Epoetin Alfa

Erythropoietin Products · Recombinant human erythropoietin

Indications

Anaemia associated with chronic renal failure in haemodialysis, in adults on peritoneal dialysis and non-dialysed adults. Anaemia and reduction of transfusions in adults receiving chemotherapy for solid tumours, malignant lymphoma or multiple myeloma. To increase yield of autologous blood. To reduce exposure to allogenic blood transfusions in adults prior to major elective orthopaedic surgery with high risk of transfusion complications.

Dosage

Haemodialysis: Adults: Initially 50 IU/kg three times per wk by SC or IV inj following dialysis. Increase if necessary by 25 IU/kg three times per wk every 4 wk to achieve a Hb 10-12 gm/dl. Maintenance, 75-300 IU/kg per wk. Children: Initially 50 IU/kg three times per wk by IV inj following dialysis. Increase if necessary by 25 IU/kg three times per wk every 4 wk to achieve a Hb 9.5-11 gm/dl. Maintenance, under 10 kg, 75-150 IU/kg; 10-30 kg, 60-150 IU/kg; over 30 kg, 30-100 IU/kg. All three times per wk. Peritoneal dialysis: Adults: 50 IU/kg twice wkly by IV inj increase if necessary by 25 IU/kg twice wkly every 4 wk to achieve a Hb 10-12 gm/dl. Maintenance, 25-50 IU/kg per wk in two divided doses. Non-dialysis: Adults: Initially 50 IU/kg three times per wk by IV inj. Increase if necessary by 25 IU/kg three times per wk every 4 wk to achieve a Hb 10-12 gm/dl. Maintenance, 17-33 IU/kg…

Administration

IV: Patients with CRF on dialysis: May be administered IV Bolus into the venous line after dialysis. Patients with CRF not on dialysis: May be administered IV or SC. Single-dose 1 mL vial contains no preservative. Use one dose per vial. Do not re-enter vial. Discard unused portions. Multidose 1 mL or 2 vial contains preservative. For minimal dilution, mix with bacteriostatic 0.9% sodium chloride, containing 20 mL of 0.9% sodium chloride and benzyl alcohol as the bacteriostatic agent. Dilutions of 1:10 and 1:20 (1 part epoetin: 19 parts sodium chloride) are stable for 18 hours at room temperature. Results showed no loss of epoetin alfa after a 1:20 dilution. 250 mcg/ mL albumin remaining after a 1:10 dilution of formulated epoetin alfa should be sufficient to prevent it from binding to commonly encountered containers. Prior to SC administration, preservative free solutions may be mixed…

Adverse Effects

Raised BP, headache, thrombosis, flu-like symptoms, seizures, skin reactions, rash, stroke, GI upset, palpebral oedema, musculoskeletal pain, cough, pyrexia. Rarely, pure red cell aplasia; withdraw and do not transfer to other erythropoietins. Inj site reactions.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Uncontrolled hypertension. Severe coronary, peripheral arterial, carotid or cerebral vascular disease in patients scheduled for major elective orthopaedic surgery and not participating in autologous blood donation. Patients unable to receive antithrombin prophylaxis. Pure red cell aplasia following erythropoietin therapy. Precautions: Hypertension; Carefully monitor BP and discontinue treatment if BP uncontrolled. Ischaemic vascular disease, epilepsy, chronic hepatic disease, porphyria. Thrombocytosis; monitor platelet count for first 8 weeks. Correct other causes of anaemia before treatment; iron supplements may be necessary. Risk of thromboembolic events; monitor Hb levels. Chronic Renal Failure Patients: Regularly monitor for loss of efficacy in patients administered r-HuEPOs…

Interactions

Drugs highly bound to red cells e.g. Cyclosporin.

Advice to Patient

If patient is self-administering this medication, exact directions for administration of injection and needle disposal must be followed. Contact prescriber if there are signs of edema (swollen extremities, respiratory difficulty, rapid weight gain), onset of severe headache, acute back pain, rash, chest pain, muscular tremors or seizure activity. Do not re-use needles. Eat adequate quantities of iron-rich foods. Do not make changes in dietary iron without consulting prescriber. Get blood tests done as recommended by prescriber.

Pharmacokinetics

Onset of action: Reticulocyte count increase: Within 10 days. Peak effect: Haemoglobin level: 2-6 wks. Absorption: SC: Slow. Metabolism: Some degradation does occur. Bioavailability: SC: Premature neonates: 42%. Adults: 36%. Intraperitoneal epoetin alfa: 3%. Half-life elimination: Neonates: With high doses, nonlinear kinetics have been observed. Anaemia of prematurity: Post menstrual age (PMA) <32 week (weight: 800 ± 206 gm): IV: 8.1 ± 2.7 hrs. SC: 7.1 ± 4.1 hrs. PMA = 32 wks (weight: 1330-1740 gm): SC: Median: 7.9 hrs. (range: 5.6-19.4 hrs). Neuroprotective /hypoxic ischaemia encephalopathy: = 36 wks GA; IV: 250 units/kg: 7.6 ± 6.9 hrs. 500 units/kg: 7.2 ± 1.9 hrs. 1000 units/kg: 15 ± 4.5 hrs. 2500 units/kg: 18.7 ± 4.7 hrs. Infants, children and adolescents: Chronic kidney disease: IV: 4-13 hrs. Adults: Cancer: SC: 16-67 hrs; Chronic kidney disease: IV: 4-13 hrs. Time to peak, serum:…

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.