Dosage/Direction for Use
Parenteral Anaemia of chronic renal failure Adult: In predialysis and haemodialysis: Initially, 50 IU/kg 3 times weekly via IV Inj over at least 1-5 minutes or as slow IV Inj in patients who have flu-like symptoms as adverse effect. May also be given via SC inj. Doses may be increased in increments of 25 units/kg at 4-week intervals until the target is reached. In peritoneal dialysis: Initially, 50 units/kg SC twice weekly. Weekly maintenance dose: Predialysis: Total max: 450 units/kg in 3 divided doses. Alternatively, max 20,000 units via SC injection given once weekly or once every 2 weeks. Haemodialysis: 75-300 units/kg in 3 divided doses. Peritoneal dialysis: 50-100 units/kg in 2 divided doses. Child: Haemodialysis: Initially, 50 units/kg 3 times weekly, given via IV inj. May increase dose by increments of 25 units/kg at 4-week intervals until the target Hb conc is reached (9.5-11 g/mL). Total weekly maintenance dose: Haemodialysis: <30 kg: 90-300 units/kg; 10-30 kg: 180-450 units/kg; >10 kg: 225-450 units/kg. To be given in 3 divided doses. Parenteral Anaemia in zidovudine-treated HIV-infected patients Adult: Titrate dose for patients individually so as to achieve and maintain the lowest haemoglobin level sufficient to avoid the need for blood transfusion and not to exceed 12 g/dL. For patients with serum erythropoietin levels ≤500 mUnits/mL who are receiving zidovudine dose ≤4200 mg/wk: Starting dose: 100 units/kg via SC/IV Inj 3 times a wk for 8 wk, may increase by 50-100 units/kg 3 times a wk at 4-8 wk intervals according to response. Not recommended to administer doses >300 units/kg 3 times a wk. Intravenous Increase yield of autologous blood Adult: 600 units/kg 2 times a wk starting 3 wk before surgery. May be used in conjunction with an iron supplement. Subcutaneous Anaemia related to non-myeloid malignant disease chemotherapy Adult: Initially, 150 units/kg 3 times weekly or 450 units/kg once weekly, increased after 4-8 weeks to 300 units/kg 3 times weekly, if necessary. Alternatively, 40,000 units once weekly, may increase to 60,000 once weekly units after 4 weeks if necessary. Stop treatment if response is still inadequate after 4 weeks of treatment at this higher dose. Subcutaneous To reduce the need for allogeneic blood transfusion Adult: 600 units/kg once wkly starting 3 wk before surgery with the 4th dose given on the day of the surgery or 300 units/kg daily starting 10 days before surgery and for 4 days after. |
Contraindications
Hypersensitivity to albumin (human) or mammalian cell-derived products; uncontrolled hypertension.
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Special Precautions
Hypertension; history of seizures; thrombocytosis; chronic liver failure; poor renal function; ischaemic vascular disease; malignant tumours. Increased risk of thrombotic events. Monitor BP during treatment. Regularly monitor platelet counts and serum-potassium concentration. Iron deficiency, infection or inflammatory disorders, haemolysis, or aluminium intoxication will reduce efficacy. Proper dosage control is required to prevent to rapid increase in the haematocrit and haemoglobin levels. Pregnancy; lactation.
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Adverse Reactions
Headache, hypertension and seizures. Hypertensive crisis with encephalopathy-like symptoms; thrombosis at vascular access sites and clotting in the dialyser. Transient increases in the platelet count. Flu-like symptoms including chills and myalgia; hyperkalaemia and skin rashes; anaphylactoid reactions. Rarely, pure red cell aplasia after prolonged treatment in patients with prolonged renal failure.
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Action
Epoetin alfa stimulates the differentiation and proliferation of erythroid precursors, release of reticulocytes into the circulation and synthesis of cellular Hb thus regulating erythropoiesis.
Absorption: SC: Slow and incomplete. IV: Rapid. Distribution: Concentrated in the liver, kidneys and bone marrow. Metabolism: Some degradation occurs. Excretion: Mainly in the faeces with small amounts in the urine. |
Storage
Intravenous: Refrigerate at 2-8°C. Do not freeze. Parenteral: Refrigerate at 2-8°C. Do not freeze. Subcutaneous: Refrigerate at 2-8°C. Do not freeze.
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CIMS Class
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