Haematopoietic growth factor (erythropoietin)
Epoetin alfa is a synthetic form of erythropoietin, the hormone that stimulates red blood cell production in the bone marrow. It is used to treat anaemia associated with chronic kidney disease, chemotherapy and HIV infection treated with zidovudine, reducing the need for transfusions.
Also known as: eritropoietina, erythropoietin, EPO, Eprex
Epoetin alfa may alter the response to warfarin; monitor INR when the erythropoietin dose is adjusted.
Epoetin alfa stimulates erythropoiesis and can alter the response to warfarin: the accelerated production of red cells increases vitamin K consumption (needed for synthesis of coagulation factors) and can lower the INR, sometimes requiring a warfarin dose increase. Reports also exist of variation in both directions. The interaction is most relevant in chronic kidney disease patients on prolonged epoetin treatment. The INR should be monitored frequently when starting and adjusting epoetin and during treatment, adjusting the warfarin dose as needed.
Epoetin can reduce the anticoagulant effect of warfarin (possible haematocrit rise and vitamin K consumption). Monitor the INR during erythropoietin treatment.
Improved erythropoiesis and haematocrit changes may alter warfarin pharmacodynamics.
Monitor INR and signs of bleeding or thrombosis.
Unstable INR, thrombotic events (vascular access thrombosis).
Monitor INR more frequently when starting or adjusting epoetin.
DailyMed (FDA) — approved Epoetin alfa label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1f2d0b28-9cc5-4523-80b8-637fdaf3f7a5 ; approved Warfarin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057 — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Epoetin alfa is given subcutaneously or intravenously; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Epoetin alfa label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1f2d0b28-9cc5-4523-80b8-637fdaf3f7a5
Epoetin alfa raises the haematocrit and can increase serum potassium; excessive potassium intake can worsen hyperkalaemia.
Monitor serum potassium; moderate very potassium-rich foods in patients with hyperkalaemia.
DailyMed/FDA (NIH/NLM) — approved Epoetin alfa label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1f2d0b28-9cc5-4523-80b8-637fdaf3f7a5
Epoetin alfa increases the risk of thrombotic and cardiovascular events; use with caution in cardiovascular disease.
Monitor haemoglobin (do not exceed SmPC targets), blood pressure and signs of thrombosis.
EMC-UK (MHRA) — approved Epoetin alfa SmPC: https://www.medicines.org.uk/emc/product/3443/smpc
Epoetin alfa is contraindicated in uncontrolled hypertension because of the risk of hypertensive crisis and encephalopathy.
Do not start with uncontrolled blood pressure; treat hypertension first.
EMC-UK (MHRA) — approved Epoetin alfa SmPC: https://www.medicines.org.uk/emc/product/3443/smpc
Data on epoetin alfa in pregnancy are limited; use only if the benefit outweighs the risk.
Avoid in the 1st trimester; use only if strictly necessary (e.g. severe anaemia of kidney disease).
Excretion into breast milk is unknown; use with caution.
In women of childbearing age, rule out pregnancy before starting long-term treatment.
EMC-UK (MHRA) — approved Epoetin alfa SmPC: https://www.medicines.org.uk/emc/product/3443/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Recombinant human erythropoietin (haematopoietic growth factor) that stimulates erythropoiesis in the bone marrow; used in anaemia of chronic kidney disease, zidovudine-associated anaemia (HIV) and chemotherapy-induced anaemia in cancer.
Binds erythropoietin receptors on bone marrow erythroid progenitors, activating signalling pathways (JAK2/STAT5, PI3K/Akt, MAPK) that promote erythroblast survival, proliferation and differentiation — increased red blood cell production.
IV: half-life 4-13 h in CKD patients; SC: peak 5-24 h after administration; in anaemic cancer patients, mean SC half-life is ~40 h (16-67 h); similar pharmacokinetics in adults and children.
Largely non-renal clearance (cellular metabolism/receptor uptake); no accumulation with 150 U/kg 3x/week or 40 000 U/week regimens; haemodialysis does not remove clinically relevant amounts.
IV half-life 4-13 h (CKD); SC ~40 h in cancer patients (16-67 h); the half-life is similar between dialysis and non-dialysis patients and above/below 65 years.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
