The short answer
Yes, aluminum-containing products reduce eltrombopag absorption, and the label tells you to take eltrombopag at least 2 hours before or 4 hours after them. In healthy volunteers an antacid containing aluminum hydroxide and magnesium carbonate cut eltrombopag exposure by about 70%. Aluminum was tested only inside that combination antacid, but the label applies the same rule to every aluminum-containing product.
What this answer covers
Aluminum as an ingredient of antacids, buffered aspirin and mineral or clay products taken by mouth, with eltrombopag tablets or oral suspension. Elemental aluminum is not a nutrient supplement; the tested form was aluminum hydroxide.
- Supplement or preparation
- aluminum
- Medication ingredient
- eltrombopag
What the label establishes
Eltrombopag binds polyvalent cations, and the label names aluminum among them. It directs patients to take eltrombopag at least 2 hours before or 4 hours after antacids, mineral supplements and other products containing these cations to avoid a significant loss of absorption. The Medication Guide repeats the instruction in plain language.
The study behind the warning
In a crossover study of 26 healthy adults, a single 75 mg eltrombopag dose taken with an antacid providing 1,524 mg aluminum hydroxide and 1,425 mg magnesium carbonate reduced total exposure and peak level by about 70% compared with fasting. The antacid also contained sodium alginate, and the label says its contribution is unknown, so the result cannot be split between aluminum and magnesium.
Which aluminum products this covers
Aluminum compounds occur in antacids and some buffered aspirin products. The eltrombopag study tested aluminum hydroxide in a combination antacid; other aluminum-containing products were not tested. The label nevertheless requires separation from products containing aluminum. Check product ingredients with a pharmacist if the form is unclear.
Timing that the label supports
Take eltrombopag at least 2 hours before or 4 hours after the aluminum product. The order matters: when the mineral product comes first, wait at least 4 hours before taking eltrombopag. The same label instruction applies to mineral supplements, antacids and calcium-rich foods. The inspected studies did not test shorter gaps with an aluminum product.
Evidence and practical considerations
Absorption & effectiveness
Aluminum-containing antacids chelate eltrombopag in the gut; an aluminum hydroxide and magnesium carbonate antacid reduced eltrombopag exposure by about 70% in healthy volunteers, and the label names aluminum among the cations to separate.
- Exact scope
- Aluminum hydroxide antacids and other aluminum-containing oral products; the tested product was a combination antacid. with Oral eltrombopag olamine tablets and oral suspension (PROMACTA and generics) and eltrombopag choline tablets (ALVAIZ). Both product labels give the same mineral-separation instruction; the products have different strengths and are not interchangeable dose for dose.
- Medication form and route
- oral medication; oral supplement
What remains uncertain
- Single-dose healthy-volunteer pharmacokinetics; aluminum was not tested alone; no platelet-count outcome data.
Factors that may matter: Aluminum content of the product; Timing relative to the eltrombopag dose; Other cations in the same product; Calcium in the accompanying meal.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 22, 2026
Population: People prescribed eltrombopag
The label states that eltrombopag chelates polyvalent cations such as aluminum in foods, mineral supplements and antacids, directs taking eltrombopag at least 2 hours before or 4 hours after any product containing them, and reports that a single 75 mg dose taken with an antacid containing 1,524 mg aluminum hydroxide, 1,425 mg magnesium carbonate and sodium alginate reduced AUC and peak concentration by approximately 70%. The contribution of sodium alginate is stated as unknown.
How this applies: Exact eltrombopag (RxCUI 711942) in every marketed oral form; the label names iron, calcium, aluminum, magnesium, selenium and zinc by element and gives one spacing rule for all of them.
Aluminum was tested only as aluminum hydroxide inside a combination antacid; no aluminum-only product was studied and the label gives one interval for all cations.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 22, 2026
Population: People prescribed eltrombopag
The ALVAIZ label repeats the PROMACTA rule word for word: eltrombopag chelates polyvalent cations such as iron, calcium, aluminum, magnesium, selenium and zinc, and ALVAIZ is taken at least 2 hours before or 4 hours after antacids, dairy products and mineral supplements to avoid significant reduction in absorption.
How this applies: Confirms that the cation rule is unchanged for the newer eltrombopag choline product; it adds no element-specific data.
No new interaction study is reported for the choline salt; the wording is carried over from the innovator label.
Source 3: pharmacokinetic crossover study
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Healthy adult volunteers (18 men in study A; 26 adults in study B).
The high-calcium breakfast reduced eltrombopag AUC by 59% (geometric mean ratio 0.41; 90% CI 0.36 to 0.46) and peak concentration by 65%. Low-calcium meals did not change exposure whatever their fat content (AUC ratios 0.87 to 1.03). The aluminum and magnesium antacid reduced AUC and peak concentration by about 70% (AUC ratio 0.30; 90% CI 0.24 to 0.36).
How this applies: The tested antacid contained aluminum hydroxide, so the 70% reduction is direct evidence for aluminum hydroxide antacids; it does not isolate aluminum from magnesium or alginate, and other aluminum forms were not tested.
Single doses in healthy volunteers read as an abstract; the antacid combined two cations plus sodium alginate, so the share of each is unknown; no mineral supplement product was tested.
Source 4: narrative review
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Patients using antacids with susceptible medicines (review).
Polyvalent cations in antacids form insoluble chelate complexes that substantially reduce bioavailability of susceptible drugs such as tetracyclines and fluoroquinolones; the review names eltrombopag among newer drugs susceptible to antacid interactions and describes spacing doses as the countermeasure.
How this applies: Supports the mechanism and the spacing approach; the quantitative eltrombopag result comes from the label and the original study.
Review read as an abstract; it summarises rather than reports the eltrombopag data.
Source 5: federal toxicological summary
wwwn.cdc.gov · Source check Sep 22, 2026
Population: General population
Aluminum compounds are found in consumer products such as antacids, astringents, buffered aspirin, food additives, cosmetics and antiperspirants; the page advises against taking large quantities of aluminum-containing antacids and buffered aspirin.
How this applies: Identifies antacids and buffered aspirin as possible sources of oral aluminum exposure. It does not quantify their contribution relative to dietary exposure or test eltrombopag interactions.
Toxicology summary; it does not address drug absorption or eltrombopag.
Research assessment: · Open full citations ↗
Timing & monitoring
The label directs taking eltrombopag at least 2 hours before or 4 hours after aluminum-containing antacids and mineral products.
- Exact scope
- Any oral product containing aluminum. with Oral eltrombopag olamine tablets and oral suspension (PROMACTA and generics) and eltrombopag choline tablets (ALVAIZ). Both product labels give the same mineral-separation instruction; the products have different strengths and are not interchangeable dose for dose.
- Medication form and route
- oral medication; oral supplement
- Timing or duration
- Every eltrombopag dose while the aluminum product is used
What remains uncertain
- The interval is a labelled instruction derived from the antacid and food studies; no study compared spacing intervals with an aluminum product.
Factors that may matter: Order of dosing (before versus after); Once-daily eltrombopag schedule.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 22, 2026
Population: People prescribed eltrombopag
The label states that eltrombopag chelates polyvalent cations such as aluminum in foods, mineral supplements and antacids, directs taking eltrombopag at least 2 hours before or 4 hours after any product containing them, and reports that a single 75 mg dose taken with an antacid containing 1,524 mg aluminum hydroxide, 1,425 mg magnesium carbonate and sodium alginate reduced AUC and peak concentration by approximately 70%. The contribution of sodium alginate is stated as unknown.
How this applies: Exact eltrombopag (RxCUI 711942) in every marketed oral form; the label names iron, calcium, aluminum, magnesium, selenium and zinc by element and gives one spacing rule for all of them.
Aluminum was tested only as aluminum hydroxide inside a combination antacid; no aluminum-only product was studied and the label gives one interval for all cations.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 22, 2026
Population: People prescribed eltrombopag
The ALVAIZ label repeats the PROMACTA rule word for word: eltrombopag chelates polyvalent cations such as iron, calcium, aluminum, magnesium, selenium and zinc, and ALVAIZ is taken at least 2 hours before or 4 hours after antacids, dairy products and mineral supplements to avoid significant reduction in absorption.
How this applies: Confirms that the cation rule is unchanged for the newer eltrombopag choline product; it adds no element-specific data.
No new interaction study is reported for the choline salt; the wording is carried over from the innovator label.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Editorial update | |
| Editorial source audit clarified label scope, evidence limits and practical wording. No clinical approval was recorded. | |
| Research summary published | |
| Article prepared | |
| Prepared exact eltrombopag and Aluminum article from inspected current labeling and original sources, with uncertainty stated. |
Article revision: bd8fb032ada4115f
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
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Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.