The short answer
Treat zinc like the other minerals: the label names zinc among the polyvalent cations that eltrombopag binds and says to take eltrombopag at least 2 hours before or 4 hours after zinc supplements, lozenges or multivitamins. No identified study measured eltrombopag levels with zinc; the 70% loss of absorption was shown with an aluminum and magnesium antacid. Zinc is a divalent metal that chelates other medicines in the same way, so the label's rule is reasonable even though its size for zinc is unmeasured.
What this answer covers
Zinc supplements (sulfate, acetate, gluconate, citrate, oxide and other salts), zinc cold lozenges and zinc in multivitamin and mineral products, with eltrombopag tablets or oral suspension.
- Supplement or preparation
- zinc
- Medication ingredient
- eltrombopag
What the label says
The PROMACTA and ALVAIZ labels list zinc among the polyvalent cations that eltrombopag chelates in foods, mineral supplements and antacids, and direct patients to take eltrombopag at least 2 hours before or 4 hours after zinc-containing products. The Medication Guide names zinc in plain language.
What has been measured
The label's interaction study used an antacid containing aluminum hydroxide and magnesium carbonate, which cut eltrombopag exposure by about 70%, and calcium-rich meals cut it by 59% to 75%. Searches of Europe PMC for eltrombopag with zinc returned no absorption study, so these other-cation results do not quantify the size of a zinc effect.
Why zinc fits the class
Zinc is a divalent metal cation that forms insoluble complexes with quinolone and tetracycline antibiotics, for which federal guidance advises the same pattern of taking the medicine 2 hours before or 4 to 6 hours after zinc. Supplements list elemental zinc, and cold lozenges and multivitamins count as zinc products.
What to do
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 on an empty stomach with zinc at the other end of the day satisfies the label. Zinc lozenges taken repeatedly through the day are harder to separate: take eltrombopag at least 4 hours after the last lozenge and at least 2 hours before the next one.
Evidence and practical considerations
Absorption & effectiveness
The label names zinc among the polyvalent cations that eltrombopag chelates and requires separation; no zinc-specific study was identified in the reviewed searches, and the measured reductions come from an aluminum and magnesium antacid and calcium meals.
- Exact scope
- Zinc supplements, lozenges and multivitamins containing zinc in any salt. 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 zinc products are used
What remains uncertain
- Label class statement supported by zinc's known chelation of other drugs; no eltrombopag pharmacokinetic or outcome data with zinc.
Factors that may matter: Zinc dose and salt; Timing relative to the eltrombopag dose; Other cations in the same product; Repeated lozenge use.
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 lists zinc among the polyvalent cations that eltrombopag chelates in foods, mineral supplements and antacids, and directs taking eltrombopag at least 2 hours before or 4 hours after supplements containing zinc. The Medication Guide repeats zinc in its list. No zinc study is reported; the measured interactions used an aluminum and magnesium antacid and calcium-rich meals.
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.
Zinc appears only in the class list; no zinc-specific pharmacokinetic data are given.
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); zinc was not tested, so this shows the size of chelation effects for other divalent and trivalent cations rather than a zinc 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: federal supplement fact sheet
ods.od.nih.gov · Source check Sep 22, 2026
Population: General consumer population; no eltrombopag co-use data
Zinc supplements contain zinc sulfate, acetate, gluconate, citrate or oxide, labelled as elemental zinc; zinc is also in cold lozenges and denture creams; listed medication interactions are quinolone and tetracycline antibiotics (take the antibiotic at least 2 hours before or 4 to 6 hours after zinc), penicillamine and thiazide diuretics, not eltrombopag.
How this applies: Establishes the supplement forms and that zinc is a divalent cation known to chelate other drugs with the same spacing pattern; the interaction list omits eltrombopag.
Consumer and professional summary; it does not mention eltrombopag.
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 Zinc article from inspected current labeling and original sources, with uncertainty stated. |
Article revision: 36fac5a2bbbdb188
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?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.