epoetin alfa (EPO, erythropoietin)

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

Monitor patient closely; target Hgb 10–12 g/dL.

ADULTS

·        Anemia of chronic renal failure: Starting dose: 50–100 units/kg three times weekly, IV for dialysis patients and IV or subcutaneously for nondialysispatients. 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 units/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; T_1/2: 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.