Aranesp Disease Interactions

The use of erythropoiesis stimulating agents increases the risk of seizures in patients with chronic renal failure. Seizure development may be related to the rate of rise in hematocrit, which is also associated with blood pressure elevations. It is recommended to monitor patients closely for the development of premonitory neurologic symptoms during the first several months after the administration of these agents. Patients with epilepsy or predisposed to seizures should be monitored closely for blood pressure changes and neurologic symptoms during therapy with these agents.

The increase in hematocrit and decrease in plasma volume associated with erythropoiesis-stimulating agents therapy may, theoretically, affect dialysis efficiency. Patients may require adjustments in their dialysis prescription after initiation of erythropoiesis stimulating agents. During hemodialysis, patients may require increased anticoagulation with heparin to prevent clotting.

The use of erythropoiesis-stimulating agents is contraindicated in patients with uncontrolled hypertension. These agents may cause blood pressure to rise. Hypertensive encephalopathy and seizures have been observed in patients with chronic renal failure treated with these agents. Blood pressure should be adequately controlled prior to initiation of therapy, and monitored closely during treatment. Aggressive antihypertensive measures may be necessary, particularly early on in treatment when the hematocrit is increasing. It is recommended to reduce or withhold the use of these agents if blood pressure becomes difficult to control.

The use of erythropoiesis-stimulating agents may be associated with an increased risk of thrombotic events and mortality. During clinical trials, an increased risk was observed in: 1) patients with chronic renal failure (CRF) and ischemic heart disease or congestive heart failure targeted to a maintenance hematocrit of 42%, and 2) in patients without CRF undergoing coronary artery bypass surgery. Although a causal relationship has not been established, therapy with these agents should be administered cautiously in patients with preexisting cardiovascular disease and/or a history of thrombotic events.