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Last updated: Acute Kidney Injury…
on 10 Apr 2017

Methoxy polyethylene glycol-epoetin beta (Mircera®)



Indication
  • Treatment of symptomatic anaemia associated with chronic kidney disease (CKD)
Preparations
  • Injection: Mircera®, prefilled syringe 30, 50, 75, 100, 120, 150, 200, 250, 360 micrograms
Contraindications
  • 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
Cautions
  • 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%
  • Pure Red Cell Aplasia caused by anti-erythropoietin antibodies has been reported in association with all ESAs, including Mircera®. These antibodies have been shown to cross-react with all ESAs, and patients suspected or confirmed to have antibodies to erythropoietin should not be switched to Mircera®
  • Mircera® is less effective when the patient is deficient in vitamin B12, iron, folic acid, during periods of infection, inflammatory or traumatic episodes, underlying haematologic diseases, severe aluminium toxicity
Side-effects
  • Hypertension
  • Hb > 12 g/dl increased risk of cardiovascular events, CVA and death
  • Thrombosis (eg fistula)
  • PRCA
Dose
  • Mircera®:  Starting dose of 0.6 microgram/kg every 2 weeks, increase by 25% according to response (e.g. if the rate of rise in Hb is less than 1.0 g/dl over a month) every 4 weeks until target Hb is obtained. Once stable – change to monthly dosing. Reduce dose if Hb rises too quickly or above target. Rise in Hb should not exceed 2 g/dl per month
  • Target Hb  = 10-12 g/dl
  • No dose adjustments based on age or hepatic function
  • Normally give injections SC
  • Equivalent dose IV vs SC – monitor response
Dose in renal impairment
  • As in normal renal function, not dialysed
Interactions
  • If given with ACEi or ARB, there is an increased risk of hyperkalaemia
How to Prescribe View Details
Patient comment
  • Target Hb  = 10-12 g/dl
  • Store in a refrigerator
  • If a dose is missed give as soon as possible and then restart at your normal (prescribed) frequency
  • Rotate the injection sites and inject slowly to avoid discomfort at the site of injection

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