Erythropoietin stimulators

Examples

Generic Name	Brand Name
darbepoetin alfa	Aranesp
epoetin alfa	Epogen, Procrit

Erythropoietin stimulators may be injected into a vein (intravenously, or IV) or under the skin (subcutaneously). Subcutaneous use does a better job of keeping red blood cell levels up, causes fewer side effects, and requires smaller doses, which cost less.

How It Works

Erythropoietin stimulators cause the bone marrow to produce more red blood cells, and they decrease your need for blood transfusions. Anemia often occurs because of a decrease in erythropoietin, a protein produced by the kidneys. Injections of erythropoietin stimulators replace this protein.

Why It Is Used

Erythropoietin stimulators replace the erythropoietin normally made by the kidneys. Therapy with erythropoietin stimulators may be used to treat anemia:

• During hemodialysis. This is the most common use of this therapy. The use of erythropoietin stimulators in people receiving hemodialysis has almost eliminated the need for blood transfusions.
• When chronic kidney disease is present but kidney failure has not yet developed. Treatment with erythropoietin stimulators may delay the need to start dialysis. It improves anemia in most people who have not started dialysis.

How Well It Works

Erythropoietin stimulators treat anemia by increasing the number of new red blood cells your body makes. This may decrease your need for blood transfusions. Your dose of an erythropoietin stimulator may need to be adjusted to maintain a certain red blood cell count or level.

Factors that may make this therapy less effective include:

• Too little iron in the blood (iron deficiency). This is the most common reason that erythropoietin stimulators may not be effective. Iron deficiency can be treated with oral or intravenous iron (iron therapy) to increase the amount of iron in your blood.
• Infection.
• Decreased sensitivity to erythropoietin.
• High levels of aluminum in your body, which may interfere with your ability to use iron.
• Dialysis procedures that are not removing enough fluids or wastes from your body (inadequate dialysis).
• Too little protein in the diet (protein malnutrition).

Side Effects

High blood pressure can develop during treatment with erythropoietin stimulators. This side effect can usually be managed with medicines to treat high blood pressure.¹

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Most people do not have problems with erythropoietin stimulators. They can help improve how well you feel and increase your appetite, energy, and activity levels. The use of erythropoietin stimulators may also delay the need for dialysis, improve some heart problems, and increase your life span.

Erythropoietin therapy is expensive. Your doctor may need to make adjustments in your dose to find the amount that gives you the most benefit but costs the least.

It may be dangerous to use erythropoietin stimulators to increase your red blood cell (hemoglobin) levels above 12 g/dL. Hemoglobin levels that are too high may increase your risk for death, heart failure, heart attack, and stroke. Talk with your doctor about your concerns and keep all your appointments for blood tests.

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Author:	Jeannette Curtis	Last Updated: November 13, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine D.C. Mendelssohn, MD, FRCPC - Nephrology
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