Erythropoietin(Epoetin)
Epoetin is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, you can develop a condition called anemia.
Mechanism of effect
Stimulates RBC production
Pharmacodynamic
Used in the treatment of anemia. Involved in the regulation of erythrocyte differentiation and the maintenance of a physiological level of circulating erythrocyte mass.
Pharmacokinetics
T max is 5 to 24 h (subcutaneous). Elimination half-life is approximately 4 to 13 h (IV) for chronic kidney disease patients and approximately 16 to 67 h (subcutaneous) for anemic cancer patients
Drug indications
Treatment of anemiaDosage
epoetin alfa :
Cancer Patients Adults Subcutaneous 150 units/kg 3 times
weekly, or 40,000 units weekly, until the completion of a chemotherapy
course Children 5 to 18 y of age IV Weekly dosing: 600 units/kg weekly
Chronic Kidney Disease
Adults IV/Subcutaneous 50 to 100 units/kg 3 times weekly
Children 1 mo to 16 y of age on dialysis IV/Subcutaneous 50 units/kg 3 times weekly.
Drug contraindications
hypersensitivity to human albumin , Uncontrolled hypertension , Pure red cell aplasiaSide effects
nausea , Headache , insomnia , dizziness , vomiting , Seizures , allergic reaction , rash , Depression , Chills , urticaria , pruritus , Hypertension , leukopenia , Erythema , edema , Cough , fever , pulmonary embolism , deep vein thrombosis , weight decrease , myalgia , Bone pain , Injection-site reaction , Arthralgia , Upper respiratory tract infection , Hypokalemia , Hyperglycemia , stomatitis , dysphagia , vascular access thrombosis , MIAlerts
1-Evaluate transferrin saturation and serum ferritin prior to and during treatment.
2-Administer supplemental iron when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. Prior to initiation and after each dose adjustment,
3- monitor Hgb weekly until the level is stable and sufficient to minimize the need for RBC transfusion. Thereafter, monitor Hgb at least monthly.
4-Closely monitor and appropriately control BP. Closely monitor patients with preexisting CV disease.
5- Closely monitor for premonitory neurologic symptoms during the first month of therapy.
6-Erythropoiesis-stimulating agents (ESAs) increase the risk of death, MI, stroke, venous thromboembolism, thrombosis of vascular access, and tumor progression or recurrence.
Points of recommendation
For subcutaneous or IV administration only. Not for intradermal, IM, or intra-arterial administration. IV route recommended for patients on hemodialysis.
• Do not shake or vigorously agitate vial. Prolonged, vigorous shaking may denature the glycoprotein, rendering it biologically inactive.
• Rotate subcutaneous injection sites.
• Single-dose vials contain no preservative. Use only 1 dose/vial. Do not reenter vial. Discard any unused portion. Do not combine unused portions or save unused portions for later use.
• Do not administer in conjunction with other drug solutions. However, at time of subcutaneous administration, single-use vials may be admixed in a syringe with bacteriostatic sodium chloride 0.9% with benzyl alcohol 0.9% at a 1:1 ratio. Multidose vials contain benzyl alcohol and admixing is not necessary.
• Individualize dosing and use the lowest dose sufficient to reduce the need for blood transfusions.
• When adjusting therapy, consider Hgb rate of rise, rate of decline, ESA responsiveness, and Hgb variability. A single Hgb excursion may not require a dosing change.
• Evaluate the iron status in all patients before and during treatment and maintain iron repletion.
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