Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: epoetin alfa

BRAND NAME: Epogen, Procrit

DRUG CLASS AND MECHANISM: Epoetin alfa is a man-made, injectable drug for treating anemia. Erythropoietin is a protein that normally is made in the body by the kidney. It causes the bone marrow to produce oxygen-carrying red blood cells. Under normal conditions, when the body senses a decrease in red blood cells or a deficiency in the supply of oxygen, more erythropoietin is produced, and this increases the number of red blood cells. When this natural mechanism is not working, it may become necessary to stimulate the bone marrow to produce red blood cells. The erythropoietin that is used for therapy, called epoetin alfa, is man-made. It is a product of the genetic engineering of ovarian cells of the Chinese hamster and is produced through recombinant DNA technology in bacteria. It does not cure the underlying cause of the anemia, and unless the underlying cause can be reversed, treatment with epoetin alfa must be continued indefinitely. Epoetin alfa belongs to a class of drugs called colony-stimulating factors because of their ability to stimulate cells in the bone marrow to multiply and form colonies of identical cells. Other colony-stimulating factors include filigrastim (Neupogen) and sargramostim (Leukine). Epogen and Procrit are both epoetin alfa, but they are marketed by two different pharmaceutical companies.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Epoetin alfa is available as a liquid for injection in vials containing from 2,000 to 40,000 units of epoetin alfa.

STORAGE: Epoetin alfa should be stored at 2-8°C (36-46°F). It should not be frozen. Multiple-use vials should be used within 21 days of the first use.

PRESCRIBED FOR: Epoetin alfa is used to treat anemia that is associated with chronic kidney failure in patients who are or will be receiving renal dialysis. It also is used to treat anemia in patients with HIV infection who are receiving zidovudine and in patients with cancer who are receiving chemotherapy and develop anemia. Epoetin alfa may be used to replace transfusions of red blood cells in patients who are anemic and undergoing surgery. Epoetin alfa has not been shown to improve fatigue or quality of life in patients  with cancer. 

DOSING: Epoetin alfa is administered intravenously or subcutaneously (under the skin) at 50-300 units per kilogram of weight, three times weekly. The dose is tailored to each patient based on targeted hemoglobin levels. Adult patients with cancer receiving chemotherapy may be treated with 40,000 to 60,000 units subcutaneously weekly. Epoetin alfa vials should not be shaken since the drug may be damaged, and bubbles may form that prevent some of the drug from being drawn up into the syringe during injection. Iron stores should be evaluated before therapy and supplemental iron should be administered if needed.

DRUG INTERACTIONS: No clinical studies have been done to demonstrate epoetin alfa drug interactions.

PREGNANCY: There are no studies of epoetin alfa use in pregnant women .

NURSING MOTHERS: It is not known if epoetin alfa is excreted into breast milk.

SIDE EFFECTS: Epoetin alfa is well-tolerated. The most common side effects in patients with kidney failure on dialysis are high blood pressure, headache, joint-pain and clotting at the injection site. Rare cases of stinging at the injection site, skin rash and flu-like symptoms (joint and muscle pain) have occurred within a few hours following administration. Allergic reactions, seizures and thrombotic events (e.g., heart attacks, strokes, and pulmonary embolism ) rarely occur.

In HIV-infected patients receiving zidovudine, the most common side effects with epoetin alfa are fever, headache, rash, and nasal or chest congestion. Rare cases of seizures or severe rash have occurred in these patients.

The most common side effects in patients undergoing surgery with anemia are fever, nausea, constipation, skin reactions, vomiting and headaches. Blood clots in veins, referred to as a deep venous thrombosis, also may occur.

Among patients with cancer receiving chemotherapy, the most common side effects of epoetin alfa are fever, diarrhea, tissue swelling, shortness of breath, paresthesia (abnormal sensations like burning or prickling that may occur anywhere in the body), and upper respiratory infection.

Treatment with epoetin alfa may increase the growth of several types of cancer and reduce survival, and, therefore, its use should be restricted to the conditions discussed previously. 

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