Epoetin alfa belongs to the class of medications known as erythropoiesis regulating hormones. It is used to increase the production of red blood cells and decrease the need for transfusions of red blood cells.

Epoetin alfa is produced naturally in the body, mostly by the kidneys. It gives bone marrow the signal to produce red blood cells (RBCs), which carry oxygen in the blood. It works by causing increased red blood cell production by the body. If the body does not produce enough epoetin alfa, severe anemia (lack of oxygen reaching the different parts of the body) can occur.

Epoetin alfa is used to treat anemia for people with chronic kidney disease (CKD), because their kidneys are unable to produce enough natural erythropoietin on their own. It is also used to treat people with cancer who develop anemia because of chemotherapy treatment. When chemotherapy is given to people with cancer, their bodies may not be able to produce enough erythropoietin. As a result, they can become anemic. Epoetin alfa has only been studied to treat people who have non-myeloid cancers (cancers other than bone marrow cancers).

Epoetin alfa is also used to treat anemia before certain surgeries and for people with HIV who are taking the medication zidovudine. It can also be used to increase red blood cell production for certain patients scheduled for surgery. This allows blood collection from the patient to be used during surgery, so blood from other donors is less likely. It takes at least 2 weeks (and as long as 6 weeks) for a noticeable response to the medication.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

Epoetin alfa is available only as an injection, which is given subcutaneously (under the skin) or intravenously (into a vein). People who receive the medication under the skin can usually be taught to give themselves the medication. Be sure you understand exactly how it is to be injected, as instructed by your doctor or nurse. People who need to receive the medication into a vein will need to have the medication administered by a doctor or nurse.

For children with chronic renal failure, the starting dose for anemia is 50 units (IU) per kilogram body weight, given 3 times a week.

For adults with chronic renal failure, the starting dose for anemia is 50 to 100 units per kilogram of body weight, injected three times a week.

For adults with anemia who have HIV, the usual starting dose is 100 units per kilogram body weight, injected 3 times a week.

For people with anemia due to chemotherapy, the starting dose is 150 units per kilogram of body weight, injected subcutaneously 3 times a week. As an alternative, epoetin alfa may be injected subcutaneously once weekly as a dose of 40,000 units.

When epoetin alfa is used for people scheduled for surgery, higher doses are used.

Your doctor may need to adjust the dose according to your body's response to the medication. Adjustments usually involve blood tests and are not done more often than once every 4 weeks. While you are being treated with epoetin alfa, your doctor may want you to take iron supplements to help the medication work as well as possible.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, administer it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not administer a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Epoetin alfa should be refrigerated and protected from light. Do not let it freeze. The prefilled syringe should be allowed to warm to room temperature just before injecting it, and may be stored for up to 7 days at room temperature. Do not shake the medication before use.

Prefilled syringes
Each syringe of sterile solution contains epoetin alfa 1,000 IU, 2,000 IU, 3,000 IU, 4,000 IU, 5,000 IU, 6,000 IU, 8,000 IU, 10,000 IU, 20,000 IU, 30,000 IU, or 40,000 IU. Nonmedicinal ingredients: glycine and polysorbate 80 as stabilizers, sodium chloride, sodium phosphate dibasic dihydrate, sodium phosphate monobasic dihydrate, and water for injection.

The needle cover on the pre-filled syringe contains dry, natural rubber (a derivative of latex).

Do not take this medication if you:

• are allergic to epoetin alfa or any ingredients of the medication
• are allergic to medications made from mammalian cells
• are scheduled for surgery and have severe disease of the heart or blood vessels
• have developed a condition called pure red cell aplasia (PRCA) after using erythropoiesis-stimulating proteins (e.g., epoetin alfa, darbepoetin alfa)
• have uncontrolled high blood pressure
• cannot receive medication to treat blood clotting

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• diarrhea
• general feeling of tiredness or weakness
• nausea
• pain, stinging, redness, or swelling around the injection site
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• clotting of the vascular access site (for people on hemodialysis)
• edema (swelling of the face, fingers, ankles, feet, or lower legs)
• flu-like symptoms (e.g., dizziness, drowsiness, fever, headache, muscle, and joint pain)
• increase in headaches
• increased or decreased blood pressure, dizziness, or feeling faint
• muscle aches and pain
• severe tiredness or fatigue
• shortness of breath with mild exertion

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• seizures
• signs of allergic reaction (symptoms may include skin rash or hives, trouble breathing, sweating, abnormal heart rate, or decreased blood pressure)
• signs of blood clots (pain or swelling in the legs, worsening shortness of breath, coughing up blood)
• signs of a serious skin reaction (such as skin rash; red skin; blistering of the lips, eyes, or mouth; skin peeling; fever; or joint pain)
• signs of stroke (confusion, severe headache, sudden weakness, dizziness, trouble speaking, or vision problems)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Blood clots: It has been identified in clinical trials that cancer patients and patients with chronic renal failure who are treated with epoetin alfa to raise their hemoglobin beyond normal levels are at a higher risk of developing blood clots, which in some cases can cause death. Your doctor will monitor your hemoglobin level closely with blood tests during treatment with this medication.

If you experience symptoms such as sharp pain and swelling in the leg, or difficulty breathing, contact your doctor immediately.

Cancer: Epoetin alfa is used to treat anemia caused by chemotherapy treatment of non-myeloid cancers. It is not used to treat anemia that is due to the cancer itself. If you have cancer and your hemoglobin is kept too high, your cancer may grow faster or you may have an increased risk of heart attack or stroke. Discuss any concerns you have with your doctor. 

Cardiovascular disease: This medication often affects blood pressure and can contribute to symptoms of heart disease. If you have high blood pressure, heart disease such as heart failure, angina, or a previous heart attack, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you are taking blood pressure pills to control blood pressure, it is important to continue taking them regularly while you are on epoetin alfa. Your doctor will monitor your hemoglobin (the protein in red blood cells that carry oxygen) until an appropriate dose of epoetin alfa has been determined.

Gout: This medication may cause symptoms of gout. If you have gout or a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney disease: This medication may be used by people with chronic kidney disease who are receiving dialysis and those who are not receiving dialysis. The dose may be different for each. Your doctor will monitor you closely for your response to the medication.

Medical conditions: Be sure to tell the doctor if you have any of the following medical problems, as they may affect how well this medication works:

• folic acid, iron, or vitamin B12 deficiency
• excess aluminum in the blood
• infection
• inflammation
• cancer
• bone problems
• blood diseases (e.g., sickle cell anemia)

Porphyria: If you have a history of porphyrin metabolism disorder (a metabolic disorder), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pure red cell aplasia: Cases of pure red cell aplasia (PRCA) have been reported among people treated with epoetin alfa. PRCA is a condition in which a person's bone marrow stops producing red blood cells, leading to severe anemia. People who develop PRCA may experience a new or worsening feeling of tiredness or shortness of breath. If you are experiencing such symptoms, call your doctor as soon as possible. Do not stop your medication without contacting your doctor first.

Seizure: This medication may contribute to an increase in seizures although the relationship between epoetin alfa and seizures is not clear. If you experience seizures or have a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stroke: Epoetin alfa can increase the risk of blood clots forming in the blood vessels. If you have a past history of stroke, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience signs and symptoms of a stroke, such as blurred vision, difficulty speaking, sudden headache, or loss of coordination, contact your doctor immediately.

Worsening of anemia: Severe and sudden tiredness and shortness of breath could be a sign of severe anemia. People who develop these symptoms should see their doctor as soon as possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if epoetin alfa passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 1 month of age. Epoetin alfa has been shown to be safe for children over the age of 1 month who need dialysis to treat chronic renal failure.

There may be an interaction between epoetin alfa and any of the following:

• lenalidomide
• pomalidomide
• thalidomide

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.