Indications of recombinant Human Erythropoietin Alfa/Epoetin Alfa injections?? Dosage and frequency?


Indications of recombinant human Erythropoietin Alfa / Epoetin Alfa injections are To treat anemia of 1) Children on dialysis 2) Chronic kidney disease patients who are on dialysis and not on dialysis. 3) Patients receiving myelosuppressive therapy for cancer. 4) Anemia due to Zidovudine in HIV Patients. 5) Acquired disorders of RBC ,WBC and Platelets such as anemia of chronic disease, renal disease or bone marrow suppression. 6) To increase the Hemoglobin in non hematological malignancies with or without chemotherapy like breast cancer, Squamous cell cancer and Colon cancer etc. 7) For reduction of allogeneic blood transfusion requirement in patients who are undergoing elective, noncardiac and vascular surgery. 8) Blood transfusion refusing Patients 9) Anemia during therapy for chronic hepatitis C. 10) Myelodysplastic syndromes. 11) Preterm Anemia. Epoetin Alfa is 165 amino acid glycoprotein manufactured by recombinant DNA technology ,which has similar biological effects as human endogenous Erythropoietin. Erythropoietin stimulates RBC production in situ. It is a hormone produced in kidney and augments the differentiation of erythroid pro genitors in the bone marrow. It induces erythropoeisis in dose dependent manner. It is available as single dose preservative free or multidose preserved vials. Mode of administration is either IV or SC. Single dose1 ml vials available in multiple strengths like 2000,3000, 4000, 10000 units of Epoetin Alfa. Multidose 2 ml vials contain 10000 units of Epoetin Alfa. and 1 ml multiple dose vial contain 20000 units of Epoetin Alfa. Dosage varies and individualised. Patients on dialysis following is recommended. It usually given 3 times a week on Patients with dialysis. Monitor Hemoglobin hematocrit and blood pressure frequently. Do not increase the dose more frequently than once in every 4 weeks. Decrease in dose occur more frequently. Avoid frequent dose adjustments. If hemoglobin raises rapidly more than 1 gm / dL in any 2 week period , reduce the dose by 25% more as needed to reduce rapid responses. For Patients whi donot respond adequately , if Hemoglobin has not increased more than 1 gm / dL after 4 weeks of therapy, increase the dose by 25%. For patients who donot respond adequately over a 12 week escalation period , increasing the dose of Epoetin is further unlikely to improve response and increase risks. Use the lowest dose that will maintain a Hemoglobin level sufficient to reduce the need of RBC transfusions. Patients not on dialysis, Initiate the Epoetin injection when hemoglobin is less than 10 gm/ dL and following considerations apply The rate of hemoglobin decline indicates the likelihood of requiring RBC transfusion and reduce the risk of alloimmunization and or other RBC transfusion related risks is the goal. If Hemoglobin levels exceed more than 10 gm/ dL reduce or interrupt the dose of Epoetin and use the lowest dose sufficient to reduce the need for RBC transfusion. Recommended starting dose for adult patients is 50 to 100 units / kg 3 times weekly intravenously or subcutaneously.

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Given in CKD with Anemia 50-100 units/kg body weight Up to three times a week Depend on serum ferritin level

Apparently anemiadue to CKD , hiv, people receiving chemotherapy in cancer

Anaemia due to CKD

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