Class: Erythropoietic Stimulating Agent
Dosage Forms. Injection Solution: 2000 units/mL, 3000 units/mL, 4000 units/mL, 10,000 units/mL, 20,000 units/mL
Common FDA Label Indication, Dosing, and Titration.
1. Anemia of cancer chemotherapy: Children, 600 units/kg (max 40,000 units) IV once weekly; adults, 40,000 units sq weekly
2. Anemia of chronic renal failure: Children, 50 units/kg IV or sq 3 times per week; adults not on dialysis, 10,000 units sq weekly, 20,000 units sq every other week, 30,000 units every 3rd wk or 40,000 units sq every 4 wk; Adults on dialysis, 50-100 units/kg IV or sq 3 times per week
3. Perioperative collection of blood for allogeneic infusion: 300 units/kg/d sq for 10 d before surgery, on the day of surgery, and for 4 d postoperatively
Off-Label Uses.
1. Anemia due to myelodysplastic syndrome: 40,000 units sq weekly
MOA. Epoetin alfa is recombinant human erythropoietin. It binds to the erythropoietin receptor on erythroid progenitor cells, stimulating production/differentiation of mature red cells.
Drug Characteristics: Epoetin
Medication Safety Issues: Epoetin
Drug Interactions: Epoetin
Adverse Reactions: Epoetin
Efficacy Monitoring Parameters. Monitor Hgb carefully and titrate dose to avoid transfusion and discontinue if Hgb 10 g/dL. Iron studies needed to ensure adequate iron stores, transferring saturation >20% and ferritin >100 ng/mL.
Toxicity Monitoring Parameters. BP, weight to monitor edema, SCr in renal failure patients.
Key Patient Counseling Points. Do not shake, dilute, or expose to light. Store in box in refrigerator. Do not combine remainders from different syringes; each syringe is single use. May require several weeks for maximum effect.
Clinical Pearls. Typically administered in hospitals and clinics only. In cancer patients with certain tumor types (eg, breast, nonsmall cell lung, head and neck, lymphoid, cervical), epoetin and darbepoetin shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies. Discontinue after the completion of the chemotherapy course and if no response after 8 wk of therapy. Hospitals and healthcare professionals who prescribe and/or dispense epoetin to patients with cancer must enroll and comply with the ESA APPRISE oncology program at www.esa-apprise.com. Renal failure patients experienced greater risks of death, stroke, and serious cardiovascular events when administered erythropoiesis-stimulating agent to target Hgb levels of 13 g/dL or higher in clinical studies. Clinical trials have shown that epoetin provides no improvement in quality of life, fatigue, or well-being.