Epoetin alfa (Eprex)
How does it work?
Eprex injections contain the active ingredient epoetin alfa, which is a synthetic version of the naturally-occurring hormone erythropoietin. Erythropoietin is produced by healthy kidneys. It stimulates the bone marrow to produce red blood cells, which carry oxygen around the body.
Epoetin alfa is used to treat anaemia in people with chronic kidney failure who are having dialysis, and in people with impaired kidney function who do not yet need dialysis. These people produce very little erythropoietin as a result of their kidney disease, so the number of red blood cells in their blood is low (anaemia). When epoetin alfa is injected, it stimulates the bone marrow to produce more red blood cells, and this corrects the anaemia.
Epoetin alfa is also used to treat anaemia in people having chemotherapy treatment for cancer. One of the major side effects of chemotherapy is that it decreases the production of blood cells. When the level of red blood cells falls too low this is most commonly treated with a blood transfusion. However, in some situations epoetin alfa is given to stimulate the bone marrow to produce more red blood cells.
Doctors may also prescribe epoetin alfa for anaemic people who are going to donate blood prior to surgery so that their own blood can be given to them during or after surgery. This is called an autologous blood pre-donation programme. Because the epoetin increases blood cell production, it means that a larger volume of blood can be taken from these people, and stored for transfusion during or after the surgery.
Your doctor may prescribe you iron supplements while you are receiving this medicine so that the body has adequate iron stores for producing new red blood cells.
What is it used for?
- Treating anaemia that is causing symptoms in people with chronic kidney failure.
- Treating anaemia that is causing symptoms in people with solid tumours being treated with chemotherapy.
- Treating anaemia that is causing symptoms in people with bone marrow cancer (multiple myeloma) or malignant lymphoma who are having chemotherapy.
- Increasing the volume of blood that can be donated by anaemic patients due to have surgery, so they can receive transfusions of their own blood during or after the surgery.
- Treating anaemia in people due to have major orthopaedic surgery (knee or hip replacement); this reduces the need for a possible blood transfusion if any complications arise.
How is it given?
- Eprex injections may be given into a vein (intravenously) or under the skin (subcuteously) in the upper thigh or abdomen. Your doctor will decide which route is most appropriate and your doctor or nurse will usually administer the injections. However, some people or caregivers can be taught to administer subcutaneous injections themselves so that treatment can be continued out of hospital. If this is the case it is important to follow your doctor's instructions and the instructions provided with the injections.
- The injections may be given once, twice or three times a week depending on the condition being treated.
- Eprex injections should be stored in a refrigerator at 2 to 8°C, but should be taken out of the fridge and left to reach room temperature before administering. This may take 15 to 30 minutes. The injections can be stored for up to three days at room temperature.
- Eprex should not be used if there is a possibility that it has been frozen, or if there has been a refrigerator failure.
- Exprex injections should not be shaken and any unused solution should be discarded.
All people having Eprex treatment so they can donate blood for retransfusion during surgery, or to stimulate blood cell production before bone surgery, should also receive iron supplements. These should ideally be started before the epoetin treatment, so that the body has adequate iron stores for producing new red blood cells.
People receiving Eprex before surgery should also receive medication to prevent blood clots, since there is an increased risk of blood clots occurring following major surgery.
- All other causes of anaemia, eg vitamin B12 or folate deficiency, should be considered by your doctor and treated if necessary, before you start treatment with this medicine.
- The number of platelets in your blood should be regularly monitored during the first eight weeks of treatment with this medicine.
- While receiving this medicine you will also need to have regular blood tests to monitor the levels of haemoglobin, blood cells and salts (electrolytes such as potassium) in your blood. Your haemoglobin needs to be maintained at a certain level because if it goes too high this increases the chances of getting a dangerous blood clot.
- Your blood pressure will also be monitored throughout treatment with this medicine. If your doctor feels it necessary, you may be given additional medicines to lower your blood pressure. If your blood pressure cannot be controlled, treatment with this medicine should be discontinued.
- Tell your doctor if you experience sudden stabbing migraine-like headaches while receiving this medicine, as this may be a possible warning sign that your blood pressure is too high.
- On very rare occasions, people treated with synthetic erythropoietin medicines such as this one have produced neutralising antibodies against erythropoietin. This can stop this medicine from working and can cause the body to suddenly stop or reduce the production of red blood cells (a condition called pure red cell aplasia). This causes severe anaemia, symptoms of which would include unusual tiredness and a lack of energy. If you experience these symptoms you should contact your doctor. If your body produces neutralising antibodies, your doctor will need to stop treatment with this medicine and determine the best course of action to treat your anaemia.
- If you are receiving dialysis treatment, your dialysis regimen may need adjusting while receiving this medicine. Your doctor will decide this.
- Eprex injections should be stored in a refrigerator at 2 to 8°C. Do not freeze. Keep the container in the outer carton, in order to protect from light.
Not to be used in
- People who have experienced a sudden drop in red blood cell production (pure red cell aplasia) during previous treatment with erythropoetin.
- Uncontrolled high blood pressure (hypertension).
- People due to have major orthopaedic surgery who have severe heart disease, blood circulation problems, have recently had a heart attack or stroke or who cant take medicines to prevent blood clots.
- People who can't be treated with medicines to prevent blood clots.
- People with cancer who are not being treated with chemotherapy.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Use with caution in
- High blood pressure (hypertension).
- People with heart disease such as angina.
- Chronic liver failure.
- People with high numbers of platelets in the blood (thrombocytosis)).
- People at increased risk of developing a blood clot in a blood vessel (thrombosis).
- Hereditary blood disorders called porphyrias.
- People with cancer. (This medicine may act as a growth factor and could therefore affect the progression of your cancer. It may also increase the chances of getting a blood clot. A blood transfusion may be preferable depending on your individual situation. Your doctor can discuss the individual risks and benefits of this treatment with you in more detail.)
- People with a high level of potassium in the blood (hyperkalaemia).
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy has not been established. It should be used with caution during pregnancy and only if the potential benefits outweigh any possible risks to the developing baby. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should be used with caution in women who are breastfeeding. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Nausea and vomiting.
- Cold or flu-like symptoms.
- Headaches (see also warning section above).
- Increase in blood pressure.
- Dangerously high blood pressure (hypertensive crisis).
- Increased numbers of platelets in the blood (thrombocytosis).
- Blood clots in the blood vessels (thrombosis).
- Reaction at site of injection.
- Skin reactions such as rash.
- Pain in muscles and joints.
- Seizures or fits.
- Swelling of the feet or ankles (peripheral oedema).
- A sudden drop in red blood cell production (pure red cell aplasia - see warning section above).
- Allergic reactions, including shortness of breath and itchy blistering skin rash.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, always check with your doctor or pharmacist before taking any new medicines while you are having treatment with this one, to make sure that the combination is safe.
This medicine may theoretically affect the blood level of the immunosuppressant medicine ciclosporin.
If you are having haemodialysis to treat kidney failure you may need an increased dose of heparin while using this medicine. This is because epoetin alfa increases the volume of cells in the blood and may therefore increase the risk of blood clotting in the dialysis system.
Other medicines containing the same active ingredient