epoetin alfa: clinical use

Prescribing considerations

• Confirm the cause of anaemia and address iron, folate or vitamin B12 deficiency, inflammation, blood loss, haemolysis and other reversible contributors.
• Assess thrombotic and cardiovascular risk and avoid excessive or rapid haemoglobin correction.
• In cancer-associated anaemia, restrict use to the licensed chemotherapy setting after individual benefit–risk discussion; transfusion may be preferable in some circumstances.
• Control blood pressure before treatment and maintain adequate antithrombotic prophylaxis where required for surgery.
• Prescribe biological products by brand and record the product name and batch number for traceability.

Contraindications and cautions

• Hypersensitivity to epoetin alfa or an excipient.
• Pure red cell aplasia following any erythropoietin treatment.
• Uncontrolled hypertension.
• Applicable contraindications to autologous blood-predonation programmes.
• For major elective orthopaedic surgery outside a predonation programme: severe coronary, peripheral arterial, carotid or cerebral vascular disease, including recent myocardial infarction or stroke.
• Surgical patients unable to receive adequate antithrombotic prophylaxis.

Monitoring

• Blood pressure before and during treatment.
• Haemoglobin regularly until stable and periodically thereafter, avoiding excessive or rapid increases.
• Iron status and other causes of inadequate response.
• Reticulocyte count and anti-erythropoietin antibodies if haemoglobin falls unexpectedly or transfusion need increases; investigate pure red cell aplasia.
• Platelets, particularly around treatment initiation, and serum potassium in chronic renal failure where clinically appropriate.
• Dialysis access and circuit thrombosis; cyclosporin concentrations when used concurrently.

Clinical pharmacology

Epoetin alfa is recombinant human erythropoietin produced in Chinese hamster ovary cells. Receptor activation reduces apoptosis and promotes proliferation and maturation of erythroid precursors. Subcutaneous administration has slower absorption and lower bioavailability than intravenous administration.

Formulation and product differences

• The selected product is a clear, colourless solution in single-use pre-filled syringes with a needle guard.
• The needle-cover liner contains dry natural rubber, a latex derivative that may cause reactions in latex-sensitive people.
• The formulation contains polysorbate 80 and is essentially sodium-free.
• Keep refrigerated in the original packaging, protect from light, and do not freeze or shake.
• Administration route varies by indication; the product must not be given by intravenous infusion or mixed with other medicines.

Injection

Route: Parenteral

Strengths: 4000 units/mL, 10000 units/mL, 40000 units/mL