Eprex

Drugs

Generic Name: Epoetin alfa
Product Name: Eprex

Indication of Eprex
Action of Eprex
Dose advice of Eprex
Schedule of Eprex
Common side effects of Eprex
Uncommon side effects of Eprex
Reference

Indication of Eprex:

This medication works by stimulating bone marrow to produce red blood cells and is therefore very useful in treating some of the causes of anaemia. It takes at least two weeks to see a clinically significant increase in red blood cells. It may require up to ten weeks in some patients.

Eprex is often used in patients with chronic kidney failure. In a malfunctioning kidney, the production of erythropoietin hormone is impaired. Erythropoietin is a hormone which stimulates red blood cell production. As a result, low erythropoietin means there is insufficient red blood cells to carry oxygen to different parts of the body for metabolic processes. Lack of red blood cells causes tiredness and makes the heart pump faster to compensate low oxygen levels. Eprex is the synthetic version of the erythropoietin hormone produced naturally and helps to overcome these problems.

Eprex is also used in cancer patients whose red cell count is consistently low as a result of chemotherapy. There are other conditions where a haematologist (specialist doctor in blood disorders) might recommend use of Eprex. This would be explained to you by your doctor.

During elective surgery, patients who have anaemia are more likely to require transfusion during surgery. Eprex can be used in these patients several weeks prior to surgery to stimulate production of red cells in the body to prevent the need of blood transfusion due to excessive blood loss. During the first 3 months of Eprex treatment, hypertensive episodes are most likely to occur. The changes in your haemoglobin and blood pressure should be monitored closely at all times. You should tell your doctor immediately if you experience any of the warning signs, such as sudden stabbing migraine-like headaches.

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Action of Eprex:

Eprex is a manufactured form of erythropoetin hormone which works by stimulating the production of red blood cells in the body. Lack of red blood cells causes tiredness and increased workload on the heart and is known as anaemia. Eprex stimulates the bone marrow cells to make more red cells to correct the anaemia in the same way that your body normally takes care of the same process. Some illnesses make the body less able to make or respond to normal erythropoetin, so use of Eprex will often help in these conditions.

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Dose advice of Eprex:

Three weeks prior to your scheduled surgery, you wil be given Eprex according to your bodyweight.This will be administered weekly and on the day of surgery or until your red cell count is greater than 150 g/L. The recommended dose is 600 IU/kg/week and can be injected under your skin or into the vein. If your scheduled surgery is less than 3 weeks, you'll be given 300 IU/kg/day for 10 days before the surgery, on the day of surgery and 4 days after the surgery. Your Eprex treatment will be ceased as soon as your red cell count reaches 150 g/L.

If you need to predonate your own blood for transfusion during major surgery, you will be given 300 - 600 IU/kg twice weekly for 3 weeks by direct injection into your vein. Your iron level will also be adjusted according to the iron level with oral supplements during the Eprex therapy.

If your kidneys are malfunctioning, you will be treated with 50 IU/kg up to three times per week initially, via direct injection into the vein if you are on dialysis, or via the skin. The dose of Eprex needs to be adjusted monthly by 25 IU/kg three times per week depending on you response to the treatment, until the desired red cell count is achieved (100 - 110 g/L). The maximum dose weekly should not exceed 200 IU/kg three times a week. Your dose will be maintained between 75 - 300 IU/kg/week.

If your red cell count is low (below 100 - 110 g/L) due to chemotherapy, you will be treated with 150 IU/kg three times per week. The dose will be increased up to 300 IU/kg three times weekly a month later if initial treatment is insufficient.

Eprex is available in pre-filled syringes. You may inject Eprex yourself after doctor's instruction. However, due to severe hypersensitivity reactions observed during clinical testing, your first Eprex injection has to be done under the supervision of your doctor.

The prefilled syringe should be stored in the refrigerator. It is important that you do not freeze the Eprex or shake the prefilled syringe. You should not remove the prefilled syringe from its original packaging until just prior to injection.

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Schedule of Eprex:

Schedule 4

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Common side effects of Eprex:

High Blood pressure (24%)
Headache (16%)
Arthralgia(11%)
Nausea (10.5%)
Water retention (9%)
Tiredness (9%)
Diarrhoea (8.5%)
Nausea and Vomiting (8.0%)

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Uncommon side effects of Eprex:

Chest pain (7.0%)
Skin irritations (7.0%)
Asthenia (7.0%)
Dizziness (7.0%)
Clotted access (6.8%)

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Reference:

Australian Medicines Handbook, Adelaide, Pharmaceutical Society of Australia, 2006.
MIMS Online [online]. 2003 [cited 2007 March 19]. Available from: URL: http://mims.hcn.net.au.ezproxy.library.uwa.edu.au/ifmx-nsapi/mims-data/?MIval=2MIMS_ssearch
eAPP. [Online]. 2007 [cited 2007 March 19]. Available from: URL: http://www.appco.com.au/appguide/drug.asp?drug_id=00045021
Janssen-Cilag. (2007). Eprex Intravenous and Subcutaneous Injection Product Information. North Ryde: Janssen-Cilag.

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