Erythropoiesis-Stimulating Agent
Pregnancy: C
Epoetin Alfa
Brand names: Eprex, Epogen
Adult dose
Dose: 50–300 units/kg three times weekly
Route: SC or IV
Frequency: Three times weekly (SC preferred in non-dialysis CKD)
Target Hb 100–120 g/L. Reduce dose if Hb rises >20g/L/month or exceeds 120g/L.
Clinical pearls
- Always ensure iron replete before starting — ESAs ineffective with iron deficiency (TSAT >20%, ferritin >200 ng/mL)
- Never target Hb >130g/L — increased cardiovascular events (TREAT trial)
- SC administration requires 20–30% less dose than IV
- Darbepoetin alfa: longer half-life, weekly or fortnightly dosing
Contraindications
- Uncontrolled hypertension
- Pure red cell aplasia
- Hypersensitivity to EPO
Side effects
- Hypertension
- Thrombosis
- Flu-like symptoms
- Pure red cell aplasia (rare)
- Headache
Interactions
- Cyclosporin — may need dose adjustment
- ACE inhibitors — may blunt response
Monitoring
- Haemoglobin (every 2–4 weeks during dose adjustment)
- Blood pressure
- Iron stores (TSAT, ferritin)
- Reticulocyte count
Reference: KDIGO Anaemia in CKD Guidelines 2012. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.