Drug reference

Erythropoietin

Recombinant human erythropoietin / hematopoietic growth factor · Antianemic agent, Hematopoietic agent

Also known as Epoetin alfa, Epoetin beta, Darbepoetin alfa, Methoxy PEG-epoetin beta, Eprex, Epogen

START

CKD: 50 U/kg SC TDS or 10,000 U weekly. Check baseline Hgb, iron studies (ferritin, TSAT), BP; ensure iron repletion before starting; target Hgb 10-11.5 g/dL (NOT >13)

TYPICAL MAX

No fixed max; titrate to Hgb target; reduce dose if Hgb rising >1 g/dL/month

STOP IF

Hgb >13 g/dL, hypertensive crisis, signs of PRCA (rapidly falling Hgb despite high doses), thromboembolic event, severe allergic reaction

WATCH

Hgb weekly until stable then monthly, BP at each visit, iron studies every 3 months, thrombosis signs, seizure risk (especially first 90 days)

CDSCO approvedSchedule HATC B03XA01

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 3h · absorption onset
PEAK: 12h · SC peak (5-24 hours range)
t½: 22h · SC: 16-28 hours
DURATION: 2d · SC dosing every 2-3 days

EXCRETION

Reticuloendothelial catabolism

route + CYP

INTERACTIONS

4 major

SEVERE in our sources

PREGNANCY

Use only if clearly needed; limited data; Category C

FDA category + note

Top interactionssee all 10 →

CarfilzomibSevereDatabaseDDInter
LenalidomideSevereDatabaseDDInter
PomalidomideSevereDatabaseDDInter
ThalidomideSevereDatabaseDDInter

Available in India

208 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Binds to erythropoietin receptors on erythroid progenitor cells in bone marrow, stimulating proliferation, differentiation, and maturation of red blood cell precursors. Also stimulates release of reticulocytes into circulation. Endogenous EPO is produced primarily by peritubular cells in the kidney in response to hypoxia.

Indications

Anemia of chronic kidney disease (CKD)Anemia due to zidovudine in HIV-infected patientsAnemia due to chemotherapy in non-myeloid malignanciesReduction of allogeneic blood transfusion in surgical patientsAnemia of prematurity (in some markets)

Dosing

Adult: CKD: Start 50-100 U/kg IV/SC 3x/week; or 10,000 U weekly; or 20,000-40,000 U q2weeks. Chemo-induced: 40,000 U SC weekly; or 150 U/kg TDS weekly. Surgery: 300 U/kg/day x 10 days pre/post-op, or 600 U/kg SC x 4 doses
Pediatric: CKD: 50 U/kg IV/SC 3x/week. Chemo: 600 U/kg IV weekly (max 40,000 U)
Renal adjustment: CKD patients require ESA; dose adjusted based on hemoglobin response
Hepatic adjustment: No adjustment needed
Geriatric: Standard dosing; monitor BP closely; increased cardiovascular risk
Max dose: No fixed maximum; dose titrated to hemoglobin target (10-12 g/dL)

Pharmacokinetics

Onset

Days (reticulocyte response); 2-6 weeks for hemoglobin rise

Peak effect

SC: 5-24 hours; IV: immediate distribution

Duration

SC: 24-48 hours; IV: shorter

Half-life

SC: 16-28 hours; IV: 4-13 hours

Bioavailability

SC: ~20-30%; IV: 100%

Protein binding

Minimal

Metabolism

Catabolized by reticuloendothelial system; proteolytic degradation

Excretion

Not renally excreted; metabolized and cleared by reticuloendothelial system

Contraindications

Uncontrolled hypertension
Hypersensitivity to epoetin alfa or excipients (albumin human, sodium citrate)
Pure red cell aplasia (PRCA) due to anti-erythropoietin antibodies
Hemoglobin >10 g/dL (oncology patients - increased mortality risk)
Use of ESAs in cancer patients not receiving chemotherapy

Side effects

Common

HypertensionHeadacheFeverNauseaArthralgiaInjection site painFatigue

Serious

Thromboembolic events (DVT, PE, stroke, MI) - increased risk with higher hemoglobin targets
Pure red cell aplasia (PRCA) - autoimmune neutralizing antibodies
Hypertensive crisis
Seizures (especially during initial therapy)
Tumor progression (in cancer patients)
Severe allergic reactions
Death (increased mortality in oncology patients targeting Hgb >12 g/dL)

Pregnancy & lactation

Pregnancy

Use only if clearly needed; limited data; Category C

Lactation

Excretion in breast milk unknown; use with caution during breastfeeding

Drug interactions

Carfilzomib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Lenalidomide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Pomalidomide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Thalidomide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Androgens

Moderate

Database

Androgens may potentiate ESA effect; may increase Hgb response

Monitor Hgb; may need ESA dose reduction

Source: Kimi deep-research + Cla

Iron Sucrose

Moderate

Database

Standard combination in CKD. EPO stimulates erythropoiesis, increasing iron demand. Iron supplementation prevents functional iron deficiency. No direct pharmacokinetic interaction.

Standard of care in CKD anemia. Monitor hemoglobin (target 10-11.5 g/dL per KDIGO), ferritin, and TSAT monthly. Adjust EPO and iron doses accordingly.

Source: Kimi deep-research + Cla

Ace Inhibitors

Mild

Database

May reduce ESA response slightly; may cause anemia via hepcidin elevation

Monitor Hgb response; may need slightly higher ESA dose

Source: Kimi deep-research + Cla

Chemotherapy

Mild

Database

Chemo may blunt ESA response due to bone marrow suppression; ESA may stimulate tumor growth (black box warning)

Use only when chemotherapy planned; do not use when chemotherapy completed; target Hgb <12 g/dL