care immediately if you experience sudden leg pain, swelling, chest pain, or difficulty breathing.
Bone marrow fibrosis — Your prescriber will monitor for bone marrow changes, particularly during extended treatment for aplastic anemia.
Worsening of myelodysplastic syndromes — Promacta is not approved for MDS or AML and may cause disease progression in patients with these conditions.

Prior Authorization for Promacta

Promacta commonly requires prior authorization before a health plan will cover it. Our team assists with the enrollment process from the start and can follow up with your prescriber or insurer on your behalf.

When Accord receives your referral, we contact your prescriber's office to gather what the insurance plan requires, submit the prior authorization request, and follow up proactively to keep things moving. If your plan issues a denial, we work alongside your prescriber to build a formal appeal with the additional clinical documentation needed to support your case. Information for prescribers →

Prior Authorization Process

PA Request Submitted

Your prescriber submits a prior authorization request including your diagnosis, platelet count history, and prior treatment history.

ITP Documentation

For ITP, insurers typically require documentation that other therapies (such as corticosteroids, IVIG, or rituximab) were tried first.

SAA Documentation

For SAA, documentation of bone marrow biopsy results and treatment plan is usually required.

Appeal if Denied

If the initial request is denied, our team can help identify the grounds and assist with an appeal or peer-to-peer review.

Note on appeals: A denial is not necessarily final. Many initially denied requests for Promacta are approved on formal appeal. Our team manages this process alongside your prescriber at no additional burden to your care team.

Promacta Cost: Financial Assistance Options

The list price of Promacta rarely reflects what patients actually pay. Several programs can help reduce your out-of-pocket cost significantly. Our team works through all available options before your first fill.

Commercially Insured

Novartis Universal Co-Pay Card

$0 per month, as low as (up to $15,000/calendar year)

Commercially insured patients may pay as little as $0 per month through the Novartis Universal Co-Pay Card. The card is available for both brand Promacta and for patients on Novartis-covered products. Our team assists with the enrollment process.⁵

Generic Option

Generic Eltrombopag (Teva Alvaiz)

Lower Cost FDA-approved bioequivalent alternative

Teva's Alvaiz is an FDA-approved eltrombopag product, but it uses a different salt form (eltrombopag choline) than brand Promacta (eltrombopag olamine), with different tablet strengths. It is not automatically substitutable with Promacta on a milligram-for-milligram basis, so pharmacies and insurance systems may handle it differently. Ask our team about availability.

Uninsured / Underinsured

Novartis Patient Assistance (PANO)

$0 for eligible patients who meet income guidelines

The Novartis Patient Assistance Now Oncology (PANO) program provides Promacta at no cost to eligible uninsured or underinsured patients, with a dedicated case manager guiding enrollment. Ask our team or PANO directly about bridge or urgent-need options if you are waiting on an insurance decision.⁵

Medicare Part D

2026 Out-of-Pocket Cap

$2,100 annual out-of-pocket maximum under the IRA

Medicare Part D patients benefit from the $2,100 annual out-of-pocket cap under the Inflation Reduction Act. Independent charitable foundations may also provide supplemental assistance. Our team can help identify foundations currently accepting applications.

Not sure which program applies to you? Call 1-855-222-6730 or contact us online. Our team identifies programs and helps connect you to every option you may qualify for.

Starting Treatment

What to Expect on Promacta

Timing Your Dose

Take Promacta once daily without food or with a meal low in calcium. Calcium, dairy, antacids, iron, and zinc can significantly reduce absorption — take Promacta at least 2 hours before or 4 hours after any of these.

Platelet Monitoring

Your platelet count will be checked regularly, especially during the first few weeks as your dose is adjusted. The goal is to reduce bleeding risk — not necessarily normalize the count.

Dose Adjustments

Your prescriber will adjust your dose based on your platelet response. Starting doses vary by indication. Do not change your dose without guidance from your prescriber.

Ongoing Lab Monitoring

Liver function tests and complete blood counts are monitored on a regular schedule. Eye exams may be recommended periodically. Keep all scheduled lab and follow-up appointments.

Accord Supports You

Our pharmacy team coordinates your refills and is available to answer questions throughout treatment. Call us at 1-855-222-6730 or contact us online anytime.

Have Questions About Promacta?

Ask a Specialty Pharmacist

Frequently Asked Questions About Promacta

How long does it take for Promacta to raise my platelet count?

Most patients see a response within 1 to 2 weeks of starting Promacta, though the full effect may take longer. Platelet counts are typically checked weekly during the initial dose-finding period. If your count has not responded after the maximum dose is reached and sustained for several weeks, your prescriber may consider stopping the medication.

What foods and supplements should I avoid while taking Promacta?

Calcium, dairy products, antacids containing aluminum, magnesium, or calcium, and supplements containing iron, zinc, or selenium can significantly reduce how much Promacta your body absorbs. Take Promacta at least 2 hours before or 4 hours after any of these.² Our pharmacy team can review your current supplements and medications for potential interactions.

How is Promacta different from Nplate (romiplostim)?

Both Promacta and Nplate are thrombopoietin receptor agonists approved for chronic ITP. The key difference is the route of administration: Promacta is an oral tablet taken daily, while Nplate is a weekly subcutaneous injection. Your prescriber will recommend one based on your individual situation.

Can Promacta be used for aplastic anemia? I thought it was only for low platelets.

Promacta's role in severe aplastic anemia goes beyond simply raising platelet counts. Research has shown that eltrombopag can stimulate pluripotent hematopoietic stem cells in the bone marrow, helping to restore production of red blood cells and white blood cells as well as platelets.

Is the generic Alvaiz exactly the same as Promacta?

Not exactly. Alvaiz uses a different salt form (eltrombopag choline) than brand Promacta (eltrombopag olamine), with different tablet strengths, and it is not automatically substitutable with Promacta on a milligram-for-milligram basis. Some pharmacy and insurance systems may not recognize it as directly interchangeable with Promacta as a result. Our pharmacy team can help clarify what applies to your prescription.

What liver monitoring is needed while on Promacta?

Liver function tests are recommended before starting Promacta and at regular intervals during treatment. Tell your care team right away if you notice yellowing of your skin or eyes, dark urine, pain in the upper right abdomen, or unusual fatigue.

What happens when Promacta is stopped?

When Promacta is discontinued, platelet counts typically fall back toward pre-treatment levels within 1 to 2 weeks. This rebound can increase bleeding risk. Do not stop taking Promacta without discussing a tapering plan with your prescriber.

What does the FDA Boxed Warning on Promacta mean?

A Boxed Warning is the FDA's most serious category of drug warning. For Promacta, it covers the risk of severe, potentially life-threatening liver injury, and, in patients with hepatitis C, an increased risk of liver complications when Promacta is combined with interferon-based antiviral therapy.² A Boxed Warning does not mean Promacta is unsafe to use, but it does mean liver function needs to be monitored closely throughout treatment. Your prescriber and our pharmacy team both track this as part of routine care.

Is Promacta available in a form other than tablets, for children or patients who have trouble swallowing?

Yes. Promacta is also available as an oral suspension, which can be mixed and measured to the exact prescribed dose. This is often used for younger pediatric patients or anyone who has difficulty swallowing tablets. Ask your prescriber or our pharmacy team whether the oral suspension is a good fit.

What should I do if I miss a dose of Promacta?

If you miss a dose, take it as soon as you remember that day. Do not take two doses at the same time or take extra doses to make up for a missed one. If you are not sure what to do, or if you have missed more than one dose, call our pharmacists at 1-855-222-6730 or check with your prescriber.

For Patients

Ready to Get Started?

Our team coordinates everything — insurance verification, prior authorization, financial assistance, and delivery. Call us or ask your prescriber to send a referral, and we take it from there.

Call 1-855-222-6730

For Prescribers

Refer a Patient to Accord

Send a referral or e-prescribe to Accord Specialty Pharmacy. We contact the patient, coordinate PA, and keep you informed throughout.

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References (5)

Promacta (eltrombopag) Prescribing Information. Novartis Pharmaceuticals Corporation. DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov
Promacta (eltrombopag) Full Prescribing Information. Novartis Pharmaceuticals Corporation. novartis.com
Cheng G, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet. 2011;377(9763):393-402. pubmed.ncbi.nlm.nih.gov
Afdhal NH, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. N Engl J Med. 2012;367(8):716-724. pubmed.ncbi.nlm.nih.gov
Novartis Pharmaceuticals Corporation. Promacta Cost Assistance and Patient Support Programs. promacta.com