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Erythropoietin

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VOL: 102, ISSUE: 12, PAGE NO: 33

GENERIC AND PROPRIETARY NAMES

- Darbepoetin alfa: Aranesp.

- Epotin alfa and beta: Eprex, NeoRecormon.

ACTION

- Erythropoietin is a naturally occurring hormone, produced by the kidneys.

- It stimulates the bone marrow to make red blood cells.

- The two types of erythropoietin, epoetin and darbepoetin, work in similar ways.

CLASSIFICATION

- Drugs used in hypoplastic, haemolytic and renal anaemias.

INDICATIONS

Darbepoetin alfa:

- Anaemia associated with chronic renal failure in patients on dialysis.

- Anaemia associated with chronic renal failure in patients not on dialysis.

- Anaemia in adults with non-myeloid malignancies who are receiving chemotherapy.

Epotin alfa and beta:

- Anaemia associated with chronic renal failure in patients on haemodialysis.

- Anaemia associated with chronic renal failure in adults on peritoneal dialysis.

- Anaemia in adults receiving cancer chemotherapy.

- To increase yield of autologous blood in pre-donation programmes in cases of moderate anaemia.

- Moderate anaemia before elective orthopaedic surgery.

CONTRAINDICATIONS

- Pure red cell aplasia following erythropoietin.

- Uncontrolled hypertension.

CAUTIONS

- Poorly controlled blood pressure.

- Sickle cell disease.

- Ischaemic vascular disease.

- Thrombocytosis.

- Epilepsy.

- Malignant disease.

- Chronic liver failure.

- Cardiovascular disease.

- Breastfeeding.

COMMON SIDE-EFFECTS

- Increased blood pressure.

- Problems at injection site.

- Headache.

- Epileptic seizures.

- Influenza-like symptoms.

- Skin reactions.

INTERACTIONS

- ACE inhibitors.

- Iron supplements.

ADMINISTRATION

- Subcutaneously.

- Erythropoietin should be stored in the fridge.

- The dose will vary according to preparation and body weight.

NURSING CONSIDERATIONS

- Avoid injections containing benzyl alcohol in neonates.

- It is important that blood pressure, reticulocyte, haemoglobin and electrolyte counts be closely monitored.

- Interrupt treatment if blood pressure becomes uncontrollable.

- Exclude other causes of anaemia and give iron supplements where appropriate.

- If used before orthopaedic surgery this may present an increased risk for thrombosis.

PATIENT TEACHING

- Ensure patients know they should report any headaches, as sudden migraine-like pain is a warning of a hypertensive crisis.

- Patients who miss a dose should not try to make this up.

- Taking a single excess dose of this medication is a cause for concern and taking too high a dose over a period of time can increase the likelihood of adverse effects.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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