• Monitor BP before and during therapy. Inform health care professional if severe hypertension is present or if BP begins to ↑. Additional antihypertensive therapy may be required during initiation of therapy.
• Monitor for symptoms of anemia (fatigue, dyspnea, pallor).
• Monitor dialysis shunts (thrill and bruit) and status of artificial kidney during hemodialysis. Heparin dose may need to be increased to prevent clotting. Monitor patients with underlying vascular disease for impaired circulation.
• Monitor patients for signs and symptoms of severe cutaneous adverse reactions, including SJS (fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis) and TEN (prodrome of fever, flu-like symptoms, mucosal lesions, progressive skin rash, lymphadenopathy). If a severe cutaneous adverse reaction is suspected, discontinue therapy and provide supportive care.
• Monitor for signs and symptoms of venous thromboembolism such as PE (chest pain, dyspnea, tachycardia), DVT (calf pain or tenderness, lower extremity edema, localized warmth or erythema), or stroke (headache, facial numbness, unilateral weakness, aphasia, eye pain or swelling, vision changes). Discontinue therapy if suspected.

Lab Test Considerations:

• May cause ↑ WBCs and platelets. May ↓ bleeding times.
  • Monitor serum ferritin, transferrin, and iron levels to assess need for concurrent iron therapy. Administer supplemental iron therapy when serum ferritin <100 mcg/L or when serum transferrin saturation <20%.
  • Monitor Hgb weekly until the Hgb level is stable and sufficient to minimize the need for RBC transfusion after starting therapy and after each dose adjustment.
• Anemia of Chronic Kidney Disease: Monitor Hgb at least weekly until stable and then at least monthly. Do not ↑ dose more frequently than once every 4 wk. A ↓ in dose can be made more frequently. Avoid frequent dose adjustments. If Hgb ↑ >12 g/dL in a 2-wk period,↓ dose by 25% or more. If Hgb ↑ by <1 g/dL over 4 wk (and iron stores are adequate),↑ dose by 25%. If no response after 12 wk of escalation, further dose ↑ is unlikely to improve response and may ↑ risks. Use lowest dose that will maintain Hgb level sufficient to reduce need for RBC transfusions.
  • Adults With Anemia of Chronic Kidney Disease on DialysisStart epoetin when Hgb >10 g/dL. If Hgb ≥11 g/dL, ↓ or hold dose.
  • Adults With Anemia of Chronic Kidney Disease Not on DialysisStart epoetin only when Hgb <10 g/dL AND rate of Hgb decline indicates likelihood of requiring a RBC transfusion AND ↓ risk of alloimmunization and/or other RBC transfusion-related risks is a goal. If Hgb level >10 g/dL, ↓ or hold dose, and use lowest epoetin dose sufficient to ↓ need for RBC transfusions.
  • Children With Anemia of Chronic Kidney DiseaseStart epoetin only when Hgb <10 g/dL. If Hgb level >12 g/dL, ↓ or hold dose.
  • Monitor renal function and electrolytes closely; resulting ↑ sense of well-being may lead to ↓ compliance with other therapies for renal failure. ↑ in BUN, serum creatinine, uric acid, phosphorus, and potassium may occur.
• Anemia Secondary to Zidovudine Therapy: Before initiating therapy, determine serum erythropoietin level before transfusion. Patients receiving zidovudine with endogenous serum erythropoietin levels >500 mUnits/mL may not respond to therapy. If Hgb does not ↑ after 8 wk of therapy,↑ dose by 50–100 units/kg at 4–8 wk intervals until Hgb reaches level needed to avoid RBC transfusions or 300 units/kg. If Hgb ≥12 g/dL, hold dose until Hgb ↓ to <11 g/dL; then ↓ dose by 25%. If ↑ in Hgb is not achieved at a dose of 300 Units/kg for 8 wk, discontinue therapy.
• Anemia From Chemotherapy: Start epoetin only if Hgb ≥10 g/dL and there is an additional 2 mo of planned chemotherapy. Patients with lower baseline serum erythropoietin levels may respond more rapidly; not recommended if levels >200 mUnits/mL. If Hgb ↑ by >1 g/dL in any 2-wk period or Hgb reaches level needed to avoid RBC transfusion,↓ dose by 25%. If Hgb ↑ by <1 g/dL after 4 wk in absence of RBC transfusion and remains <10 g/dL,↑ dose to 300 units/kg three times per wk in adults or 60,000 units weekly (adults) or 900 units/kg (max: 60,000 units) in children. If no response in Hgb levels or if RBC transfusions are still required after 8 wk of therapy, discontinue epoetin.
• Surgery: Implement prophylaxis of venous thromboembolism during therapy.