Epoetin

Epoetin - (recombinant human erythropoetin) is available as epoetin alfa and beta. Both are similar in clinical efficacy and can be used interchangeably.

Uses
Anaemia associated with erythropoetin deficiency in chronic renal failure
Severe anaemia due to blood loss in Jehovah’s Witness (unlicensed)

Contraindications
Uncontrolled hypertension
Anaemia due to iron, folic acid or vitamin B12 deficiency

Administration
• Chronic renal failure
Aim to increase haemoglobin concentration at rate not > 2 g/100 ml per month to stable level of 10–12 g/100 ml
SC (maximum 1 ml per injection site) or IV given over 3–5 min
Initially 50 units/kg three times weekly increased according to response in steps of 25 units/kg at intervals of 4 weeks
Maintenance dose (when haemoglobin 10–12 g/100 ml) 50–300 units/kg weekly in 2–3 divided doses

• Severe anaemia due to blood loss in Jehovah’s Witness
150–300 units/kg daily SC until desired haemoglobin reached
Supplementary iron (e.g. ferrous sulphate 200 mg PO) and O2 is mandatory
Monitor: BP, haemoglobin, serum ferritin, platelet, and electrolytes

How not to use epoetin
Avoid contact of reconstituted injection with glass; use only plastic materials

Adverse effects
Dose-dependent increase in BP and platelet count
Flu-like symptoms (reduced if IV given over 5 min)
Shunt thrombosis
Hyperkalaemia
Increase in plasma urea, creatinine and phosphate
Convulsions
Skin reactions
Palpebral oedema
Myocardial infarction
Anaphylaxis

Cautions
Hypertension (stop if uncontrolled)
Ischaemic vascular disease
Thrombocytosis (monitor platelet count for first 8 weeks)
Epilepsy
Malignant disease
Chronic liver disease