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Epoetin Alfa Injection : Uses, Dosage, Contraindications, Side Effects, Overdose


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BRAND NAME :  Epoetin Alfa Injection

Brand Names:

Epogen ®, Procrit ®

Medication prescribed:

Epoetin is used to treat anemia (a lower than normal number of red blood cells in people with serious kidney disease. Epoetin is also used to treat anemia caused by certain medications, including some types of chemotherapy (medications to treat cancer) and zidovudine ( Retrovir, Trizivir, Combivir), a medication to treat human immunodeficiency virus (HIV). Epoetin is also used before and after certain types of surgery to prevent and treat anemia that may develop because of blood loss during the surgery. Epoetin is in a class of medications called erythropoiesis stimulating proteins. It works by causing the bone marrow (soft tissue inside the bones where blood is made) to make more red blood cells. This may improve your energy and activity level and may decrease your need for transfusion (transfer of another person's blood to your body)

How should this medicine be used:

Epoetin comes as a solution (liquid) to inject subcutaneously (just under the skin) or intravenously (into a vein). It is usually injected one to three times weekly. Epoetin may be injected once daily for 10 days before surgery, on the day of surgery and for 4 days after surgery. Epoetin may also be injected once weekly, beginning 3 weeks before surgery. To help you remember to use epoetin, mark a calendar to keep track of when you are to receive a dose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use epoetin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Your doctor may start you on a low dose of erythropoietin and gradually increase or decrease your dose, not more than once every month. Your doctor may also tell you to stop using epoetin for a time. Follow these instructions carefully. If your doctor tells you to stop using epoetin, do not begin using it again until your doctor tells you that you should. It is likely your doctor will restart your treatment with a lower dose of epoetin than you were using. Epoetin controls anemia but does not cure it. It may take up to 6 weeks before you feel the full benefit of epoetin. Continue to use epoetin even if you feel well. Do not stop using epoetin without talking to your doctor. Epoetin injections are usually given by a doctor or nurse. Your doctor may decide that you can inject epoetin yourself, or have a friend or relative give the injections.Your doctor will train the person who will be injecting the medication, and will test him to be sure he can give the injection correctly. Be sure that you and the person who will be giving the injections read the manufacturer's information for the patient that comes with epoetin before you use it for the first time at home. If you are using epoetin at home, you will need to use disposable syringes to inject your medication. Your doctor or pharmacist will tell you what type of syringe you should use. Do not use any other type of syringe because you may not get the right amount of medication. Use a disposable syringe only once. Throw away used syringes in a puncture-resistant container, out of the reach of children. Talk to your doctor or pharmacist about how to throw away the puncture-resistant container. There may be special state and local laws for throwing away used needles and syringes. If your doctor has prescribed epoetin in a single use vial, the vial cannot be used more than once. Do not put a needle through the rubber stopper of a single use epoetin vial more than once. Throw away the vial after you have used it for one dose, even if it is not empty. If your doctor has prescribed epoetin in a multidose vial, the vial may be used to inject several doses as prescribed by your doctor, but should be thrown away 21 days after you first use it. You should prepare doses of epoetin just prior to use. Epoetin solution comes ready to use. Never shake a vial of epoetin solution, and never mix it with any other medication. If you are injecting epoetin subcutaneously, you can inject it just under the skin anywhere on your upper arms, thighs, or stomach. Choose a new spot at least one inch away from spots you have already used each time you inject epoetin. Write down the date, time, dose of epoetin, and the spot where you injected your dose in a record book. Do not inject epoetin into a spot that is painful, red, or swollen. To prepare a dose of epoetin, follow these steps. Wash your hands well with soap and water. Remove the vial of epoetin from the refrigerator and put it on a flat surface to allow it to come to room temperature. Do not leave the epoetin in direct sunlight, and do not shake the vial. Check the date on the epoetin vial to be sure the medication is not expired. If the medication is expired, do not use it and call your pharmacist. Check to be sure the liquid in the vial is clear and colorless. If the liquid in the vial is discolored, cloudy, frothy, bubbly, or contains lumps, flakes, or particles, do not use it and call your doctor or pharmacist. Set out the following supplies for your injection: antiseptic swabs, disposable syringe, and puncture-proof needle disposal container. Once the epoetin has come to room temperature, wash your hands well again with soap and water. Flip the protective cap off of the epoetin vial without removing the rubber stopper. Be careful not to touch the rubber stopper. Use an antiseptic swab to wipe the top of the rubber stopper. Choose a spot where you will inject your medication from those suggested, and clean it with an antiseptic swab. Take the syringe out of its package. Pull out the syringe plunger until the black tip reaches the line (milliliters or mL) that marks your dose. Remove the protective needle cover from the syringe by pulling it straight off. Make sure the needle does not touch anything. If it does, throw that syringe away in the proper container and start with a new syringe. Put the needle straight through the rubber stopper on top of the epoetin vial. Push the syringe plunger all the way in to push air into the vial. Keep the needle in the vial and turn the vial upside down with one hand. Make sure the tip of the needle is in the epoetin liquid. With your other hand, pull the syringe plunger out until it is lined up a little past the number of milliliters for your correct dose. Keep the needle in the vial and check the syringe for air bubbles. If you see air bubbles trapped in the syringe, lightly tap on the syringe to make all the bubbles go toward the needle. Then slowly push the plunger toward the needle to remove the bubbles. Adjust the plunger so that it is lined up for your correct dose in milliliters. Double-check your dose. Remove the needle from the vial. Do not let the needle touch anything while it is uncovered. Follow the steps below to inject epoetin subcutaneously or intravenously. To inject epoetin subcutaneously, follow the steps above to prepare your dose from a vial of epoetin, but use the following steps for injecting your dose: Hold the syringe in one hand and carefully pull off the needle cap with the other. Pinch up a fold of your skin at the injection spot. While holding the syringe like a pencil, insert the needle with a quick dart-like motion just under your skin at a 90-degree angle (straight up and down). After the needle is inserted, let go of the skin. Pull the syringe plunger back slightly. If no blood appears, slowly push the plunger all the way down until your dose of epoetin is injected. If blood comes into the syringe, do not inject epoetin. Pull the syringe straight out of the skin and throw away the syringe in the puncture-proof container. Press an antiseptic swab over the injection spot for a few seconds to stop any bleeding. Repeat the steps to choose and clean a new injection spot and prepare a new dose. Remember to check for blood again before injecting epoetin. Cover the injection site with an antiseptic swab. Gently press, but do not rub. If a little blood appears, apply a small adhesive bandage. Throw away the syringe in the puncture-proof container. If you used a single dose vial of epoetin, throw it away in the garbage. If you used a multi dose vial of epoetin, put it back in the refrigerator until it is time for your next dose. If you are being treated with hemodialysis and your doctor has told you to inject epoetin into your hemodialysis tubing, follow the steps above to prepare your dose from a vial of epoetin, but use the following steps for injecting your dose intravenously: Clean the venous port of your hemodialysis tubing with an antiseptic swab. Insert the needle of the syringe containing your prepared dose into the cleaned venous port and push the plunger all the way down to inject all the epoetin. Remove the syringe from the venous port. Throw away the syringe in a puncture-proof container.

Other uses for this medicine:

This medication may be prescribed for other uses, including anemia in premature (born too early) babies; anemia from rheumatoid arthritis (condition in which the body attacks its own joints, causing pain, swelling, and loss of function); Castleman disease (spread of growths in certain parts of the body that can cause anemia); Gaucher's disease (build up of a fatty substance in certain parts of the body that can cause liver, spleen, bone, and blood problems); myelodysplastic syndrome (a disease that causes bone marrow to make unhealthy red blood cells); paroxysmal nocturnal hemoglobinuria (disease where red blood cells are destroyed and leave the body through the urine during sleep); and sickle cell anemia (a type of anemia in which red blood cells have an abnormal shape). Ask your doctor or pharmacist for more information.

Special precautions:

Before taking epoetin, tell your doctor and pharmacist if you are allergic to epoetin, darbepoetin (Aranesp), medications made from animal cells,albumin, or any other medications. Ask your doctor or pharmacist if you don't know if a medication you are allergic to is made from animal cells. tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: androgens such as danazol (Danocrine); fluoxymesterone (Halotestin); methyltestosterone (Android, Testred, Virilon, others); testosterone (Androderm, AndroGel, Testim, others) ; desmopressin (DDAVP, DDVP, Stimate); estrogen-containing products such as hormone replacement therapy or oral contraceptives ('birth control pills'); iron supplements; medications to control high blood pressure; or probenecid . Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had bleeding problems or blood diseases that affect your blood such as leukemia, myelodysplastic syndrome, sickle cell disease (an inherited blood disease that causes pain, anemia, and organ damage), thalassemia (an inherited blood disease that causes abnormal development and other problems), or porphyria (an inherited blood disease that may cause skin or nervous system problems); blood clots in your heart, legs, or lungs; heart attack; parathyroid (small glands in the neck that help balance calcium levels in the body) disease, especially if it has affected your bones; seizures; stroke or mini-stroke (TIA); tumors; heart disease, or any disease that affects your brain or nervous system. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking epoetin, call your doctor. If you stopped menstruating (getting your period) because of your anemia, your period may come back while you are taking epoetin. Talk to your doctor about the type of birth control that is right for you. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking epoetin. you should know that epoetin may cause seizures, usually during the first 3 months of treatment. Talk to your doctor about driving a car or operating machinery during this time. you should know that your blood pressure may rise while you are using epoetin. Tell your doctor if you have or have ever had high blood pressure. Be sure to check your blood pressure as often as your doctor tells you to, to call your doctor if your blood pressure is higher than your doctor says it should be, and to take any medications your doctor prescribes to control your blood pressure exactly as directed. you should call your doctor if you are planning to travel or if your activity becomes limited, such as spending more time sitting or in bed. if you are on hemodialysis, you should know that blood clots may form in the tubing that goes into your vein. Call your doctor if you think there is a clot in your tubing.

Special dietary instructions:

If you are on a prescribed special diet because you have kidney disease or high blood pressure, follow it carefully, even if you feel better while using epoetin. Epoetin will not work unless your body has enough iron. Your doctor or dietician will probably tell you to eat foods that are rich in iron. If you cannot get enough iron from your diet, your doctor may prescribe an iron supplement. Take this supplement exactly as directed.

If I forget a dose:

Call your doctor to ask what to do if you miss a dose of epoetin.Do not use a double dose to make up for a missed one. Always keep a spare syringe and needle on hand.

What side effects:

Epoetin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: redness, swelling, stinging, bruising, itching, or a lump at the place where you injected epoetin headache joint or muscle pain upset stomach vomiting indigestion or "heartburn" stomach pain diarrhea constipation runny nose sneezing difficulty falling asleep or staying asleep Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately: leg pain or swelling shortness of breath coughing up blood cough that doesn't go away blue-grey color or darkening around mouth or nails dizziness fainting blurred vision temporary confusion slow or difficult speech loss of memory or ability to concentrate hallucinating (seeing things or hearing voices that do not exist) extreme tiredness seizures weakness, numbness, heaviness, or tingling in arms or legs floppiness or loss of muscle tone lack of energy increased or rapid heart beat irregular heart beat chest pain or tightness excessive sweating fever, sore throat, chills, cough, and other signs of infection rash hives itching swelling of the face, throat, tongue, lips, eyes, hands, feet, or ankles wheezing difficulty breathing or swallowing hoarseness You should know epoetin and other erythropoiesis stimulating medications may increase the risk of cardiovascular problems, including death, especially in patients with heart disease. It is important for your doctor to check your hemoglobin while you are taking epoetin. If your hemoglobin rises too high or too fast while using epoetin, serious problems may occur, including edema (swelling of the hands, feet, ankles, or lower legs), heart attack or heart failure, high blood pressure, seizures, stroke, and blood clots in your heart, legs, or lungs. This increased risk for high blood pressure, seizures, and blood clots reported with epoetin appears to be less in people with HIV using zidovudine and epoetin, and less in people with cancer using epoetin, than in people with serious kidney disease using epoetin. Talk to your doctor about the risks of using epoetin. Epoetin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions:

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it in the refrigerator, but do not freeze it. Keep epoetin away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Throw away a multi-dose vial of epoetin 21 days after you first used it. Talk to your pharmacist about the proper disposal of your medication. When traveling, place epoetin in its original box in a cooler with ice packs. Do not place epoetin vials directly on ice, and do not allow them to freeze. If a vial does freeze, do not use it. Do not use dry ice. Do not store epoetin in an airplane refrigerator.If you are traveling by airplane, do not put epoetin through airport security x-ray machines. Ask for it to be inspected by hand.

In case of overdose:

In case of overdose, call your local poison control center. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include: headache leg pain or swelling chest pain or tightness increased or rapid heartbeat irregular heart beat shortness of breath coughing up blood swelling of the hands, feet, or ankles blue-grey color or darkening around mouth or nails excessive sweating dizziness fainting blurred vision temporary confusion slow or difficult speech weakness or numbness of an arm or leg loss of memory or ability to concentrate extreme tiredness seizures coma

Other information:

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to epoetin. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking erythropoietin. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

More information:    Epoetin Alfa Injection

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