Question: Dear Dr DE

Thank you for your advice to my previous thread http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=199680

     You advised earlier that the maximum dosage of promacta is 75 mg for people with east asian origin. But according to this document (re. section 2.3, the maximum dosage for severe aplastic anemia for East Asians should also be 150 mg (the initial dose for East Asian should be 25 mg daily, instead of 50 mg daily).
http://www.nejm.org/doi/suppl/10.1056/NEJMoa0000/suppl_file/nejmoa0000_protocol.pdf

I am confused. Which should be the maximum dosage for SAA patients of East Asian origin? 75 mg or 150 mg daily?


     You advised earlier that “I year and above use causes chromosome changes” and that my niece “should continue the medicine at 75 mg for another 11 months” (i.e. total 18 months). My niece has been on eltrombopag for 8 months. If she is to try for over one year, this would likely cause chromosome changes in my niece? What is the probability of chromosome change for Promacta use of more than a year? We are very worried about chromosome change.

     You advised earlier that “with 75 mg dosage noticeable improvement are seen”. My niece has been on 75 mg for 3.5 months since late March. Our doctor suggest stopping eltrombopag because no noticeable improvement is seen. According to your experience, Is 75 mg a dosage likely or unlikely to yield noticeable improvements? What is the usual dosage at which signs of noticeable improvements can be seen? In your opinion, should my niece continue trying eltrombopag and increase the dosage up to 150 mg? or should she continue to stay on 75 mg?


Would appreciate your expert advice.

Best Regards,