EPOETIN ALFA MAY BE GIVEN BY INTRAVENOUS INJECTION OVER AT LEAST 1 MINUTE; SLOW INTRAVENOUS INJECTION OVER 5 MINUTES MAY BE USED IN PATIENTS WHO EXPERIENCE FLU-LIKE SYMPTOMS AS ADVERSE EFFECTS. EPOETIN ALFA MAY ALSO BE GIVEN SUBCUTANEOUSLY, BUT PREPARATIONS THAT CONTAIN POLYSORBATE 80 SHOULD ONLY BE GIVEN INTRAVENOUSLY IN THIS GROUP OF PATIENTS (SEE EFFECTS ON THE BLOOD).
IN PREDIALYSIS AND HAEMODIALYSIS PATIENTS, A RECOMMENDED INITIAL DOSE OF EPOETIN ALFA IS 50 INTERNATIONAL UNITS/KG THREE TIMES WEEKLY; A HIGHER INITIAL DOSE OF 50 TO 100 UNITS/KG THREE TIMES WEEKLY HAS BEEN SUGGESTED IN THE USA.
DOSES MAY BE INCREASED AT 4-WEEK INTERVALS IN INCREMENTS OF 25 UNITS/KG THREE TIMES WEEKLY UNTIL THE TARGET IS REACHED.
IN PATIENTS ON PERITONEAL DIALYSIS AN INITIAL DOSE OF 50 UNITS/KG GIVEN INTRAVENOUSLY TWICE WEEKLY MAY BE USED.
ONCE THE TARGET IS REACHED DOSES MAY NEED TO BE ADJUSTED, AND EVEN DECREASED, FOR MAINTENANCE THERAPY.
THE USUAL TOTAL WEEKLY MAINTENANCE DOSE OF EPOETIN ALFA IN PREDIALYSIS PATIENTS IS 50 TO 100 UNITS/KG GIVEN IN THREE DIVIDED DOSES, AND IN HAEMODIALYSIS PATIENTS IT IS ABOUT 75 TO 300 UNITS/KG GIVEN IN THREE DIVIDED DOSES. IN PREDIALYSIS PATIENTS A TOTAL WEEKLY DOSE OF 600 UNITS/KG SHOULD NOT BE EXCEEDED. IN PATIENTS ON PERITONEAL DIALYSIS, THE USUAL TOTAL WEEKLY MAINTENANCE DOSE IS 50 TO 100 UNITS/KG GIVEN INTRAVENOUSLY IN TWO DIVIDED DOSES.
IN CHILDREN, EPOETIN ALFA MAY BE GIVEN INTRAVENOUSLY TO THOSE ON HAEMODIALYSIS.
THE INITIAL DOSE IS 50 UNITS/KG THREE TIMES WEEKLY. THE DOSE MAY BE INCREASED AT 4-WEEK INTERVALS IN INCREMENTS OF 25 UNITS/KG THREE TIMES WEEKLY UNTIL A TARGET HAEMOGLOBIN CONCENTRATION OF 9.5 TO 11 G PER 100 ML IS REACHED.
THE USUAL TOTAL WEEKLY MAINTENANCE DOSE GIVEN IN THREE DIVIDED DOSES IS:
225 TO 450 UNITS/KG FOR THOSE WEIGHING LESS THAN 10 KG
180 TO 450 UNITS/KG FOR THOSE WEIGHING 10 TO 30 KG
90 TO 300 UNITS/KG FOR THOSE WEIGHING OVER 30 KG.
EPOETIN BETA IS USED SIMILARLY IN THE MANAGEMENT OF ANAEMIA OF CHRONIC RENAL FAILURE IN DIALYSIS AND PREDIALYSIS PATIENTS. IT MAY BE GIVEN SUBCUTANEOUSLY OR BY INTRAVENOUS INJECTION OVER 2 MINUTES. THE FOLLOWING DOSAGES MAY BE USED IN ADULTS AND CHILDREN:
FOR SUBCUTANEOUS INJECTION THE INITIAL DOSE IS 60 UNITS/KG WEEKLY FOR 4 WEEKS; THE TOTAL WEEKLY DOSE MAY BE DIVIDED TO BE GIVEN IN DAILY DOSES OR THREE TIMES A WEEK.
FOR INTRAVENOUS INJECTION THE INITIAL DOSE IS 40 UNITS/KG THREE TIMES WEEKLY FOR 4 WEEKS; THE DOSE MAY THEN BE INCREASED TO 80 UNITS/KG THREE TIMES WEEKLY.
THEREAFTER THE DOSE OF EPOETIN BETA MAY BE INCREASED AT 4-WEEK INTERVALS, FOR BOTH SUBCUTANEOUS AND INTRAVENOUS INJECTION, IN INCREMENTS OF 60 UNITS/KG WEEKLY IN DIVIDED DOSES, UNTIL THE TARGET HAEMOGLOBIN CONCENTRATION OR HAEMATOCRIT IS REACHED. A TOTAL WEEKLY DOSE OF 720 UNITS/KG OF EPOETIN BETA SHOULD NOT BE EXCEEDED.
FOR MAINTENANCE, THE DOSE IS HALVED INITIALLY AND THEN ADJUSTED EVERY 1 TO 2 WEEKS ACCORDING TO RESPONSE. THE WEEKLY SUBCUTANEOUS MAINTENANCE DOSE MAY BE DIVIDED INTO 1, 3, OR 7 DOSES; IN PATIENTS STABILISED ON A ONCE-WEEKLY DOSE, IT MAY BE POSSIBLE TO ADJUST TO A SINGLE DOSE EVERY 2 WEEKS.
IN PATIENTS WITH NON-MYELOID MALIGNANT DISEASE RECEIVING CHEMOTHERAPY, EPOETIN ALFA OR EPOETIN BETA MAY BE GIVEN BY SUBCUTANEOUS INJECTION IN AN INITIAL DOSE OF 150 UNITS/KG THREE TIMES WEEKLY. THE DOSE MAY BE INCREASED AFTER 4 OR 8 WEEKS, IF NECESSARY, TO 300 UNITS/KG THREE TIMES WEEKLY. IF THE RESPONSE IS STILL INADEQUATE AFTER 4 WEEKS AT THIS HIGHER DOSE, TREATMENT SHOULD BE STOPPED. AS ALTERNATIVE REGIMENS, THE TOTAL WEEKLY DOSE OF EPOETIN BETA MAY BE GIVEN AS A SINGLE DOSE OR DIVIDED INTO 3 TO 7 DOSES. EPOETIN ALFA MAY ALSO BE GIVEN IN ONCE-WEEKLY DOSES OF 450 UNITS/KG OR 40 000 UNITS; THE DOSE MAY BE INCREASED TO 60 000 UNITS AFTER 4 WEEKS IF NECESSARY. THE RISE IN HAEMOGLOBIN SHOULD BE GRADUAL; A RATE NOT EXCEEDING 2 G PER 100 ML PER MONTH, AND A TARGET HAEMOGLOBIN CONCENTRATION OF NOT MORE THAN 12 G PER 100 ML, ARE SUGGESTED. AFTER THE END OF CHEMOTHERAPY, EPOETIN ALFA OR EPOETIN BETA MAY BE CONTINUED FOR UP TO ONE MONTH.
IN HIV-POSITIVE PATIENTS ON ZIDOVUDINE THERAPY, EPOETIN ALFA MAY BE BENEFICIAL IF THE ENDOGENOUS SERUM-ERYTHROPOIETIN CONCENTRATION IS 500 MILLIUNITS/ML OR LESS. EPOETIN ALFA IS GIVEN BY SUBCUTANEOUS OR INTRAVENOUS INJECTION IN AN INITIAL DOSE OF 100 UNITS/KG THREE TIMES WEEKLY FOR 8 WEEKS. THE DOSE MAY THEN BE INCREASED EVERY 4 TO 8 WEEKS BY 50 TO 100 UNITS/KG THREE TIMES WEEKLY ACCORDING TO RESPONSE. HOWEVER, PATIENTS ARE UNLIKELY TO BENEFIT FROM DOSES ABOVE 300 UNITS/KG THREE TIMES WEEKLY IF THIS DOSE HAS FAILED TO ELICIT A SATISFACTORY RESPONSE.
IN THE MANAGEMENT OF ANAEMIA OF PREMATURITY EPOETIN BETA IS GIVEN SUBCUTANEOUSLY IN A DOSE OF 250 UNITS/KG THREE TIMES WEEKLY. TREATMENT SHOULD BE STARTED AS EARLY AS POSSIBLE AND CONTINUED FOR 6 WEEKS.
TO INCREASE THE YIELD OF AUTOLOGOUS BLOOD, EPOETIN ALFA OR EPOETIN BETA MAY BE USED WITH IRON SUPPLEMENTATION. THE DOSE DEPENDS ON THE VOLUME OF BLOOD REQUIRED FOR COLLECTION AND ON FACTORS SUCH AS THE PATIENT'S WHOLE BLOOD VOLUME AND HAEMATOCRIT. SUGGESTED REGIMENS ARE:
EPOETIN ALFA 600 UNITS/KG GIVEN INTRAVENOUSLY TWICE WEEKLY STARTING 3 WEEKS BEFORE SURGERY
UP TO 800 UNITS/KG OF EPOETIN BETA INTRAVENOUSLY, OR UP TO 600 UNITS/KG SUBCUTANEOUSLY, TWICE WEEKLY FOR 4 WEEKS BEFORE SURGERY
TO REDUCE THE NEED FOR ALLOGENEIC BLOOD TRANSFUSION EPOETIN ALFA MAY BE GIVEN IN A DOSE OF 600 UNITS/KG SUBCUTANEOUSLY ONCE WEEKLY STARTING 3 WEEKS BEFORE SURGERY, WITH A FOURTH DOSE GIVEN ON THE DAY OF SURGERY; ALTERNATIVELY, WHEN THE TIME BEFORE SURGERY IS SHORT, 300 UNITS/KG SUBCUTANEOUSLY DAILY MAY BE GIVEN FOR 10 DAYS BEFORE SURGERY, ON THE DAY OF SURGERY, AND FOR 4 DAYS AFTER.
ZIDOVUDINE-TREATED HIV-INFECTED - 100 UNITS/KG AS AN IV OR SC INJECTION TIW FOR 8 WEEKS.