Epoetin Alfa Dosage

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Usual Adult Dose for Anemia Associated with Zidovudine

Initial: 100 units/kg subcutaneously or IV 3 times a week.

Usual Adult Dose for Anemia Associated with Chemotherapy

Initial: 150 units/kg subcutaneously 3 times weekly or 40,000 units subcutaneously once weekly until completion of chemotherapy course.

Initiate epoetin alpha in patients on cancer chemotherapy only if the hemoglobin is less than 10 g/dL, and if there is a minimum of two additional months of planned chemotherapy.
Use the lowest dose of epoetin alpha necessary to avoid RBC transfusions

Usual Adult Dose for Anemia Associated with Chronic Renal Failure

50 to 100 units/kg subcutaneously or IV 3 times weekly.

The intravenous route is recommended for patients on hemodialysis.

Usual Adult Dose for Anemia Prior to Surgery

In patients with hemoglobin greater than 10 to less than or equal to 13 g/dL scheduled to undergo elective, noncardiac, nonvascular surgery to reduce the need for allogenic blood transfusions: 300 units/kg/day subcutaneously for 10 days before and on the day of surgery, and 4 days after surgery for a total of 14 days of epoetin therapy.

Alternate dosage schedule: 600 units/kg subcutaneously in once weekly doses (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery.

Usual Pediatric Dose for Anemia Associated with Zidovudine

Infants and Children 8 months to 17 years: Limited data available; doses ranging from 50 to 400 units/kg 2 to 3 times/week have been reported. If patients have not responded satisfactorily to a dose of 300 units/kg 3 times weekly, it is unlikely that they will respond to higher doses.

Usual Pediatric Dose for Anemia Associated with Chemotherapy

Infants and Children 6 months to 18 years: Doses ranging from 25 to 300 units/kg 3 to 7 times a week have been reported.

Manufacturer's recommendation: Starting dose: Using intravenous administration only: 600 units/kg weekly (not to exceed 40,000 units/week); may increase to 900 units/kg weekly (not to exceed 60,000 units/week). Use caution in considering this dosage for administration by the subcutaneous route as subcutaneous administration has been shown to produce effect at doses 30% to 50% lower than intravenous administration.

Reduce dose by 25% when hemoglobin reaches a level needed to avoid transfusion or increases by greater than 1 g/dL in any two weeks. Increase dose by 25% if response is not satisfactory to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion.

Usual Pediatric Dose for Anemia Associated with Chronic Renal Failure

Starting dose for infants, children and adolescents: 50 units/kg, intravenously or subcutaneously, 3 times weekly. Increase dose by 25% if hemoglobin is less than 10 g/dL and has not increased by 1 g/dL after 4 weeks of therapy or if hemoglobin decreases below 10 g/dL. In patients on hemodialysis, the intravenous route is recommended.

Usual Pediatric Dose for Anemia

The safety and efficacy of epoetin alfa in children have not been established. However, the use of epoetin alfa may be appropriate in some situations.

Anemia of prematurity: Dosing range: 500 to 1250 units/kg/week divided into 2 to 5 doses for 10 doses; commonly used dose: 250 units/kg/dose 3 times weekly; supplement with oral iron therapy 3 to 8 mg/kg/day.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Zidovudine treated patients:

The dose can be adjusted after 8 weeks and every 4 to 8 weeks thereafter, in 50 to 100 units/kg increments 3 times weekly until hemoglobin reaches a level needed to avoid RBC transfusion or up to a maximum dose of 300 units/kg three times weekly. Withhold epoetin alpha if hemoglobin exceeds 12 g/dL. Resume therapy at a dose 25% below the previous dose when hemoglobin declines to less than 11 g/dL.

All CKD patients:

When initiating or adjusting therapy, monitor hemoglobin levels at least weekly until stable, then monitor at least monthly.

When adjusting therapy consider hemoglobin rate of rise, rate of decline, ESA responsiveness and hemoglobin variability. A single hemoglobin excursion may not require a dosing change.

Do not increase the dose more frequently than once every 4 weeks. Decreases in dose can occur more frequently. Avoid frequent dose adjustments.

If the hemoglobin rises rapidly (e.g., more than 1 g/dL in any 2 week period), reduce the dose of epoetin alfa by 25% or more as needed to reduce rapid responses.

For patients who do not respond adequately, if the hemoglobin has not increased by more than 1 g/dL after 4 weeks of therapy, increase the dose by 25%.

For patients who do not respond adequately over a 12 week escalation period, increasing the epoetin alfa dose further is unlikely to improve response and may increase risks. Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions. Evaluate other causes of anemia. Discontinue epoetin alfa if responsiveness does not improve.

CKD, on Dialysis:

If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the dose of epoetin alfa.

CKD, not on Dialysis:

If the hemoglobin level exceeds 10 g/dL, reduce or interrupt the dose of epoetin alfa, and use the lowest dose of epoetin alfa sufficient to reduce the need for RBC transfusions.

Cancer chemotherapy patients:

Reduce dose by 25% if hemoglobin increases greater than 1 g/dL in any 2 week period or hemoglobin reaches a level needed to avoid RBC transfusion.

Withhold dose if hemoglobin exceeds a level needed to avoid RBC transfusion. Reinitiate at a dose 25% below the previous dose when hemoglobin approaches a level where RBC transfusions may be required.

After the initial 4 weeks of epoetin alfa therapy, if hemoglobin increases by less than 1 g/dL and remains below 10 g/dL, increase dose to either 300 Units/kg 3 times per week or 60,000 Units weekly in adults.

After 8 weeks of therapy, if there is no response as measured by hemoglobin levels or if RBC transfusions are still required, discontinue epoetin alfa.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

In patients on hemodialysis, the IV route is recommended.

A supplemental dose is not necessary with hemo- or peritoneal dialysis.

While the administration of epoetin alfa is independent of the dialysis procedure, epoetin alfa may be administered into the venous line at the end of the dialysis procedure to eliminate the need for additional venous access.

Other Comments

All patients should receive adequate iron supplementation. Iron supplementation should be started at the start of treatment with epoetin alfa and should continue throughout the duration of therapy.

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