II. Indications
- See Erythropoietin
- Anemia of Chronic Renal Failure (Hemoglobin <10 g/dl)
- Anemia of Myelosuppressive Cancer Chemotherapy (not intended for cure, Hemoglobin <10 g/dl)
- Perioperative non-cardiovascular surgery patients to avoid or reduce Blood Transfusion
- See resources below for protocol
III. Contraindications
- See Erythropoietin
IV. Mechanism
- See Erythropoietin
V. Precautions
- Not a substitute for Blood Products in acute severe, symptomatic Anemia
- Avoid Hemoglobin targets above 11 g/dl (higher risk of cardiovascular and thrombotic events)
- Use the lowest effective dose
-
Iron Supplementation if needed
- Check for Iron Deficiency before administration
VI. Medications
- Available in single dose 1 ml, preservative-free vials ranging from 2000 to 40,000 units
- Multiple dose vials contain Benzyl Alcohol and are containdicated in pregnancy, Lactation and infants
VII. Dosing: Adults
-
Anemia of Chronic Renal Failure
- Start 50 to 100 units/kg IV/SQ three times per week
- Indicated for Hemoglobin <10 g/dl
- Stop if Hemoglobin >10 g/dl (or >11 g/dl if on Hemodialysis)
-
Anemia of Myelosuppressive Cancer Chemotherapy (not intended for cure)
- Start 150 to 300 units/kg SQ three times per week OR
- Start 40,000 units SQ once per week
- Indicated for Hemoglobin <10 g/dl AND >=2 months planned of myelosuppression
VIII. Dosing: Children
-
Anemia of Chronic Renal Failure on Hemodialysis (age 1 month to 16 years)
- Start 50 units/kg IV or SQ three times weekly
- Indicated for Hemoglobin <10 g/dl
- Stop if Hemoglobin >12 g/dl
-
Anemia of Myelosuppressive Cancer Chemotherapy (age >=5 years)
- Give 600 units/kg IV each week until Chemotherapy completed
IX. Adverse Effects
- See Erythropoietin
X. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
XI. Resources
- Epoetin Alfa (DailyMed)