Erythropoietin

Trade name: Erypo™ Vials with 2,000, 4,000 or 10,000 I.U./ml Drug class: anti-anemic Manufacturer: Janssen-Cilag

Indications: anemia in renal failure, induced by drugs such as AZT, ribavirin or chemotherapy (symptomatic anemia; asymptomatic anemia only occurs when hemoglobin values are below 10-11 g/dl or hematocrit is below 33 %, and endogenous erythropoietin levels are below 500 mU/ml). Note: Always exclude other, more frequent causes of anemia (iron deficiency?)!

Dose: 100 I.U./kg body weight once weekly subcutaneously until a hematocrit of 30 to 35 % is reached. If there is no response after 6 weeks of treatment, increase dose to 200 I.U./kg/week. If there is no response after a further 6 weeks: discontinue. If response is achieved, a weekly maintenance dose of 100-200 I.U./kg body weight is usually sufficient. At hematocrit values > 40 % or hemoglobin > 13 g/dl: discontinue.

Side effects: flu-like symptoms especially at the start of treatment, such as headache, arthralgia, asthenia, dizziness and fatigue.

Comments/Warnings: erythropoietin is contraindicated with uncontrolled hypertension. It is expensive and should be used very sparingly. Before initiating treatment, other causes of anemia should be excluded, as mentioned above. These include:

■ Vitamin B12 or folic acid deficiency, iron deficiency, occult blood loss, hematological disorders such as thalassemia and myelodysplasia.

■ AIDS-defining illnesses with bone marrow involvement such as MAC infection, tuberculosis, CMV infection, malignant lymphoma, Kaposi's sarcoma.

Strict monitoring of blood pressure initially!

Subcutaneous administration of Erypo™ is contraindicated in patients with chronic renal insufficiency or terminal renal failure due to the risk of antibody-induced erythroblastopenia (PRCA, Pure Red Cell Aplasia). Erypo™ must be stored at 2° to 8° Celsius in the original package. Do not freeze!

Drug interactions: erythropoietin can diminish the efficacy of concurrently administered antihypertensives. Concurrent treatment with anticonvulsive drugs may increase seizure susceptibility.

As cyclosporine A binds to erythrocytes, blood concentrations of cyclosporine A should be monitored if administered together with erythropoietin.

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