What is Epoetin?
EPOETIN ALFA (e POE e tin AL fa) helps your body create more red blood cells. This drug is used to treat anemia caused by chronic renal disease, cancer chemotherapy, or HIV therapy. It may also be administered before surgery if you have anemia.
This medicine may be used for additional purposes; consult your health care practitioner or pharmacist if you have questions.
Epoetin uses
Epoetin alfa is used to treat anemia caused by chemotherapy in adults and children at least 5 years old.
Epoetin alfa is also used to treat anemia caused by chronic renal disease in adults and children at least 1-month-old.
Epoetin alfa is also used to treat anemia in individuals using zidovudine to treat HIV (human immunodeficiency virus) (human immunodeficiency virus).
Epoetin alfa is also used to lessen the requirement for red blood cell transfusions in people having certain types of surgery.
Mechanism of action
Erythropoietin or exogenous epoetin alfa interacts with the erythropoietin receptor (EPO-R) and activates intracellular signal transduction pathways 3. The affinity (Kd) of EPO for its receptor on human cells is ∼100 to 200 pM 4. Upon binding to EPO-R on the surface of erythroid progenitor cells, a conformational shift is produced which brings EPO-R-associated Janus family tyrosine-protein kinase 2 (JAK2) molecules into close contact. JAK2 molecules are subsequently activated by phosphorylation, then phosphorylate tyrosine residues in the cytoplasmic domain of the EPO-R that serve as docking sites for Src homology 2-domain-containing intracellular signaling proteins 3.Â
The signaling proteins include STAT5 that once phosphorylated by JAK2, dissociates from the EPO-R, dimerizes, and translocates to the nucleus where they serve as transcription factors to activate target genes involved in cell division or differentiation, including the apoptosis inhibitor Bcl-x 3. The suppression of apoptosis by the EPO-activated JAK2/STAT5/Bcl-x pathway is crucial in erythroid development. Via JAK2-mediated tyrosine phosphorylation, erythropoietin and epoetin alfa also activate additional intracellular proteins important in erythroid cell proliferation and survival, such as Shc, phosphatidylinositol 3-kinase (PI3K), and phospholipase C-γ1 3.
Dosage of Epoetin
For injectable dosage form:
For anemia from chemotherapy:
Adults—Dose is depending on body weight and must be set by your doctor. The beginning dose is 150 units per kilogram (kg) injected under the skin three times a week or 40,000 units administered under the skin once a week. Your doctor may alter the dose as needed.
Children 5 years of age and older—Dose is depending on body weight and must be set by your doctor. The starting dose is 600 units per kg injected into a vein once a week. Your doctor may alter the dose as needed.
Children fewer than 5 years of age—Use and dose must be determined by your doctor.
For anemia from chronic renal failure on dialysis:
Adults—Dose is depending on body weight and must be set by your doctor. The first dose is 50 to 100 units per kilogram (kg) injected into a vein or under the skin three times a week. Your doctor may alter the dose as needed.
Children 1 month to 16 years of age—
Dose is depending on body weight and must be set by your doctor. The starting dose is 50 units per kilogram injected into a vein or under the skin three times a week. Your doctor may alter the dose as needed.
Children younger than 1 month of age—Use and dose must be determined by your doctor.
For anemia from chronic renal failure not on dialysis:
Adults—Dose is depending on body weight and must be set by your doctor. The first dose is 50 to 100 units per kilogram (kg) injected into a vein or under the skin three times a week. Your doctor may alter the dose as needed.
Children—Use and dose must be determined by your doctor.
For anemia from HIV therapy:
Adults—Dose is depending on body weight and must be set by your doctor. The starting dose is 100 units per kilogram (kg) injected into a vein or under the skin three times a week for 8 weeks. Your doctor may alter the dose as needed.
Children—Use and dose must be determined by your doctor.
For anemia from surgery:
Adults—Dose is depending on body weight and must be set by your doctor. The starting dose is 300 units per kilogram (kg) injected under the skin for 10 days before the surgery, on the day of the surgery, and for 4 days after surgery.
Children—Use and dose must be determined by your doctor.
Administration of Epoetin
IV Incompatibilities
Solution: D10W
IV Preparation
For minimal dilution, mix with bacteriostatic NS containing 20 mL NS and benzyl alcohol as bacteriostatic agent in 1:1 ratio
Administration
- Do not administer vials admixed with bacteriostatic saline containing benzyl alcohol to pregnant females, lactating females, neonates, or infants
- Single-dose vial: pH 6.6-7.2
- Multidose vial: pH 5.8-6.4
- Administer by direct injection without dilution
- Do not mix with other drugs
- Do not shake
- The drug may be given via venous return line of dialysis tubing after dialysis to eliminate the need for additional IV access
Epoetin side effects
The following side effects are common (occurring in greater than 30 percent ) for patients taking epoetin alfa:
- High blood pressure
- Fever
- Nausea
- Vomiting
These are less common side effects (occurring in 10-29 percent ) for patients receiving epoetin alfa:
- Headache
- Rash
- Itching
- Joint aches
- Cough
Interaction with other medications
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
Precautions/ safety information
- Before starting epoetin alfa treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter drugs, vitamins, or herbal remedies).
- Epoetin alfa should be used with caution in people with high blood pressure or heart disease.
- Inform your health care provider if you are pregnant or may be pregnant prior to starting this treatment.
- Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- For nursing women, consult your physician to determine if it is recommended to continue breast feeding
Storage
Store at 36°F to 46°F (2°C to 8°C). Do not freeze. Do not shake. Do not use Epogen that has been shaken or frozen.
Contraindications
Epoetin alfa is contraindicated in patients with serious allergic reactions, such as anaphylactic reactions, angioedema, bronchospasm, skin rash, and urticaria, to the product. Immediately and permanently discontinue epoetin alfa and administer appropriate therapy if a hypersensitivity reaction occurs.
Pregnancy or lactation
Inform your doctor if you are currently breastfeeding or plan to start.
Epoetin alfa does not cross into human milk. Because many medications pass into human milk and because this medication may cause serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue use of this medication. Your doctor will determine whether the benefits of using epoetin alfa outweigh the risks.
