Epoetin alfa
EPOGEN
Pronunciation: e-POE-e-tin AL-fa (EE-poe-jen)
“Erythrocyte generator”
What it isRecombinant erythropoietin stimulating marrow red-cell production; anemia of CKD and chemotherapy.
Why this oneIts shorter action than darbepoetin permits finer titration but requires more frequent administration.
What limits it⚑ Chasing a normal hemoglobin increases death, stroke, and thrombosis; target symptom relief and ensure adequate iron.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anemia due to chronic kidney disease | Adults | 50-100 Units/kg 3 times weekly (IV or SC; IV preferred on hemodialysis) | Individualized to lowest dose reducing RBC transfusions | |
| Anemia due to chronic kidney disease | Pediatric patients ≥1 month | 50 Units/kg 3 times weekly (IV or SC) | Individualized | |
| Anemia due to zidovudine in HIV infection | Adults | 100 Units/kg 3 times weekly (IV or SC) | Titrate by 50-100 Units/kg at 4-8 week intervals | 300 Units/kg 3 times weekly |
| Anemia due to myelosuppressive chemotherapy | Adults | 150 Units/kg SC 3 times weekly, or 40,000 Units SC weekly | Lowest dose to avoid RBC transfusion | 300 Units/kg 3 times weekly or 60,000 Units weekly |
| Anemia due to myelosuppressive chemotherapy | Pediatric patients 5-18 years | 600 Units/kg IV weekly | 900 Units/kg (max 60,000 Units) weekly | |
| Reduction of allogeneic RBC transfusions in elective noncardiac, nonvascular surgery | Adults | 300 Units/kg SC daily x15 days, or 600 Units/kg SC weekly x4 doses | 600 Units/kg weekly |
Titration CKD: do not increase dose more frequently than once every 4 weeks (decreases may be more frequent); HIV/zidovudine: adjust at 4-8 week intervals
Renal Undefined
Hepatic Undefined
Instructions
- Evaluate and maintain iron status; correct/exclude other causes of anemia before initiating
- Do not shake; do not dilute; protect from light
- In pregnant women, lactating women, neonates, and infants use only single-dose (benzyl alcohol-free) vials
- Reduce dose by ~25% if hemoglobin rises >1 g/dL in any 2-week period; withhold/reduce if hemoglobin exceeds target
- DVT prophylaxis recommended in surgery patients
Available strengths
- inj 2000, 3000, 4000, 10000, 20000, 40000 [iu]/ml
Contraindications
- Uncontrolled hypertension
- Pure red cell aplasia (PRCA) that begins after treatment with Epogen or other erythropoietin protein drugs
- Serious allergic reactions to Epogen
- Multiple-dose vials (contain benzyl alcohol) in neonates, infants, pregnant women, and lactating women
Cautions
- Increased mortality, MI, stroke, thromboembolism (esp. targeting higher hemoglobin)
- Increased mortality/tumor progression in cancer
- Hypertension — control before and during; hypertensive encephalopathy/seizures reported
- Seizures in CKD; PRCA from neutralizing antibodies
- Serious allergic and severe cutaneous reactions (SJS/TEN); benzyl alcohol 'gasping syndrome' in neonates/infants
Adverse reactions
- Hypertension
- Arthralgia
- Muscle spasm
- Pyrexia
- Dizziness
- Vascular access thrombosis
- Nausea/vomiting (cancer)
- Deep vein thrombosis (surgery)
Pregnancy Multiple-dose vials (benzyl alcohol) contraindicated; use single-dose vial; limited data insufficient to determine risk
Lactation Multiple-dose vials (benzyl alcohol) contraindicated; advise not to breastfeed for at least 2 weeks after last dose
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 2000 [iu]/ml | inj | per unit | $22.52/mL | — | not offered |
| 3000 [iu]/ml | inj | per unit | — | $78.06/mL | not offered |
| 4000 [iu]/ml | inj | per unit | — | $84.32/mL | not offered |
| 10000 [iu]/ml | inj | per unit | $112.68/mL | — | not offered |
| 20000 [iu]/ml | inj | per unit | $224.79/mL | — | not offered |
| 40000 [iu]/ml | inj | per unit | $448.01/mL | — | not offered |
⚠ BOXED WARNING
- Increased mortality, myocardial infarction, stroke, thromboembolism and tumor progression
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityThrombosis, cardiovascular events and tumor progression at excessive hemoglobin targets