BMA Concise Guide to Medicine & Drugs

Erythropoietin

Brand names Aranesp, Binocrit, Eprex, Mircera, NeoRecormon, Retacrit

Used in the following combined preparations None

QUICK REFERENCE

Drug group Kidney hormone

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Erythropoietin is a naturally occurring hormone produced by the kidneys; it stimulates the body to produce red blood cells. In medicine, artificially produced erythropoietin is used to treat the anaemia associated with chronic kidney disease and with certain cancer treatments. Erythropoietin is also used to boost the level of red blood cells before surgery. It may also be used as an alternative to blood transfusions in major orthopaedic (bone) surgery. Erythropoietin has been used by athletes to enhance their performance. However, this is not a recognized use and the drug is banned by sport governing bodies.

Erythropoietin may worsen hypertension (high blood pressure), and blood pressure should therefore be monitored during treatment with the drug.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Injection.

Frequency and timing of doses 1–3 x weekly, depending on the product and condition being treated.

Dosage range Dosage is calculated on an individual basis according to body weight. The dosage also varies depending on the product and condition being treated.

Onset of effect Active inside the body within 4 hours, but effects may not be noted for 2–3 months.

Duration of action Some effects may persist for several days.

Diet advice None. However, if you have kidney failure, you may have to follow a special diet.

Storage Store at 2–8°C, out of the reach of children. Do not freeze or shake. Protect from light.

Missed dose Do not make up any missed doses.

Stopping the drug Discuss with your doctor.

Exceeding the dose A single excessive dose is unlikely to be a cause for concern. Too high a dose over a long period can increase the likelihood of adverse effects.

POSSIBLE ADVERSE EFFECTS

The most common adverse effects are increased blood pressure and problems at the injection site. More rarely, there may be flu-like symptoms, bone pain, seizures, a rash, or a stabbing headache. All unusual symptoms should be discussed with your doctor immediately.

INTERACTIONS

Ciclosporin Erythropoietin may affect the blood level of ciclosporin and more frequent monitoring of ciclosporin blood levels should therefore be carried out when erythropoietin treatment starts.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have high blood pressure.

· You have a long-term liver problem.

· You have previously suffered allergic reactions to any drugs.

· You have peripheral vascular disease.

· You have had epileptic fits.

· You are taking other medicines.

Pregnancy Not usually prescribed. Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 No known problems.

Driving and hazardous work Not applicable.

Alcohol Follow your doctor’s advice regarding alcohol.

PROLONGED USE

If the level of anaemia is overcorrected, there is an increased risk of thrombosis, which is potentially fatal, hence the need for careful monitoring. Prolonged use of erythropoietin may also reduce survival in some patients with cancer.

Monitoring Regular blood tests to monitor blood composition and blood pressure monitoring are required.