Synthetic EPO, so-called recombinant, has definitively changed the treatment in the anaemia of chronic renal failure and regularly find new indications, legal (anaemia of cancer, anaemia of chronic inflammatory syndromes, myelodysplastic syndromes, neurology, cardiology...) or illegal (doping substance in sport).
Haematopoietic growth factor
Erythropoietin is recombinant human erythropoietin (EPO). It is expressed in Chinese hamster ovary cells and has a 165 amino acid sequence identical to that of human urinary EPO; the two are indistinguishable on the basis of functional assays. The apparent molecular weight of erythropoietin is about 30,400 daltons.
INTRAVENOUS Increase yield of autologous blood: Adult: As epoetin alfa or zeta: 600 U/ kg over 2 mins twice wkly for 3 wk before surgery; in conjunction w/ iron, folate & B12 supplementation. PARENTERAL Anaemia of chronic renal failure: Adult: As epoetin alfa: Initially, 50 U/kg SC/IV 3 times wkly for predialysis & haemodialysis patients & 50 U/kg twice wkly for. peritoneal dialysis patients, may increase according to response in steps of 25 U/kg 3 times wkly at 4 wkly intervals. Child: As epoetin alfa: Initially, 50 U/kg 3 times wkly. May increase dose at 4 wkly intervals in increments of 25 U/kg 3 times wkly until a target Hb conc of 9.5-11 g/100 mL is reached. Usual maintenance dose: <10 kg: 225-450 U/ kg/wk; 10-30 kg: 180-450 U/kg/wk & >30 kg: 90-300 U/kg/wk. Anaemia in zidovudine-treated HIVinfected patients: Adult: As epoetin alfa: Initially, 100 U/kg SC/IV thrice wkly for 8 wk; increase every 4-8 wk by 50-100 U/ kg according to response. Max: 300 U/kg thrice wkly. SUBCUTANEOUS Anaemia related to non-myeloid malignant disease chemotherapy: Adult: As epoetin alfa or zeta: Initially, 150 U/kg 3 times wkly. Dose may be increased at 4-8 wk intervals to 300 U/kg 3 times wkly. Stop treatment if response is still inadequate after 4 wk of treatment using this higher dose.
There are no known clinically significant drug interactions but the effect of Erythropoietin alfa may be potentiated by the simultaneous therapeutic administration of a haematinic agent such as ferrous sulphate when a deficiency state exists.
Uncontrolled hypertension, hypersensitivity to mammalian cell products & human albumin. Chronic renal failure, ischaemic heart diseases, hypertension, pregnancy, seizures, liver dysfunction, lactation.
Hypertension. myalgia, arthralgia, flu-like syndrome, rashes & urticaria. Hypertensive crisis w/ encephalopathy like symptoms e.g. headache, confusion, generalised seizures. Thrombosis.
Erythropoietin was used in the treatment of maternal anemia. Because of the molecule's large size, recombinant EPO does not appear to cross the placenta. No fetal morbidity or mortality was noted. Therefore, this is a safe therapy that can be used in pregnancy. In small studies, epoetin alfa administration decreased serum prolactin in patients with amylotrophic lateral sclerosis, but had no effect in normal subjects or in patients with renal failure undergoing chronic ambulatory peritoneal dialysis. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
The therapeutic margin of Erythropoietin alfa is very wide. Erythropoietin alfa overdosage can cause hemoglobin levels above the desired level, which should be managed with discontinuation or reduction of Erythropoietin alfa dosage and/or with phlebotomy, as clinically indicated. Cases of severe hypertension have been observed following overdose with ESAs.
Store at 2ºC to 8ºC. Do not freeze or shake. This temperature range should be closely maintained until administration to the patient. Store in original package in order to protect from light.
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