epoetin

Contraindicated in:

Hypersensitivity to albumin or mammalian cell-derived products;
Uncontrolled hypertension;
Erythropoietin levels >200 mUnits/mL;
Patients with cancer receiving hormonal agents, biologic products, or radiotherapy, unless also receiving concomitant myelosuppressive chemotherapy;
Patients receiving chemotherapy when anticipated outcome is cure;
Patients with cancer receiving myelosuppressive chemotherapy in whom the anemia can be managed by transfusion;
Patients who require immediate correction of anemia when RBC transfusions can be used instead;
Patients scheduled for surgery who are willing to donate autologous blood;
Patients undergoing cardiac or vascular surgery;
OB: Multidose vials should not be used as they contain benzyl alcohol and may cause fatal gasping syndrome in fetus in utero and breastfed infants;
Pedi: Neutropenia in newborns; multidose vials should not be used in neonates and infants, as they contain benzyl alcohol, which can cause potentially fatal gasping syndrome.

Use Cautiously in:

History of seizures or stroke;
Cardiovascular disease;
History of porphyria;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, HF, MI, THROMBOEMBOLIC EVENTS (ESPECIALLY WITH HGB >11 G/DL)

Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, transient rash

Endo: restored fertility, resumption of menses

Neuro: headache, SEIZURES, STROKE

Misc: ↑MORTALITY AND ↑ TUMOR GROWTH (ESPECIALLY WITH HGB >12 G/DL)

Interactions ⬆ ⬇

Drug-drug:

May ↑ requirement for heparin anticoagulation during hemodialysis.

Availability ⬆ ⬇

Solution for injection: 2,000 units/mL; 3,000 units/mL; 4,000 units/mL; 10,000 units/mL; 20,000 units/mL; 40,000 units/mL
Solution for injection (prefilled syringes): 1,000 units/0.5 mL; 2,000 units/0.5 mL; 3,000 units/0.3 mL; 4,000 units/0.4 mL; 5,000 units/0.5 mL; 6000 units/0.6 mL; 8,000 units/0.8 mL; 10,000 units/1 mL; 20,000 units/0.5 mL; 30,000 units/0.75 mL; 40,000 units/1 mL

Route/Dosage ⬆ ⬇

Anemia of Chronic Kidney Disease

(Do not initiate if Hgb ≥10 g/dL)
SC IV (Adults ): 50–100 units/kg 3 times weekly initially; use lowest dose sufficient to ↓ the need for RBC transfusions (do not exceed Hgb of 11 g/dL [patients on dialysis] or 10 g/dL [patients not on dialysis]); if Hgb ↑ by >1.0 g/dL in 2 wk, ↓ dose by 25%; if Hgb ↑ by <1.0 g/dL after 4 wk of therapy (with adequate iron stores), ↑ dose by 25%; do not ↑ dose more frequently than every 4 wk.
SC IV (Children 1 mo–16 yr): 50 units/kg 3 times weekly initially; use lowest dose sufficient to ↓ the need for RBC transfusions (do not exceed Hgb of 12 g/dL; if Hgb ↑ by >1.0 g/dL in 2 wk, ↓ dose by 25%; if Hgb ↑ by <1.0 g/dL after 4 wk of therapy (with adequate iron stores), ↑ dose by 25%; do not ↑ dose more frequently than every 4 wk.

Anemia Secondary to Zidovudine Therapy

SC IV (Adults ): 100 units/kg 3 times weekly for 8 wk; if inadequate response, may ↑ by 50–100 units/kg every 4–8 wk (max: 300 units/kg 3 times weekly).
SC IV (Children 8 mo–17 yr): 50–400 units/kg 2–3 times weekly.

Anemia From Chemotherapy

(Use only for chemotherapy-related anemia and discontinue when chemotherapy course is completed; do not initiate if Hgb ≥10 g/dL)
SC (Adults ): 150 units/kg 3 times weekly or 40,000 units weekly; adjust dose to maintain lowest Hgb level sufficient to avoid RBC transfusions (do not exceed Hgb of 12 g/dL); if Hgb ↑ by >1.0 g/dL in 2 wk or reaches a level needed to avoid RBC transfusions, ↓ dose by 25%; if Hgb ↑ by <1.0 g/dL (and remains <10 g/dL) after initial 4 wk of therapy (with adequate iron stores), ↑ dose to 300 units/kg 3 times weekly or 60,000 units weekly.
IV (Children 5–18 yr): 600 units/kg weekly; adjust dose to maintain lowest hemoglobin level sufficient to avoid RBC transfusions (do not exceed Hgb of 12 g/dL); if Hgb ↑ by >1.0 g/dL in 2 wk or reaches a level needed to avoid RBC transfusions, ↓ dose by 25%; if Hgb ↑ by <1.0 g/dL (and remains <10 g/dL) after initial 4 wk of therapy (with adequate iron stores), ↑ dose to 900 units/kg (maximum = 60,000 units) weekly.

Surgery

SC (Adults ): 300 units/kg/day for 10 days before surgery, day of surgery, and 4 days after or 600 units/kg 21, 14, and 7 days before surgery and on day of surgery.

US Brand Names ⬆ ⬇

Epogen, Procrit, Retacrit

Action ⬆ ⬇

Stimulates erythropoiesis (production of RBCs).

Therapeutic effects:

Maintains and may elevate RBCs, decreasing the need for transfusions.

Classifications ⬆ ⬇

Therapeutic Classification: antianemics

Pharmacologic Classification: hormones, erythropoiesis stimulating agents (ESA)

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after SUBQ administration.

Distribution: Concentrated in kidneys, liver, and bone marrow.

Metabolism/Excretion: Unknown.

Half-Life: Children and Adults: 4–13 hr; Neonates: 11–17 hr.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(increase in RBCs)

ROUTE	ONSET‡	PEAK	DURATION
IV, SUBQ	7–10 days	within 2 mo	2 wk‡

‡Increase in reticulocytes.

‡After discontinuation.

Patient/Family Teaching ⬆ ⬇

Advise patient to read the Medication Guide prior to initiating therapy and with each Rx refill in case of changes. Patient must sign the patient–health care provider acknowledgment form before each course of therapy.
Explain rationale for concurrent iron therapy (increased RBC production requires iron).
- Discuss ways of preventing self-injury in patients at risk for seizures. Driving and activities requiring continuous alertness should be avoided.
- Inform patient that use of epoetin may result in shortened overall survival and/or ↓ time to tumor progression.
- Advise patient to notify health care professional immediately if signs and symptoms of blood clots (chest pain, trouble breathing or shortness of breath; pain in the legs, with or without swelling; a cool or pale arm or leg; sudden confusion; trouble speaking or trouble understanding others’ speech; sudden numbness or weakness in the face, arm, or leg, especially on one side of the body; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance or coordination; loss of consciousness or fainting; hemodialysis vascular access stops working), allergic reactions (rash, itching, shortness of breath, wheezing, dizziness and fainting, swelling around mouth or eyes, fast pulse, sweating), skin reactions (blisters, skin sores, peeling, or areas of skin coming off) occur.
- Advise patient to inform health care professional of medication prior to treatment or surgery.
- Discuss possible return of menses and fertility with health care professional. Advise female patients of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Anemia of CKD: Stress importance of compliance with dietary restrictions, medications, and dialysis. Foods high in iron and low in potassium include liver, pork, veal, beef, mustard and turnip greens, peas, eggs, broccoli, kale, blackberries, strawberries, apple juice, watermelon, oatmeal, and enriched bread. Epoetin will result in increased sense of well-being, but it does not cure underlying disease.
Home Care Issues: Home dialysis patients determined to be able to safely and effectively administer epoetin should be taught proper dosage, administration technique, and disposal of equipment. Information for Home Dialysis Patients should be provided to patient along with medication.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

55513- Amgen Inc
- 55513-126- EPOGEN
  - 55513-126-10- 10 VIAL in 1 PACKAGE (55513-126-10) > 1 mL in 1 VIAL (55513-126-01)

55513- Amgen Inc
- 55513-144- EPOGEN
  - 55513-144-10- 10 VIAL in 1 PACKAGE (55513-144-10) > 1 mL in 1 VIAL (55513-144-01)

55513- Amgen Inc
- 55513-148- EPOGEN
  - 55513-148-10- 10 VIAL in 1 PACKAGE (55513-148-10) > 1 mL in 1 VIAL (55513-148-01)

55513- Amgen Inc
- 55513-267- EPOGEN
  - 55513-267-10- 10 VIAL in 1 PACKAGE (55513-267-10) > 1 mL in 1 VIAL (55513-267-01)

55513- Amgen Inc
- 55513-283- EPOGEN
  - 55513-283-10- 10 VIAL in 1 PACKAGE (55513-283-10) > 2 mL in 1 VIAL (55513-283-01)

55513- Amgen Inc
- 55513-478- EPOGEN
  - 55513-478-10- 10 VIAL in 1 PACKAGE (55513-478-10) > 1 mL in 1 VIAL (55513-478-01)

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Indications ⬇

Contraind./Precautions ⬆ ⬇