epoetin alfa (EPO, erythropoietin)

(e poe e' tin)

Epogen, Eprex (CAN), Procrit

 

Pregnancy Category C

 

Drug class

Recombinant human erythropoietin

 

Therapeutic actions

A natural glycoprotein produced in the kidneys, which stimulates RBC production in the bone marrow.

 

Indications

        Treatment of anemia associated with chronic renal failure, including patients on dialysis

        Treatment of anemia of renal failure requiring dialysis ages 1 mo–16 yr; not recommended for < 1 mo

        Treatment of anemia related to therapy with AZT in HIV-infected patients

        Treatment of anemia related to chemotherapy in cancer patients

        Reduction of allogenic blood transfusions in surgical patients

        Unlabeled use: Pruritus associated with renal failure; to decrease the number of RBC transfusions in critically ill infants who have anemia of prematurity, myelodysplastic syndrome, chronic inflammation associated with rheumatoid arthritis

 

Contraindications and cautions

        Contraindicated with uncontrolled hypertension; hypersensitivity to mammalian cell-derived products or to albumin human.

        Use cautiously with pregnancy, lactation.

 

Available forms

Injection—2,000, 3,000, 4,000, 10,000, 20,000, 40,000 units/mL

 

Dosages

ADULTS

        Anemia of chronic renal failure: Starting dose: 50–100 units/kg three times weekly, IV for dialysis patients and IV or subcutaneously for nondialysis patients. Reduce dose if Hct increases > 4 points in any 2-wk period. Increase dose if Hct does not increase by 5–6 points after 8 wk of therapy. For maintenance dose, individualize based on Hct, generally 25 units/kg three times weekly. Target Hct range 30%–36%.

        Treatment of anemia in HIV-infected patients on AZT therapy: For patients receiving AZT dose < 4,200 mg/wk with serum erythropoietin levels < 500 mU/mL, use 100 units/kg IV or subcutaneously three times/wk for 8 wk; when desired response is achieved, titrate dose to maintain Hct with lowest possible dose.

        Treatment of anemia in cancer patients on chemotherapy (Procrit only): 150 units/kg subcutaneously three times/wk; after 8 wk, can be increased to 300 units/kg.

        Reduction of allogenic blood transfusions in surgery: 300 units/kg/day subcutaneously for 10 days before surgery, on day of surgery, and 4 days after surgery. Ensure Hgb is > 10–< 13 g/dL

PEDIATRIC PATIENTS 1 MO–16 YR

        Chronic renal failure on dialysis: 50 mcg/kg IV or subcutaneously three times/wk.

        Anemia of prematurity: 25–100 units/kg/dose three times/wk.

 

Pharmacokinetics

Route

Onset

Peak

Duration

SC

7–14 days

5–24 hr

24 hr

 

Metabolism: Serum; T1/2: 4–13 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

 

IV facts

Preparation: As provided; no additional preparation. Enter vial only once; do not shake vial. Discard any unused solution. Refrigerate.

Infusion: Administer by direct IV injection or into tubing of running IV.

Incompatibilities: Do not mix with any other drug solution.

 

Adverse effects

        CNS: Headache, arthralgias, fatigue, asthenia, dizziness, seizure, CVA, TIA

        CV: Hypertension, edema, chest pain

        GI: Nausea, vomiting, diarrhea

        Other: Clotting of access line

 

Nursing considerations

Assessment

        History: Uncontrolled hypertension, hypersensitivity to mammalian cell-derived products or to albumin human, lactation

        Physical: Reflexes, affect; BP, P; urinary output, renal function; renal function tests; CBC, Hct, iron levels, electrolytes

 

Interventions

        Confirm chronic, renal nature of anemia; not intended as a treatment of severe anemia or substitute for emergency transfusion.

        Gently mix; do not shake, shaking may denature the glycoprotein. Use only one dose per vial; do not reenter the vial. Discard unused portions.

        Do not give with any other drug solution.

        Administer dose three times per week. If administered independent of dialysis, administer into venous access line. If patient is not on dialysis, administer IV or subcutaneously.

        Monitor access lines for signs of clotting.

        Arrange for Hct reading before administration of each dose to determine dosage. If patient fails to respond within 8 wk of therapy, evaluate patient for other etiologies of the problem.

        Evaluate iron stores prior to and periodically during therapy. Supplemental iron may need to be ordered.

        Institute seizure precautions.

 

Teaching points

        Drug must be given three times per week and can only be given intravenously, subcutaneously, or into a dialysis access line. Prepare a schedule of administration dates.

        Keep appointments for blood tests necessary to determine the effects of the drug on your blood count and to determine dosage.

        Maintain all of the usual activities and restrictions that apply to your chronic renal failure. If this becomes difficult, consult with your health care provider.

        You may experience these side effects: Dizziness, headache, seizures (avoid driving or performing hazardous tasks); fatigue, joint pain (may be medicated); nausea, vomiting, diarrhea (proper nutrition is important).

        Report difficulty breathing, numbness or tingling, chest pain, seizures, severe headache.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.