injection to be given over 1 – 5 minutes, reduce dose by
approximately 25 % if rise in haemoglobin
concentration exceeds 2 g/ 100 mL over 4 weeks or if
haemoglobin concentration exceeds^12 g/^100 mL; if
haemoglobin concentration continues to rise, despite
dose reduction, suspend treatment until haemoglobin
concentration decreases and then restart at a dose
approximately 25 % lower than the previous dose
▶Child (body-weight 61 kg and above):Initially 50 units/kg
3 times a week, adjusted in steps of 25 units/kg 3 times
a week, dose adjusted according to response at
intervals of at least 4 weeks; maintenance
75 – 300 units/kg once weekly, maintenance dose can be
given as a single dose or in divided doses, intravenous
injection to be given over 1 – 5 minutes, reduce dose by
approximately 25 % if rise in haemoglobin
concentration exceeds 2 g/ 100 mL over 4 weeks or if
haemoglobin concentration exceeds 12 g/ 100 mL; if
haemoglobin concentration continues to rise, despite
dose reduction, suspend treatment until haemoglobin
concentration decreases and then restart at a dose
approximately 25 % lower than the previous doselINTERACTIONS→Appendix 1 : epoetin alfa
lSIDE-EFFECTS
▶Common or very commonChills.cough.diarrhoea.fever.
myalgia.nausea.pain.peripheral oedema.vomiting
▶UncommonHyperkalaemia
lPREGNANCYNo evidence of harm. Benefits probably
outweigh risk of anaemia and of blood transfusion in
pregnancy.
lBREAST FEEDINGUnlikely to be present in milk. Minimal
effect on infant.
lHEPATIC IMPAIRMENTManufacturers advise caution in
chronic hepatic failure.
lPRESCRIBING AND DISPENSING INFORMATIONEpoetin alfa
is a biological medicine. Biological medicines must be
prescribed and dispensed by brand name, seeBiological
medicinesandBiosimilar medicines, under Guidance on
prescribing p. 1.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Eprex(Janssen-Cilag Ltd)
Epoetin alfa 2000 unit per 1 mlEprex 1 , 000 units/ 0. 5 ml solution for
injection pre-filled syringes| 6 pre-filled disposable injectionP
£ 33. 18
Epoetin alfa 4000 unit per 1 mlEprex 2 , 000 units/ 0. 5 ml solution for
injection pre-filled syringes| 6 pre-filled disposable injectionP
£ 66. 37
Epoetin alfa 10000 unit per 1 mlEprex 6 , 000 units/ 0. 6 ml solution
for injection pre-filled syringes| 6 pre-filled disposable
injectionP£ 199. 11
Eprex 4 , 000 units/ 0. 4 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 132. 74
Eprex 5 , 000 units/ 0. 5 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 165. 92
Eprex 3 , 000 units/ 0. 3 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 99. 55
Eprex 10 , 000 units/ 1 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 331. 85
Eprex 8 , 000 units/ 0. 8 ml solution for injection pre-filled syringes|
6 pre-filled disposable injectionP£ 265. 48
Epoetin alfa 40000 unit per 1 mlEprex 20 , 000 units/ 0. 5 ml solution
for injection pre-filled syringes| 1 pre-filled disposable
injectionP£ 110. 62
Eprex 30 , 000 units/ 0. 75 ml solution for injection pre-filled syringes|
1 pre-filled disposable injectionP£ 199. 11
Eprex 40 , 000 units/ 1 ml solution for injection pre-filled syringes|
1 pre-filled disposable injectionP£ 265. 48eiiiiF 563Epoetin beta
lINDICATIONS AND DOSE
Symptomatic anaemia associated with chronic renal
failure
▶BY SUBCUTANEOUS INJECTION
▶Neonate:Initially 20 units/kg 3 times a week for 4 weeks,
increased in steps of 20 units/kg 3 times a week,
according to response at intervals of 4 weeks, total
weekly dose may be divided into daily doses;
maintenance dose, initially reduce dose by half then
adjust according to response at intervals of 1 – 2 weeks,
total weekly maintenance dose may be given as a single
dose or in 3 or 7 divided doses. Subcutaneous route
preferred in patients not on haemodialysis. Reduce dose
by approximately 25 % if rise in haemoglobin
concentration exceeds 2 g/ 100 mL over 4 weeks or if
haemoglobin concentration approaches or exceeds
12 g/ 100 mL; if haemoglobin concentration continues to
rise, despite dose reduction, suspend treatment until
haemoglobin concentration decreases and then restart
at a dose approximately 25 % lower than the previous
dose; maximum 720 units/kg per week.▶Child:Initially 20 units/kg 3 times a week for 4 weeks,
increased in steps of 20 units/kg 3 times a week,
according to response at intervals of 4 weeks, total
weekly dose may be divided into daily doses;
maintenance dose, initially reduce dose by half then
adjust according to response at intervals of 1 – 2 weeks,
total weekly maintenance dose may be given as a single
dose or in 3 or 7 divided doses. Subcutaneous route
preferred in patients not on haemodialysis. Reduce
dose by approximately 25 % if rise in haemoglobin
concentration exceeds 2 g/ 100 mL over 4 weeks or if
haemoglobin concentration approaches or exceeds
12 g/ 100 mL; if haemoglobin concentration continues
to rise, despite dose reduction, suspend treatment until
haemoglobin concentration decreases and then restart
at a dose approximately 25 % lower than the previous
dose; maximum 720 units/kg per week
▶BY INTRAVENOUS INJECTION
▶Neonate:Initially 40 units/kg 3 times a week for 4 weeks,
then increased to 80 units/kg 3 times a week, then
increased in steps of 20 units/kg 3 times a week if
required, at intervals of 4 weeks; maintenance dose,
initially reduce dose by half then adjust according to
response at intervals of 1 – 2 weeks. Intravenous
injection to be administered over 2 minutes.
Subcutaneous route preferred in patients not on
haemodialysis. Reduce dose by approximately 25 %if
rise in haemoglobin concentration exceeds 2 g/ 100 mL
over 4 weeks or if haemoglobin concentration
approaches or exceeds 12 g/ 100 mL; if haemoglobin
concentration continues to rise, despite dose reduction,
suspend treatment until haemoglobin concentration
decreases and then restart at a dose approximately 25 %
lower than the previous dose; maximum 720 units/kg
per week.▶Child:Initially 40 units/kg 3 times a week for 4 weeks,
then increased to 80 units/kg 3 times a week, then
increased in steps of 20 units/kg 3 times a week if
required, at intervals of 4 weeks; maintenance dose,
initially reduce dose by half then adjust according to
response at intervals of 1 – 2 weeks. Intravenous
injection to be administered over 2 minutes.
Subcutaneous route preferred in patients not on
haemodialysis. Reduce dose by approximately 25 %if
rise in haemoglobin concentration exceeds 2 g/ 100 mL566 Anaemias BNFC 2018 – 2019
Blood and nutrition9