– Reduction of need for red blood cell (RBC) transfusion in patients with chronic kidney disease (CKD) on dialysis and not on dialysis
CKD on Dialysis
– Initiate treatment when hemoglobin (Hgb) level <10 g/dL
– If Hgb level approaches or >11 g/dL, reduce or interrupt dose
– 50-100 units/kg IV/SC 3 times weekly initially
CKD NOT on Dialysis
– Initiating treatment only when Hbg level is <10 g/dL and the following:
– Rate of Hgb decline indicates the likelihood of requiring a RBC transfusion
– Reducing the risk of alloimmunization and/or other RBC transfusion-related risks is a goal
– If Hgb level >10 g/dL, reduce or interrupt dose, and use the lowest dose of epoetin alfa sufficient to reduce the need for RBC transfusions
– 50-100 units/kg IV 3 times weekly initially
Chemotherapy-Related Anemia
– Treatment of anemia in patients with non-myeloid malignancies where anemia is due to effect of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of 2 additional months of planned chemotherapy
– Initial Dose: 150 units/kg IV/SC 3 times weekly
– 40,000 units SC once weekly until completion of chemotherapy course
– SC is the preferred route of administration except in patients with CKD on hemodialysis
– In patients with CKD on hemodialysis, the IV route is recommended.
– Do not shake
– Epoetin is usually administered undiluted, although preservative-free (single-dose vial) formulations may be diluted in a syringe prior to administration as a 1:1 dilution using bacteriostatic NS
Storage
– Vials should be stored at 2°C to 8°C (36°F to 46°F)
