Last updated: Lesson of the Month - January 2019…
on 01 Jan 2019

Epoetin Alfa (Eprex®)

  • Treatment of anaemia associated with CKD

  • An Erythropoiesis-Stimulating Agent (ESA)
  • Epoetin alfa injection = Eprex®, prefilled syringe 1000, 2000, 3000, 4000, 5000, 6000, 8000, 10000 units

  • Hypersensitivity to the active substance or to any of the excipients
  • Uncontrolled hypertension
  • Patients who develop pure red cell aplasia (PRCA) following treatment with erythropoietin

  • Monitor FBC (aim Haemoglobin 10-12 g/dl), avoid a sustained haemoglobin level of greater than 12 g/dl
  • Monitor BP
  • Ensure patients have sufficient iron stores. Keep ferritin >100 ng/ml and TSAT >20%
  • Antibody-mediated pure red cell aplasia (PRCA) has been reported after months to years of subcutaneous epoetin treatment mainly in CKD patients
  • Epoetin alfa is less effective when the patient is deficient in vitamin B12, during periods of infection or raised PTH

  • Hypertension, Pure Red Cell Aplasia (PRCA; McCoy, 2008), headache, venous and arterial thrombosis, vascular access (fistula or graft) thrombosis
  • Hb > 12 g/dl increased risk of cardiovascular events and death, CVA

  • Correction phase: Eprex ®: 50 units/kg 2-3 times per week. Increase dose according to response every 4 weeks until target Hb is obtained. Then adjust dose to maintain required target Hb. Reduce dose if Hb rises too quickly or above target. Rise in Hb should not exceed 2 g/dl per month. The increase or reduction in dose should be of 25 IU/kg, 3 times per week
  • Maintenance phase: Eprex ®: recommended total weekly dose is between 75 and 300 IU/kg
  • When given IV, a higher dose is usually needed to produce the required response. The bioavailability of subcutaneous injectable Eprex ®, is approximately 20% lower than that of the intravenous drug
  • Give injections IV if patient is on haemodialysis, SC for patients not on HD

  • As in normal renal function, not dialysed

  • If given with ACEi, increased risk of hyperkalaemia
  • May affect ciclosporin and tacrolimus levels

EPOETIN ALFA (EPREX)#3000 units#see prescribing section#IV#

  • Target Haemoglobin (Hb) = 10-12 g/dl
  • Rotate the injection sites and inject slowly to avoid discomfort at the site of injection
  • Store in the fridge