The short answer
Yes, keep iron supplements apart from eltrombopag. The label names iron among the minerals that eltrombopag binds in the gut and tells you to take eltrombopag at least 2 hours before or 4 hours after iron-containing supplements or multivitamins. No identified study measured eltrombopag levels with an iron tablet; the 70% loss of absorption was shown with an aluminum and magnesium antacid. Eltrombopag also binds iron inside the body, so long-term users can become iron deficient and may be prescribed iron, which makes the spacing rule a daily routine rather than a one-off precaution.
What this answer covers
Iron supplements (ferrous and ferric salts, polysaccharide iron and other forms) and iron-containing multivitamins taken by mouth, with eltrombopag tablets or oral suspension.
- Supplement or preparation
- iron
- Medication ingredient
- eltrombopag
What the label establishes
Eltrombopag chelates polyvalent cations, and the label names iron first in its list. Patients are directed to take eltrombopag at least 2 hours before or 4 hours after iron-containing supplements and multivitamins. The label's measured interaction, about a 70% fall in exposure, comes from an aluminum and magnesium antacid rather than iron, and calcium-rich meals produced falls of 59% to 75%.
Eltrombopag is a strong iron binder
Laboratory work shows that eltrombopag binds ferric iron tightly and removes iron from cells at concentrations reached in patients. Observational studies link prolonged treatment to lower ferritin and, in some people, iron-deficiency anemia. In an NIH cohort, estimated iron clearance had a half-life of about 15 months during treatment. These findings support the label's chelation rationale but do not quantify the effect of an iron tablet on eltrombopag absorption.
Some people need iron supplementation during treatment
In a Japanese series, 6 of 36 people with aplastic anemia developed iron-deficiency anemia after a median of roughly three years of eltrombopag. Their hemoglobin improved after oral iron supplementation. In a separate study of 283 adults with immune thrombocytopenia, including 110 who received eltrombopag, iron replacement was associated with a smaller ferritin decline but did not eliminate the association with eltrombopag. The abstracts do not report iron-dose spacing or measure eltrombopag levels.
How to take both
Take eltrombopag at least 2 hours before or 4 hours after the supplement, antacid or calcium-rich food, as the label directs. A once-daily eltrombopag dose taken on an empty stomach, with iron at the other end of the day, satisfies the label. Iron-only supplements commonly contain 65 mg iron and many multivitamins marketed for women about 18 mg; both count. Do not stop prescribed iron on your own, and ask the prescriber to check ferritin if fatigue or anemia develops on long-term treatment.
Evidence and practical considerations
Absorption & effectiveness
The label names iron among the polyvalent cations that chelate eltrombopag and reduce its absorption; the size of the effect was measured with an aluminum and magnesium antacid and with calcium meals, not with iron, while laboratory and clinical data confirm eltrombopag binds iron strongly.
- Exact scope
- Iron supplements and iron-containing multivitamins in any salt or complex. 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
- No iron-specific pharmacokinetic study; the label applies a class rule; clinical iron-depletion studies do not measure eltrombopag levels.
Factors that may matter: Iron dose and form; Timing relative to the eltrombopag dose; Other cations in the same product; Duration of eltrombopag treatment and iron status.
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 iron in foods, mineral supplements and antacids, and directs taking eltrombopag at least 2 hours before or 4 hours after supplements containing iron. The Medication Guide lists multivitamins or products that contain iron among products to separate. The interaction study reported in the label used an aluminum and magnesium antacid, not iron.
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.
No iron-specific pharmacokinetic study is reported; the label applies the class rule to iron. The label does not describe iron depletion during long-term treatment.
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: Comparator cations (aluminum and magnesium in an antacid, calcium in food); iron was not tested, so the 70% figure shows the size of chelation effects rather than an iron result.
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: laboratory study
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Cultured human and animal cell lines (no patients).
Eltrombopag bound iron(III) with a very high affinity, mobilised cellular iron at clinically achievable concentrations (1 micromolar), removed more iron from cardiomyocytes than the licensed chelators at equal binding equivalents, and shuttled iron to deferasirox synergistically.
How this applies: Mechanistic proof that eltrombopag is a strong iron chelator, which underpins both the absorption warning and the iron depletion seen in patients; it does not measure what happens when iron tablets and eltrombopag meet in the gut.
Cell and chemistry study, not a human absorption study; abstract only.
Source 5: retrospective cohort study
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Five hundred twenty-one adults and children with bone marrow failure at the NIH.
Duration of eltrombopag exposure correlated with ferritin reduction regardless of response or dose; iron clearance followed first-order kinetics with a half-life of 15.3 months versus 47.5 months in historical responders; prolonged use depleted iron and produced iron-deficiency anemia that mimicked relapse and responded to iron supplementation.
How this applies: Shows that eltrombopag chelates body iron in patients and that iron supplements are needed by some long-term users; it does not measure eltrombopag absorption with iron tablets.
Retrospective cohort; iron supplementation is reported as effective without dosing or timing details; abstract only.
Source 6: retrospective case series
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Thirty-six adults with aplastic anemia in Japan.
Six of 36 patients (17%) developed iron-deficiency anemia without bleeding after a median of 1,142.5 days (range 389 to 1,442) of eltrombopag, with higher cumulative eltrombopag doses; after oral iron supplementation all six reached hemoglobin levels above their previous peak.
How this applies: Reports correction of iron-deficiency anemia with oral iron in people treated long term with eltrombopag. The abstract does not establish the dose-spacing regimen or quantify an absorption interaction.
Small single-centre series; the abstract does not state how iron and eltrombopag doses were spaced or whether eltrombopag levels or platelet counts changed during iron treatment.
Source 7: multicentre retrospective cohort study
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Two hundred eighty-three adults with immune thrombocytopenia in Turkey.
Eltrombopag was associated with greater declines in ferritin and transferrin saturation, graded across 25 mg to 75 mg daily doses, and was the dominant independent predictor of ferritin decline (about 79.8 micrograms per litre lower); iron replacement therapy attenuated the decline but did not negate it.
How this applies: Shows iron deficiency is a routine-practice consequence of eltrombopag and that iron replacement given during treatment only partly offsets it; the study cannot separate ongoing chelation from reduced iron absorption.
Retrospective and observational; iron replacement regimens and their timing relative to eltrombopag are not described; abstract only.
Source 8: federal supplement fact sheet
ods.od.nih.gov · Source check Sep 22, 2026
Population: General consumer population; no eltrombopag co-use data
Ferrous and ferric iron salts are the most common supplement forms; multivitamin and mineral products for women typically provide 18 mg iron and iron-only supplements often 65 mg; listed medication interactions cover levodopa, levothyroxine and proton pump inhibitors, not eltrombopag.
How this applies: Establishes typical iron supplement forms and doses; the fact sheet's interaction list does not include eltrombopag.
Consumer and professional summary; it does not mention eltrombopag.
Research assessment: · Open full citations ↗
Timing & monitoring
The label directs taking eltrombopag at least 2 hours before or 4 hours after iron-containing supplements; long-term eltrombopag can cause iron deficiency that is treated with oral iron, so the spacing applies for as long as both are used.
- Exact scope
- Iron supplements and multivitamins with iron. 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 iron products are used
What remains uncertain
- Interval is a labelled instruction not tested with iron; iron-depletion cohorts do not report spacing.
Factors that may matter: Order of dosing (before versus after); Prescribed iron for eltrombopag-related deficiency.
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 iron in foods, mineral supplements and antacids, and directs taking eltrombopag at least 2 hours before or 4 hours after supplements containing iron. The Medication Guide lists multivitamins or products that contain iron among products to separate. The interaction study reported in the label used an aluminum and magnesium antacid, not iron.
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.
No iron-specific pharmacokinetic study is reported; the label applies the class rule to iron. The label does not describe iron depletion during long-term treatment.
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: retrospective case series
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Thirty-six adults with aplastic anemia in Japan.
Six of 36 patients (17%) developed iron-deficiency anemia without bleeding after a median of 1,142.5 days (range 389 to 1,442) of eltrombopag, with higher cumulative eltrombopag doses; after oral iron supplementation all six reached hemoglobin levels above their previous peak.
How this applies: Reports correction of iron-deficiency anemia with oral iron in people treated long term with eltrombopag. The abstract does not establish the dose-spacing regimen or quantify an absorption interaction.
Small single-centre series; the abstract does not state how iron and eltrombopag doses were spaced or whether eltrombopag levels or platelet counts changed during iron treatment.
Source 4: retrospective cohort study
pubmed.ncbi.nlm.nih.gov · Source check Sep 22, 2026
Population: Five hundred twenty-one adults and children with bone marrow failure at the NIH.
Duration of eltrombopag exposure correlated with ferritin reduction regardless of response or dose; iron clearance followed first-order kinetics with a half-life of 15.3 months versus 47.5 months in historical responders; prolonged use depleted iron and produced iron-deficiency anemia that mimicked relapse and responded to iron supplementation.
How this applies: Shows that eltrombopag chelates body iron in patients and that iron supplements are needed by some long-term users; it does not measure eltrombopag absorption with iron tablets.
Retrospective cohort; iron supplementation is reported as effective without dosing or timing details; abstract only.
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 Iron article from inspected current labeling and original sources, with uncertainty stated. |
Article revision: ef2fb02d21696756
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.
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