Indications And Dose
Aplastic anaemia ▶BY MOUTH ▶Adult: 1–5 mg/kg daily for 3 to 6 months
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Drug reference
Aplastic anaemia ▶BY MOUTH ▶Adult: 1–5 mg/kg daily for 3 to 6 months
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Patients unable to receive thromboprophylaxis. pure red cell aplasia following erythropoietin therapy. uncontrolled hypertension
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Aluminium toxicity (can impair the response to erythropoietin). concurrent infection (can impair the response to erythropoietin). correct factors that contribute to the anaemia of chronic renal failure, such as iron or folate deficiency, before treatment.. during dialysis (increase in unfractionated or low molecular weight heparin dose may be needed). epilepsy. inadequately treated or poorly controlled blood pressure—interrupt treatment if blood pressure uncontrolled. ischaemic vascular disease. malignant disease. other inflammatory disease (can impair the response to erythropoietin). risk of thrombosis may be increased when used for anaemia before orthopaedic surgery—avoid in cardiovascular disease including recent myocardial infarction or cerebrovascular accident. risk of thrombosis may be increased when used for anaemia in adults receiving Blood and nutrition cancer chemotherapy. sickle-cell disease (lower target haemoglobin concentration may be appropriate). sudden stabbing migraine-like pain (warning of a hypertensive crisis). thrombocytosis (monitor platelet count for first 8 weeks)
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→Appendix 1: oxymetholone
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MHRA/CHM ADVICE: RECOMBINANT HUMAN ERYTHROPOIETINS: VERY RARE RISK OF SEVERE CUTANEOUS ADVERSE REACTIONS (UPDATED JANUARY 2018) The MHRA is aware of very rare cases of severe cutaneous adverse reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, in patients treated with erythropoietins; some cases were fatal. More severe cases were recorded with long-acting agents (darbepoetin alfa and methoxy polyethylene glycol- epoetin beta). Patients and their carers should be advised of the signs and symptoms of severe skin reactions when starting treatment and instructed to stop treatment and seek immediate medical attention if they develop widespread rash and blistering; these rashes often follow fever or flu-like symptoms—discontinue treatment permanently if such reactions occur. MHRA/CHM ADVICE (DECEMBER 2007) ERYTHROPOIETINS— HAEMOGLOBIN CONCENTRATION Overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase the risk of death and serious cardiovascular events, and in patients with cancer may increase the risk of thrombosis and related complications: . patients should not be treated with erythropoietins for the licensed indications in chronic kidney disease or cancer in patients receiving chemotherapy unless symptoms of anaemia are present . the haemoglobin concentration should be maintained within the range 10–12 g/100 mL . haemoglobin concentrations higher than 12 g/100 mL should be avoided . the aim of treatment is to relieve symptoms of anaemia, and in patients with chronic kidney disease to avoid the need for blood transfusion; the haemoglobin concentration should not be increased beyond that which provides adequate control of symptoms of anaemia (in some patients, this may be achieved at concentrations lower than the recommended range) MHRA/CHM ADVICE (DECEMBER 2007 AND AUGUST 2008) ERYTHROPOIETINS—TUMOUR PROGRESSION AND SURVIVAL IN PATIENTS WITH CANCER Clinical trial data show an unexplained excess mortality and increased risk of tumour progression in patients with anaemia associated with cancer who have been treated with erythropoietins. Many of these trials used erythropoietins outside of the licensed indications (i.e. overcorrected haemoglobin concentration or given to patients who have not received chemotherapy): . erythropoietins licensed for the treatment of symptomatic anaemia associated with cancer, are licensed only for patients who are receiving chemotherapy . the decision to use erythropoietins should be based on an assessment of the benefits and risks for individual patients; blood transfusion may be the preferred treatment for anaemia associated with cancer chemotherapy, particularly in those with a good cancer prognosis
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▶Common or very common Arthralgia. embolism and thrombosis. headache. hypertension (dose-dependent). influenza like illness. skin reactions. stroke ▶Uncommon Hypertensive crisis (in isolated patients with normal or low blood pressure). respiratory tract congestion. seizure ▶Rare or very rare Thrombocytosis ▶Frequency not known Pure red cell aplasia (more common following subcutaneous administration in patients with chronic renal failure). severe cutaneous adverse reactions (SCARs) SIDE-EFFECTS, FURTHER INFORMATION Hypertensive crisis In isolated patients with normal or low blood pressure, hypertensive crisis with encephalopathy-like symptoms and generalised tonic-clonic seizures requiring immediate medical attention has occurred with epoetin. Pure red cell aplasia There have been very rare reports of pure red cell aplasia in patients treated with erythropoietins. In patients who develop a lack of efficacy with erythropoietin therapy and with a diagnosis of pure red cell aplasia, treatment with erythropoietins must be discontinued and testing for erythropoietin antibodies considered. Patients who develop pure red cell aplasia should not be switched to another form of erythropoietin.
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▶Monitor closely blood pressure, reticulocyte counts, haemoglobin, and electrolytes—interrupt treatment if blood pressure uncontrolled. ▶Other factors, such as iron or folate deficiency, that contribute to the anaemia of chronic renal failure should be corrected before treatment and monitored during therapy. Supplemental iron may improve the response in resistant patients. eiiii F above
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Capsule ▶Oxymetholone (Non-proprietary) Oxymetholone 50 mg Oxymetholone 50mg capsules | 50 capsule P £475.00 e EPOETINS Epoetins f
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1–5 mg/kg daily for 3 to 6 months
First-line fragment. Read the complete Indications and Dose section above.
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