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21 September 2006

A - Z of Epoetin (EPO)

Epoetin is a man-made version of human erythropoietin (EPO) stimulates the bone marrow to produce red blood cells.

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Epoetin (eh-POH-ee-tin) is a man-made version of human erythropoietin (EPO). EPO is produced naturally in the body, mostly by the kidneys. It stimulates the bone marrow to produce red blood cells. If the body does not produce enough EPO, severe anemia can occur. This often occurs in people whose kidneys are not working properly. Epoetin is used to treat severe anaemia in these people.

Epoetin may also be used to prevent or treat anemia caused by other conditions, such as Aids, cancer, or surgery, as determined by your doctor.

Epoetin is given by injection. It is available only with your doctor's prescription.

Before using this medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For epoetin, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to epoetin or to human albumin. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Epoetin has not been reported to cause birth defects or other problems in humans. However, it did cause problems, including unwanted effects on the bones and spine, in some animal studies.

Breast-feeding—It is not known whether epoetin passes into the breast milk. However, it has not been reported to cause problems in nursing babies.

Children—This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems than it does in adults.

Older adults—Epoetin has been given to elderly people. However, there is no specific information about whether epoetin works the same way it does in younger adults or whether it causes different side effects or problems in older people.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking epoetin, it is important that your health care professional know if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of epoetin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Aluminum poisoning
  • Blood clots (history of) or other problems with the blood or
  • Folic acid, iron, or vitamin B12 deficiencies
  • Heart or blood vessel disease or
  • High blood pressure—The chance of side effects may be increased
  • Infection, inflammation, or cancer
  • Bone problems or
  • Porphyrin (red blood cell pigment) metabolism disorder—Symptoms include change in color of urine, increased sun sensitivity, abdominal pain, and nerve swelling
  • Sickle cell anaemia - Epoetin may not work properly
  • Seizures (history of)—The chance of seizures may be increased

Precautions while using this medicine
Epoetin sometimes causes convulsions (seizures), especially during the first 90 days of treatment. During this time, it is best to avoid driving, operating heavy machinery, or other activities that could cause a serious injury if a seizure occurs while you are performing them. People with severe anemia usually feel very tired and sick. When epoetin begins to work, usually in about 6 weeks, most people start to feel better. Some people are able to be more active. However, epoetin only corrects anemia. It has no effect on kidney disease or any other medical problem that needs regular medical attention. Therefore, even if you are feeling much better, it is very important that you do not miss any appointments with your doctor or any dialysis treatments.

Many people with kidney problems need to be on a special diet. Also, people with high blood pressure (which may be caused by kidney disease or by epoetin treatment) may need to be on a special diet and/or to take medicine to keep their blood pressure under control. After their anemia has been corrected, some people feel so much better that they want to eat more than before. To keep your kidney disease or your high blood pressure from getting worse, it is very important that you follow your special diet and take your medicines regularly, even if you are feeling better.

In addition to epoetin, your body needs iron to make red blood cells. Your doctor may direct you to take iron supplements. He or she may also direct you to take certain vitamins that help the iron work better. Be sure to follow your doctor's orders carefully, because epoetin will not work properly if there is not enough iron in your body.

Side effects of this medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur:

  • More common–in any treatment group: Chest pain; shortness of breath
  • Less common–in any treatment group: Convulsions (seizures)

Also, check with your doctor as soon as possible if any of the following side effects occur:

  • More common—for patients being treated for anemia due to chronic kidney failure:
    Headache; increased blood pressure; swelling of face, fingers, ankles, feet, or lower legs; vision problems; weight gain
  • Rare—for patients being treated for anemia due to chronic kidney failure
    Skin rash or hives
  • More common—for patients being treated for anemia due to chronic kidney failure who require dialysis (in addition to those listed above)
    Cough; fast heartbeat; fever; sneezing; sore throat
  • More common—for zidovudine-treated HIV-infected patients
    Fever; headache; skin rash or hives
  • More common—for cancer patients on chemotherapy
    Cough, sneezing or sore throat; fever ; swelling of face, fingers, ankles, feet or lower legs; weight gain
  • More common—for surgical patients
    Blood in urine, lower back pain, or pain or burning while urinating ; fever; headache; increased blood pressure; skin rash or hives; swelling of face, fingers, ankles, feet or lower legs; swelling or pain in legs; weight gain

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Epoetin sometimes causes an influenza-like reaction, with symptoms such as muscle aches, bone pain, chills, shivering, and sweating, occurring about 1 or 2 hours after an injection. These symptoms usually go away within 12 hours. However, check with your doctor if this influenza-like reaction or any of the following side effects continue or are bothersome:

  • More common—in all treatment groups
    Diarrhoea; dizziness; nausea or vomiting
  • More common —for patients being treated for anemia due to chronic kidney failure (in addition to those listed above)
    Bone or joint pain, muscle aches, chills, shivering, sweating ; general feeling of tiredness or weakness; itching or stinging at site of injection; loss of strength or energy; muscle pain or weakness
  • More common—for patients being treated for anemia due to chronic kidney failure who require dialysis (in addition to those listed above)
    Abdominal pain and swelling; constipation ; cough; fever; sore throat; weight loss
  • More common —for zidovudine-treated HIV-infected patients
    Congestion in the lungs; cough; general feeling of tiredness or weakness; itching or stinging at site of injection; loss of strength or energy; muscle pain or weakness
  • More common—for cancer patients on chemotherapy
    General feeling of tiredness or weakness; loss of strength or energy; muscle pain or weakness ; tingling, burning or prickly sensation
  • More common—for surgical patients
    Anxiety; constipation; heartburn or belching, acid or sour stomach; inability to sleep; itching or stinging at site of injection; skin pain; stomach discomfort, upset or pain

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

- Information supplied by the National Institute of Health

 
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