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Erythropoiesis-Stimulating Agent Pregnancy: No adequate and well-controlled studies in pregnant women; animal studies have shown reproduction toxicity. Use in pregnancy only if potential benefit outweighs potential risk to the fetus. Not recommended in pregnant or lactating surgical patients in an autologous predonation programme. Use with caution in nursing women.

Epoetin Alfa

Brand names: Eprex, Epogen

Epoetin alfa is a recombinant human erythropoietin (an erythropoiesis-stimulating agent) used to treat anaemia associated with chronic kidney disease and, in some settings, chemotherapy-induced anaemia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 50 IU/kg three times per week (correction phase, adult haemodialysis / renal failure)
Route: Intravenous or subcutaneous (IV preferable in haemodialysis where access is readily available)
Frequency: Three times per week
Symptomatic anaemia in adult chronic renal failure - target haemoglobin 10-12 g/dL (do not exceed 12 g/dL; avoid a rise of more than 2 g/dL over 4 weeks). Adult haemodialysis: correction phase starting dose 50 IU/kg three times per week, adjust in 25 IU/kg steps (at least 4-week intervals); maintenance total weekly dose 75-300 IU/kg. Renal insufficiency not yet on dialysis: correction 50 IU/kg three times per week (increments of 25 IU/kg); maintenance 3 times/week or (SC) once weekly or once every 2 weeks - maximum 150 IU/kg 3x/week, 240 IU/kg (max 20,000 IU) once weekly, or 480 IU/kg (max 40,000 IU) once every 2 weeks. Peritoneal dialysis: correction 50 IU/kg twice per week; maintenance 25-50 IU/kg twice per week. Chemotherapy-induced anaemia (Hb <= 10 g/dL): initial 150 IU/kg SC three times per week, or 450 IU/kg SC once weekly, adjusted to maintain Hb 10-12 g/dL. Reduce dose by 25% if Hb rises >2 g/dL/month or exceeds 12 g/dL; if Hb exceeds 13 g/dL, discontinue until <12 g/dL then restart 25% below previous dose. Ensure adequate iron stores; exclude/treat other causes of anaemia first.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or any excipient
  • Pure red cell aplasia (PRCA) following treatment with any erythropoietin
  • Uncontrolled hypertension
  • Patients scheduled for major elective orthopaedic surgery (not in an autologous predonation programme) with severe coronary, peripheral arterial, carotid or cerebral vascular disease, including recent MI or CVA
  • Surgery patients who cannot receive adequate antithrombotic prophylaxis

Side effects

  • Dose-dependent increase in blood pressure / aggravation of hypertension
  • Diarrhoea, nausea, vomiting (very common)
  • Pyrexia (very common)
  • Headache; convulsion (uncommon)
  • Venous and arterial thromboses (thrombotic vascular events); rash, arthralgia/bone pain/myalgia

Interactions

  • SPC section 4.5 not captured in this bundle (no specific medicinal-product interactions extracted). Blood pressure should be closely monitored and antihypertensive treatment may need to be added or increased.

Clinical monograph

How it works

It is a synthetic analogue of endogenous erythropoietin that binds erythropoietin receptors on erythroid progenitor cells in the bone marrow, stimulating red cell proliferation, differentiation and maturation.

Prescribing in practice

  • Avoid raising or aiming for a normal/high haemoglobin, as overcorrection increases the risk of thrombosis, hypertension and cardiovascular events; target the lowest level that avoids transfusion.
  • Ensure iron, folate and B12 status are adequate before and during therapy, as deficiency is the commonest cause of an inadequate response.
  • It can cause or worsen hypertension, so blood pressure should be controlled before starting.

Monitoring

Monitor haemoglobin regularly along with blood pressure and iron indices, adjusting the dose to keep haemoglobin within the recommended target range.

Counselling the patient

  • Attend for regular blood tests so the dose can be adjusted safely.
  • Report severe headache, visual disturbance or signs of a blood clot promptly.
  • Good blood pressure control is important while on this treatment.

Evidence & guidelines

NICE guidance supports erythropoiesis-stimulating agents for managing anaemia of chronic kidney disease with conservative haemoglobin targets to limit cardiovascular harm.

Reference: KDIGO Anaemia in CKD Guidelines 2012; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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