Epoetin Alfa

How it works

It is a synthetic analogue of endogenous erythropoietin that binds erythropoietin receptors on erythroid progenitor cells in the bone marrow, stimulating red cell proliferation, differentiation and maturation.

Prescribing in practice

• Avoid raising or aiming for a normal/high haemoglobin, as overcorrection increases the risk of thrombosis, hypertension and cardiovascular events; target the lowest level that avoids transfusion.
• Ensure iron, folate and B12 status are adequate before and during therapy, as deficiency is the commonest cause of an inadequate response.
• It can cause or worsen hypertension, so blood pressure should be controlled before starting.

Monitoring

Monitor haemoglobin regularly along with blood pressure and iron indices, adjusting the dose to keep haemoglobin within the recommended target range.

Counselling the patient

• Attend for regular blood tests so the dose can be adjusted safely.
• Report severe headache, visual disturbance or signs of a blood clot promptly.
• Good blood pressure control is important while on this treatment.

Evidence & guidelines

NICE guidance supports erythropoiesis-stimulating agents for managing anaemia of chronic kidney disease with conservative haemoglobin targets to limit cardiovascular harm.