Pharm

Erythropoietin

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Erythropoietin, Epoetin, Procrit, Epogen

Indications

Illicit use by athletes as ergonomic aid (banned)
Anemia
1. Chronic Renal Failure
  1. Indicated to maintain Hemoglobin 10-12 mg/dl
  2. Decreases cardiovascular morbidity and mortality
  3. Increases quality of life
2. Cancer Chemotherapy
  1. Indicated to maintain Hemoglobin >10 g/dl
  2. Contraindicated if serum Erythropoietin >200 mU/ml
  3. Increases Hemoglobin 2 g/dl
  4. Decreases transfusion need
  5. Increases quality of life
  6. Does not improve survival or delay disease progress
    1. Henke (2003) Lancet 362:1255-60 [PubMed]
3. Anemia secondary to HIV Management (e.g. Zidovudine)
  1. Contraindicated if serum Erythropoietin >500 mU/ml
  2. Increases quality of life (e.g. Energy)
  3. Prolongs AIDS survival
4. Prophylaxis before elective surgery (non-cardiac)
  1. Indicated before surgery where transfusion is otherwise predicted
5. Other possible indications (covered by Medicare)
  1. Myelodysplastic Syndrome
  2. Hepatitis C (during treatment)
  3. Inflammatory Bowel Disease
  4. Rheumatoid Arthritis
  5. Systemic Lupus Erythematosus

Adverse effects

Hypertension (25% of Renal Failure patients)
1. Hypertensive Encephalopathy
2. Seizures
Thrombotic events (e.g. Myocardial Infarction)
May promote growth of certain Breast Cancers

Disadvantages

See adverse effects above
Cost: $3000 for 8 week cancer course

References