Epoetin alfa

Erythropoietin (EPO) is a sialoglycoprotein hormone produced by peritubular cells of the kidney that is essential for normal erythropoiesis. Anemia and hypoxia induce rapid secretion of EPO, which acts on erythroid marrow to stimulate proliferation of colony-forming cells, induce hemoglobin formation, erythroblast maturation, and release reticulocytes. EPO binds to specific JAK-STAT-binding receptors on target cells, altering phosphorylation of intracellular proteins and activating transcription factors to regulate gene expression, thereby inducing erythropoiesis in a dose-dependent manner.

Adult

Symptomatic anaemia associated with chronic renal failure (haemodialysis, peritoneal dialysis, or not on dialysis): Initially 50 units/kg 3 times a week by intravenous or subcutaneous injection. Adjust in steps of 25 units/kg 3 times a week, according to response at intervals of at least 4 weeks. Maintenance: 75–300 units/kg once weekly.…

Pediatric

Children less than 5 years of age generally require a higher dose in CKD. For anemia of prematurity, dosing is not explicitly provided but discussed as having limited efficacy.

Renal adjustment

For symptomatic anaemia associated with chronic renal failure: Reduce dose by approximately 25% if rise in haemoglobin concentration exceeds 2 g/100 mL over 4 weeks or if haemoglobin concentration exceeds 12 g/100 mL.…

• Not recommended when hemoglobin level exceeds 11 g/dL in patients with chronic kidney disease
• Not to be used when cancer therapy is being given with curative intent
• pre-existing uncontrolled hypertension