Alvaiz (eltrombopag choline)
An approved treatment for Immune Thrombocytopenia and Aplastic Anemia.
The same compound appears under different names depending on the context. Here is how to identify Eltrombopag choline wherever you encounter it, plus the key facts at a glance.
- Generic name
- Eltrombopag choline
- Brand name
- Alvaiz
- Drug class
- Small molecule TPO receptor agonist
- Manufacturer
- Teva Pharmaceuticals
- How it's taken
- For ITP in adults and children 6 and older, Alvaiz starts at 36 mg by mouth once a day.
A once-daily eltrombopag tablet from Teva, approved by the FDA on November 29, 2023. It contains the same active drug as Promacta but in a different salt form and strength, so it is not swapped milligram for milligram with Promacta or generic eltrombopag: the usual ITP starting dose is 36 mg instead of 50 mg. It is approved for persistent or chronic immune thrombocytopenia (ITP) in adults and children 6 and older, for severe aplastic anemia after immunosuppressive therapy, and for low platelets in hepatitis C.
We'll email you when Alvaiz's FDA label changes, when the FDA acts on it, and when new trials for the condition you pick open. Unsubscribe anytime.
You'll get new recruiting trials, changes to trials, FDA decisions and condition news for Immune Thrombocytopenia. Turn any of these off from the link in every email.
Where Eltrombopag choline fits
Same active drug as Promacta and its generics, with the same calcium timing rule and liver monitoring. The differences are the salt form, the dose numbers and the youngest approved age.
How Eltrombopag choline works
Eltrombopag attaches to the thrombopoietin (TPO) receptor on the bone marrow cells that make platelets and switches on the signal to make more of them. Alvaiz uses eltrombopag choline, while Promacta and its generics use eltrombopag olamine. The body absorbs the 2 forms differently, which is why Alvaiz tablets come in different strengths (9, 18, 36 and 54 mg) and why the label says it cannot be substituted milligram for milligram.
Mechanism: Oral thrombopoietin (TPO) receptor agonist; a different salt form of eltrombopag from the one in Promacta
Side effects and safety
- Liver damage. Liver tests (ALT, AST and bilirubin) before starting, every 2 weeks while the dose is being adjusted, and monthly once it is stable.
- MDS and leukemia. Not for myelodysplastic syndromes, where eltrombopag was linked to more deaths and progression to leukemia.
- Blood clots. Clots in veins and arteries were seen at low and at normal platelet counts. The goal is a safe platelet count, never a normal one.
- Cataracts. New or worse cataracts were reported with eltrombopag, so eye exams are part of care.
- Liver tests before starting, every 2 weeks during dose adjustment, then monthly
- Complete blood counts weekly until platelets are stable, then monthly
- Eye exams for cataracts
Alvaiz carries the same boxed warning as Promacta: it may cause severe, possibly life-threatening liver damage, and in people with hepatitis C taking interferon and ribavirin it can raise the risk of liver failure. The label also warns about a higher risk of death and progression to leukemia in myelodysplastic syndromes (MDS), blood clots, and new or worse cataracts. Common side effects reported in trials of eltrombopag include nausea, diarrhea, upper respiratory infections, cough, fever and tiredness. Breastfeeding is not recommended during treatment.
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Eltrombopag choline
For ITP in adults and children 6 and older, Alvaiz starts at 36 mg by mouth once a day. The starting dose is 18 mg for people of East or Southeast Asian ancestry or with liver impairment, and 9 mg can be considered for people with both. The maximum is 54 mg a day. Take it without a meal or with a meal low in calcium (50 mg or less), and at least 2 hours before or 4 hours after antacids, calcium-rich foods such as dairy, and mineral supplements like iron, calcium, magnesium or zinc. Tablets are swallowed whole. Moving between Alvaiz and Promacta or generic eltrombopag needs a new prescription with a new dose, not a straight swap.
Availability and cost
Only available as the brand-name product.
A branded alternative to Promacta approved through the FDA's 505(b)(2) pathway rather than as a generic, so pharmacies cannot substitute it for Promacta or generic eltrombopag.
Help paying for Alvaiz
Pick your insurance to see which help fits. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE; charity funds are the usual route there.
- Copay help
Teva's Alvaiz Savings Program: patients with commercial prescription insurance that covers Alvaiz may pay as little as $0 out of pocket; maximum assistance per prescription and annual benefits apply. Not valid for uninsured or cash-paying patients or anyone enrolled in or eligible for Medicare, Medigap, Medicaid, VA, DoD, TRICARE or other government coverage. The current card expires December 31, 2026. Questions: 844-248-7949.
For: private insurance · source
Good to know: The Alvaiz site does not describe a free-drug program or a support hub; the savings program is managed by Mercalis for Teva.
- From a charity · NORD RareCareImmune Thrombocytopenia Medical Assistance fundOpen
Pays for: Medical and medication costs.
The foundation says: “Accepting new applications and re-enrollments for current year” - From a charity · NORD RareCareImmune Thrombocytopenia Premium Copay Assistance fundOpen
Pays for: Insurance premiums and copays.
The foundation says: “Accepting new applications and re-enrollments for current year” - From a charity · The Assistance FundThrombocytopenia fundWaitlist
Pays for: Copays, coinsurance, deductibles and other health-related expenses.
The foundation says: “WAITLIST — Accepting Waitlist Patients. TAF is currently accepting requests to join the enrollment waitlist for this program. Waitlists a…”
Clinical trial results
Alvaiz was approved without new efficacy trials of its own: the FDA relied on the trials of eltrombopag olamine (Promacta), shown in the Alvaiz label, plus studies of how Alvaiz is absorbed. In the Promacta trials, 59% of adults with chronic ITP on 50 mg reached a platelet count of 50,000 or higher against 16% on placebo (Study 773B), and in the 6-month RAISE trial patients averaged 11.3 weeks at that level against 2.4 weeks on placebo.
Development history
Teva developed Alvaiz and the FDA approved it on November 29, 2023 as an alternative eltrombopag tablet. Teva describes it as the first eltrombopag pharmaceutical alternative to Promacta. Generic eltrombopag olamine, the same form as Promacta, reached US pharmacies in May 2025, so 3 versions of eltrombopag are now dispensed: brand Promacta, its generics and Alvaiz.
Explore Immune Thrombocytopenia and Aplastic Anemia trials
Other Immune Thrombocytopenia & Aplastic Anemia treatments
Steroids and IVIG are usually tried first. When they are not enough, options include the TPO receptor agonists Nplate (romiplostim), Promacta and generic eltrombopag, Alvaiz and Doptelet (avatrombopag), which raise platelet production; Tavalisse (fostamatinib) and Wayrilz (rilzabrutinib), which slow platelet destruction; and rituximab or spleen removal.
Eltrombopag choline in Trial Friend News and Guides
Common questions about Eltrombopag choline
▸What is Eltrombopag choline (Alvaiz)?
A once-daily eltrombopag tablet from Teva, approved by the FDA on November 29, 2023. It contains the same active drug as Promacta but in a different salt form and strength, so it is not swapped milligram for milligram with Promacta or generic eltrombopag: the usual ITP starting dose is 36 mg instead of 50 mg. It is approved for persistent or chronic immune thrombocytopenia (ITP) in adults and children 6 and older, for severe aplastic anemia after immunosuppressive therapy, and for low platelets in hepatitis C.
▸How does Eltrombopag choline work?
Eltrombopag attaches to the thrombopoietin (TPO) receptor on the bone marrow cells that make platelets and switches on the signal to make more of them. Alvaiz uses eltrombopag choline, while Promacta and its generics use eltrombopag olamine. The body absorbs the 2 forms differently, which is why Alvaiz tablets come in different strengths (9, 18, 36 and 54 mg) and why the label says it cannot be substituted milligram for milligram.
▸What are the side effects of Eltrombopag choline?
Alvaiz carries the same boxed warning as Promacta: it may cause severe, possibly life-threatening liver damage, and in people with hepatitis C taking interferon and ribavirin it can raise the risk of liver failure. The label also warns about a higher risk of death and progression to leukemia in myelodysplastic syndromes (MDS), blood clots, and new or worse cataracts. Common side effects reported in trials of eltrombopag include nausea, diarrhea, upper respiratory infections, cough, fever and tiredness. Breastfeeding is not recommended during treatment.
▸How is Eltrombopag choline taken?
For ITP in adults and children 6 and older, Alvaiz starts at 36 mg by mouth once a day. The starting dose is 18 mg for people of East or Southeast Asian ancestry or with liver impairment, and 9 mg can be considered for people with both. The maximum is 54 mg a day. Take it without a meal or with a meal low in calcium (50 mg or less), and at least 2 hours before or 4 hours after antacids, calcium-rich foods such as dairy, and mineral supplements like iron, calcium, magnesium or zinc. Tablets are swallowed whole. Moving between Alvaiz and Promacta or generic eltrombopag needs a new prescription with a new dose, not a straight swap.
▸Is Eltrombopag choline FDA approved?
Yes, Eltrombopag choline (Alvaiz) is FDA approved (2023) for the treatment of Immune Thrombocytopenia and Aplastic Anemia.
▸Is Alvaiz the same as Promacta?
Same active drug, different salt form, so the 2 are not swapped milligram for milligram.
Dose: the usual ITP start is 36 mg of Alvaiz against 50 mg of Promacta, and the maximum is 54 mg against 75 mg.
Ages: Alvaiz is approved from age 6 for ITP, Promacta from age 1.
Switching: needs a new prescription and platelet checks, not a pharmacy substitution.
Source: Alvaiz prescribing information
▸Do I still have to avoid dairy with Alvaiz?
Yes. Take Alvaiz without a meal or with a low-calcium meal, and at least 2 hours before or 4 hours after dairy, antacids and mineral supplements.
Same rule: this matches Promacta and generic eltrombopag.
Source: Alvaiz prescribing information
▸Does the Alvaiz copay card work with Medicare?
No. The Alvaiz Savings Program is only for commercially insured patients.
Excluded: Medicare, Medigap, Medicaid, VA, DoD, TRICARE, uninsured and cash-paying patients.
Commercial insurance: as little as $0 out of pocket, with maximums; the card expires December 31, 2026.
Source: Alvaiz.com savings
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- U.S. National Library of Medicine, DailyMed · 2026-01. ALVAIZ (eltrombopag) tablets: prescribing information. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed51e463-7a03-4858-bbd2-882ce4753d5a
- U.S. Food and Drug Administration. Alvaiz approval history. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=216774
- Teva Pharmaceuticals. Teva's ALVAIZ (eltrombopag tablets) Savings Program. https://www.alvaiz.com/savings/
- U.S. Food and Drug Administration. Alvaiz (eltrombopag choline) clinical pharmacology review. https://www.fda.gov/media/179554/download
- OncLive · 2025-05-14. Generic eltrombopag is now available for severe aplastic anemia and immune thrombocytopenia. https://www.onclive.com/view/generic-eltrombopag-is-now-available-for-severe-aplastic-anemia-and-immune-thrombocytopenia