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Epoetin is a prescription medicine and synthetic version of erythropoietin, used to treat anemia by stimulating cells in the bone marrow; Epoetin is used to produce additional red blood cells. The body normally produces the protein erythropoietin in the kidneys, when the body identifies insufficient oxygen or insufficient red blood cells. An epoetin injection is used as treatment for anemia when the body's normal mechanism for creating red blood cells is not working. Certain health conditions and medical treatment can cause anemia, and epoetin injection treatments can manage the anemia. Epoetin is used to treat individuals with ESRD, chronic kidney failure, who are on dialysis, or will be soon, and have developed anemia, as a result. Those with cancer, and anemia from chemotherapy treatments are treated with epoetin. Individuals suffering from HIV, who are also receiving zidovudine treatment receive epoetin injections, to address the resulting anemia. Epoetin is also used to treat individuals throughout or after certain surgeries in order to minimize the number of required blood transfusions.
Epoetin suggested dosing requirements were modified based on studies on patients with anemia, resulting from chronic kidney disease, showing increased risk of cardiovascular reactions and death. The suggested dosing of epoetin should occur only when the patient's hemoglobin (hb) measurement is less than 10 g/dL. It is recommended that patients with chronic kidney failure, on hemodialysis, receive intravenous dosing with epoetin:
- 50 to 100 units per kg subcutaneous or intravenous delivery, 3 times each week.
Dosage for anemia with chemotherapy only if patient hb < 10 g/dL:
- Initial dose: 150 units per kg subcutaneously 3 times each week or 40,000 units subcutaneously once each week until completion of chemotherapy treatment course.
Dosage for HIV patients receiving Zidovudine treatment:
- 100 units per kg subcutaneously or intravenously 3 times each week.
Dosage prior to surgery to reduce the need for blood transfusions:
- 300 units per kg per day subcutaneously for 10 days prior to, on the day of, and 4 days following surgery, for 14 days of epoetin treatment in total, for patients with hb between 10 and 13 g/dL.
- Alternate dosing: 600 units per kg subcutaneously, dosing once each week on 21, 14 and 7 days prior to, and on the day of surgery.
Epoetin Side Effects
Some epoetin side effects may be more likely to occur in patients with chronic kidney failure or following chemotherapy treatments for cancer, including the possibility of death. The lowest possible dose of epoetin should be prescribed in each instance. In all patients receiving epoetin treatments there is the risk of heart problems, heart attack, stroke, heart failure and death if dosing occurs when hb > 12 g/dL. Blood clots may occur from epoetin treatment. Those undergoing surgery may benefit from taking a blood thinner, in addition to epoetin, to reduce risk of a blood clot or deep vein thrombosis, after surgery. Most common side effect in patients with chronic kidney failure:
- High blood pressure
- Joint pain
- Clotting at injection site
- Common side effects among surgery patients with anemia:
- Skin reaction
Common side effects among chemotherapy patients:
- Swelling of tissue
- Shortness of breath
- Upper respiratory infection
Rare side effect for all patients:
- Stinging at injection site
- Flu symptoms including joint and muscle pain
Rare allergic reactions include:
- Heart attack
- Pulmonary embolism
There are 25 drugs, 63 brand and generic drugs, with interactions with epoetin. 3 are major, serious drug interactions, 1 is moderate and 21 are minor drug interactions, associated with epoetin. Patients with known hypersensitivity to albumin should avoid epoetin, as should those with uncontrolled hypertension. Drug interactions can occur when there is a change in the absorption, distribution and elimination of the drug from or in the body. The body's metabolism can also make alterations to the drug, including epoetin. Drug-to-drug interactions: