epoetin (e-poe-e-tin) Epogen, Eprex, Procrit

 Indications

Anemia associated with chronic kidney disease (CKD).

Anemia secondary to zidovudine (AZT) therapy in HIVinfected

patients. Anemia from chemotherapy in patients

with nonmyeloid malignancies when there is 2

additional mo of planned chemotherapy. Reduction of

need for allogeneic red blood cell transfusions in patients

undergoing elective, noncardiac, nonvascular

surgery.

Action

Stimulates erythropoiesis (production of red blood

cells). Therapeutic Effects: Maintains and may elevate

RBCs, decreasing the need for transfusions.

Pharmacokinetics

Absorption: Well absorbed after subcut administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Children and Adults—4–13 hr; Neonates—

11–17 hr.

TIME/ACTION PROFILE (increase in RBCs)

ROUTE ONSET† PEAK DURATION

IV, Subcut 7–10 days within 2 mo 2 wk‡

†Increase in reticulocytes.

‡After discontinuation.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to albumin or

mammalian cell-derived products; Uncontrolled hypertension;

Patients with erythropoietin levels 200 m-

Units/mL; Patients with cancer receiving hormonal

agents, biologic products, or radiotherapy, unless also

receiving concomitant myelosuppressive chemotherapy;

Patients receiving chemotherapy when anticipated outcome is cure; Patients with cancer receiving myelosuppressive

chemotherapy in whom the anemia can be

managed by transfusion; Patients who require immediate

correction of anemia when RBC transfusions can be

used instead; Patients scheduled for surgery who are

willing to donate autologous blood; Patients undergoing

cardiac or vascular surgery; Neutropenia in newborns.

Use Cautiously in: History of seizures or stroke;

Cardiovascular disease; History of porphyria; OB: Evidence

of fetal harm in animal studies—use only if potential

benefit outweighs potential risk to fetus; OB, Lactation:

Little published information, however,

erythropoetin alfa is a normal constituent of breast

milk; Pedi: Multidose vials contain benzyl alcohol,

which can cause potentially fatal gasping syndrome in

neonates.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache. CV: HF, MI, STROKE, THROMBOEMBOLIC

EVENTS (especially with hemoglobin 11 g/

dL), hypertension. Derm: transient rashes. Endo:

restored fertility, resumption of menses. Misc:qmortality

andqtumor growth (with hemoglobin 12 g/dL).

Interactions

Drug-Drug: Mayqrequirement for heparin anticoagulation

during hemodialysis.

Route/Dosage

Anemia of CKD

(Do not initiate if hemoglobin 10 g/dL).

Subcut, IV (Adults): 50–100 units/kg 3 times weekly

initially; use lowest dose sufficient topthe need for red

blood cell transfusions (do not exceed hemoglobin of

11 g/dL [patients on dialysis] or 10 g/dL [patients not

on dialysis]); if Hgbqby 1.0 g/dL in 2 wk,pdose by

25%; if Hgbqby 1.0 g/dL after 4 wk of therapy (with

adequate iron stores),qdose by 25%; do notqdose

more frequently than q 4 wk.

Subcut, IV (Children 1 mo–16 yr): 50 units/kg 3

times weekly initially; use lowest dose sufficient topthe

need for red blood cell transfusions (do not exceed hemoglobin

of 11 g/dL [patients on dialysis] or 10 g/dL

[patients not on dialysis]); if Hgbqby 1.0 g/dL in 2

wk,pdose by 25%; if Hgbqby 1.0 g/dL after 4 wk of

therapy (with adequate iron stores),qdose by 25%; do

notqdose more frequently than q 4 wk.

Anemia Secondary to AZT Therapy

Subcut, IV (Adults): 100 units/kg 3 times weekly for

8 wk; if inadequate response, mayqby 50–100 units/

kg every 4–8 wk (max: 300 units/kg 3 times weekly).

Subcut, IV (Children 8 mo–17 yr): 50–400 units/

kg 2–3 times weekly.

Anemia from Chemotherapy

(Use only for chemotherapy-related anemia and discontinue

when chemotherapy course is completed; do

not initiate if hemoglobin 10 g/dL).

Subcut (Adults): 150 units/kg 3 times weekly or

40,000 units weekly; adjust dose to maintain lowest hemoglobin

level sufficient to avoid blood transfusions

(do not exceed hemoglobin of 12 g/dL); if Hgbqby

1.0 g/dL in 2 wk or reaches a level needed to avoid

red blood cell transfusions,pdose by 25%; if Hgbqby

1.0 g/dL (and remains 10 g/dL) after initial 4 wk of

therapy (with adequate iron stores),qdose to 300

units/kg 3 times weekly or 60,000 units weekly.

IV (Children 5–18 yr): 600 units/kg weekly; adjust

dose to maintain lowest hemoglobin level sufficient to

avoid blood transfusions (do not exceed hemoglobin of

12 g/dL); if Hgbqby 1.0 g/dL in 2 wk or reaches a

level needed to avoid red blood cell transfusions,p

dose by 25%; if Hgbqby 1.0 g/dL (and remains 10

g/dL) after initial 4 wk of therapy (with adequate iron

stores),qdose to 900 units/kg (maximum60,000

units) weekly.

Surgery

Subcut (Adults): 300 units/kg/day for 10 days before

surgery, day of surgery, and 4 days after or 600 units/kg

21, 14, and 7 days before surgery and on day of surgery.

Availability

Solution for injection: 2,000 units/mL, 3,000 units/

mL, 4,000 units/mL, 10,000 units/mL, 20,000 units/mL,

40,000 units/mL.