Promacta / Revolade (eltrombopag) & hidden calcium

So I've been taking Promatca for a couple of years and do very well with it. Over the last 18 months, I've been losing a lot of weight under a doctors supervision on a Protein Sparing Modified fast which doesn't allow milk, breads, sugars, fats, flavoring, etc. The plan calls for 120 days on, then a 3 week break. We've identified a pattern where my counts drop towards the end of the break, so we've been thinking food allergies / intolerances, etc. I was at 23K two days ago, but since no symptoms, holding the dose and a retest next week.

I got a call yesterday from the office after they had had a visit from the GSK drug reps. They had mentioned my case and the reps got funny smiles on their faces and she asked what was up. They had a new Pamphlet on meal planning and Promacta. I'll pick it up when I go in next week, but they read the information to me over the phone and I did some web surfing.

www.promacta.com/assets/pdf/PTA487R0_Meal_Planner_Download.pdf
www.promacta.com/assets/pdf/PTA676R0.pdf

Now, I thought I'd been following the guidelines well. Take on an empty stomach (1 hour before or 2 after a meal) and avoid calcium for 4 hours before and after. So I take mine first thing in the morning and don't eat for an hour. Then no dairy products, vitamins or minerals for 4 hours.

Well, the info started me to doing a bit more label reading and research
- Green smoothies with almond milk for breakfast
Kale and Spinach are high in calcium
I read the label of my almond milk, it says high in calcium
- Coffee with non-dairy creamer
label says "has milk derivatives"
- Tea flavored with nuts starting mid morning
- "Fortified" protein powders, breads and cereals
The list of minor things that go beyond dairy products goes on and adds up....

So, I'm diligently reading labels and rethinking what my breakfasts and morning snacks contain and we'll see what the blood test says next week.

I've been hypothyroid for years. Prescription thyroid hormone has the same requirements as Promacta ... Empty stomach 4-6 apart from calcium and iron supplements or estrogen drugs. The problem is that the hormone binds to the calcium and can't be absorbed from the gut when bound. I don't know, but must assume, it's the same for Promacta.

I've done much research about T. hormone and calcium. I found that calcium carbonate in supplemental form is the primary culprit, and that dietary calcium is not that much of an issue. I found one study that found calcium carbonate specifically is more problematic than either cal citrate or cal aspartate. I take my hormone, immediately have coffee with non-dairy creamer, and wait an hour to eat. Breakfast will often be cereal with milk. I always wait at least 4 hours for my first calcium citrate tablet of the day. The creamer and milk have never affected my thyroid levels; my dose has been the same for more than 10 years.

Of course, I haven't had need to read up on Promacta and calcium interaction. I can only report what I've learned and done with my thyroid hormone.
For what it's worth.

bunnie,

I wish I could remember who it was but someone was very curious about foods and Promacta on here a few weeks ago. Hopefully they will read your post! Thanks for sharing!

I'm also have Hashimoto's (hypothryroid) and take my Thyroid meds and Promatca at the same time and haven't noticed any significant changes in my TSH when I change the diet, but the platelets have varied far more. Promacta may be more sensitive than the thyroid drugs. If you see the links above to the new phamplets from GlaxcoSmithKline, they definitely outline foods in addition to supplements to avoid 4 hours before and after.

7 DRUG INTERACTIONS

In vitro, CYP1A2, CYP2C8, UDP-glucuronosyltransferase (UGT)1A1 and UGT1A3 are involved in the metabolism of eltrombopag. In vitro, eltrombopag inhibits the following metabolic or transporter systems: CYP2C8, CYP2C9, UGT1A1, UGT1A3, UGT1A4, UGT1A6, UGT1A9, UGT2B7, UGT2B15, OATP1B1 and breast cancer resistance protein (BCRP) [see Clinical Pharmacology (12.3)].

7.1 Polyvalent Cations (Chelation)
Eltrombopag chelates polyvalent cations (such as iron, calcium, aluminum, magnesium, selenium, and zinc) in foods, mineral supplements, and antacids. In a clinical trial, administration of PROMACTA with a polyvalent cation-containing antacid decreased plasma eltrombopag systemic exposure by approximately 70% [see Clinical Pharmacology (12.3)].

PROMACTA must not be taken within 4 hours of any medications or products containing polyvalent cations such as antacids, dairy products, and mineral supplements to avoid significant reduction in PROMACTA absorption due to chelation [see Dosage and Administration (2.3)].

Thank you for sharing all that you've found.
There isn't any Promacta in my immediate future, but it's not out of the realm of possibility.
It's not a bad idea for any of us to know everything there is to about taking it correctly.

Wishing you lots of platelets next week.

Could be coincidence or not, but count has risen over 50K in 6 days after I started paying more attention to what I eat within the 4 hour window. With a count of 87K and no bleeding symptoms last week, I'm not scheduled for another test for 4 weeks.

Since I typically take my Thyroid meds and Promatca first thing when I get up, the spinach omelets, leafy green smoothies, and fortified protein shakes are now off the breakfast menu and I'm going to have to be more diligent in reading labels for foods within the 4 hours before or after before taking the drugs. I've discovered coffee is okay with the SoDelicious Coconut milk creamer if you add a little sugar-free hazelnut syrup. It gets me through having the first cup of the day and I can enjoy my standard fix in the afternoon

If the Promacta is this sensitive, the empty stomach rule (1 hour before or 2 after) is probably also something to stay diligent with.