Erythropoietin regulates erythropoiesis by stimulating the differentiation and proliferation of erythroid precursors, stimulating the release of reticulocytes into the circulation, and synthesis of cellular haemoglobin. Recombinant human erythropoietin is available as epoetin alfa and epoetin beta which are used in the management of anaemias associated with CRF, cancer chemotherapy and anti-AIDS drug zidovudine
Treatment of anemia in chronic renal failure:
Erythropoietin is administered to maintain hemoglobin concentration between 11 to 12 g/dl and hematocrit of 33 -36 % in adults.
Adult: usually 50 to 100 IU/kg three times in a week (TIW) by IV or Subcutaneous route
Pediatric: 50 IU/kg TIW by IV or Subcutaneous route
Dose adjustment: Dose should be increased if hematocrit doses not increase by 5 to 6 points after 8 weeks therapy, and hematocrit is below suggested target range. Dose should be reduced when hematocrit approaches 36% or hematocrit increases >4 points in any 2-week period.
Maintenance dose: Maintenance dose must be individualized for each patient. In patients undergoing dialysis, the median maintenance dose is 75 IU/kg TIW, with a range from 12.5 to 525 IU/kg TIW as directed by the physician. In CRF patients not on dialysis, maintenance dose is 75 to 150 IU/kg/week.
Treatment of Anemia in Cancer Patients on Chemotherapy:
Adult: 150 IU/kg TIW by Subcutaneous route or 40,000 IU Subcutaneous route weekly
Pediatric: 25 to 300 IU/kg 3 to 7 times per week by Subcutaneous or IV route
Dose adjustment: If the response is not satisfactory, the dose should be increased to 300 IU/kg TIW. If the hematocrit exceeds 40%, the dose should be withheld until the hematocrit falls to 36%. The dose should be reduced to 25% when treatment is resumed and titrated to maintain the desired hematocrit.
The recommended dose is 300 IU/kg/day subcutaneously for 10 days before surgery, on the day of surgery, and for 4 days after surgery. An alternate dose schedule is 600 IU/kg subcutaneously in once weekly dose (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery.
Zidovudine-treated HIV-infected Patients:
Adult: 100 IU/kg as an IV or Subcutaneous injection TIW for 8 weeks
Pediatric: 50 to 400 IU/kg 2 to 3 times per week by Subcutaneous or IV route
Dose adjustment: If the response is not satisfactory, the dose should be increased by 50-100 IU/kg TIW. Response should be evaluated every 4 to 8 weeks thereafter and the dose adjusted accordingly by 50 to 100 IU/kg increments TIW.
Maintenance dose: The dose is titrated to maintain the hematocrit between 33-36%.