Other Brands/Names

Binocrit, Eprex, Epodion, Eporon, Erykine, Hemapo, Recormon, Renogen.

How It Works

Epoetin alfa is a synthetic (artificial) version of the body’s natural hormone erythropoietin and belongs to the erythropoiesis-stimulating agent (ESA) class. Erythropoietin is produced by the kidneys and promotes red blood cell production in the bone marrow.

Other ESAs include epoetin beta, epoetin zeta, darbepoetin alfa, and methoxy polyethylene glycol-epoetin beta.

Indications

In kidney disease, anemia (low red blood cells) can occur due to:

• Reduced renal production of erythropoietin.

• Poor responsiveness to endogenous erythropoietin.

In these situations, epoetin alfa can be used to increase hemoglobin or red blood cell levels. This medicine is commonly given to chronic kidney disease patients on dialysis, but may also be used in non-dialysis patients with severe, symptomatic anemia caused by renal impairments.

Epoetin alfa is also used for:

• Patients undergoing major orthopedic surgery who are at risk of anemia because of large transfusion needs.

• Patients receiving chemotherapy for solid tumors, malignant lymphoma, or multiple myeloma.

• Patients donating their own blood prior to surgery.

• Patients with myelodysplastic syndrome and symptomatic anemia with low erythropoietin levels.

• People with HIV treated with zidovudine.

This medicine is not a substitute for red blood cell transfusion in severe anemia and has not been shown to improve fatigue or weakness caused by anemia.

Contraindication

• Severe, uncontrolled hypertension.

• Hypersensitivity to albumin (a blood protein) or products derived from mammalian sources.

• Pure red cell aplasia (PRCA) following prior erythropoietin therapy, due to anti-erythropoietin antibodies that suppress red cell production without affecting other blood cell lines.

Side Effects

Not everyone experiences adverse effects, but the most common (up to >1 in 10) include:

• Diarrhea

• Abdominal discomfort

• Vomiting

• Fever

• Sore throat

• Nasal congestion

In patients with kidney disease, a very rare effect (about 1 in 1,000) is PRCA, which causes sudden, severe anemia with unusual fatigue, dizziness, and shortness of breath. This generally occurs after months to years of ESA exposure.

Types

Pre-filled syringes containing injectable solution in multiple strengths, typically 2,000 IU to 40,000 IU.

Dosage

Anemia in chronic kidney disease:

Adults

• Initial dose: 50 IU/kg three times weekly by IV or SC injection.

• Increase the dose by 25 IU/kg every 4 weeks until the target hemoglobin is achieved.

Children

• Initial dose: 50 IU/kg by IV injection.

• Increase the dose by 25 IU/kg every 4 weeks until the target hemoglobin is achieved.

Safety

Pregnancy category C: Data in human studies is inadequate; animal studies report fetal risk. Use only if the potential benefit justifies the potential risk. (Information on excretion in human milk is limited, so please consult your doctor if you are currently breastfeeding.)

Drug Interactions

No clear evidence that epoetin alfa alters the metabolism of other medicines. However, because ciclosporin binds to red cells, its serum concentration may rise when used with epoetin alfa; monitoring may be required.

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