Epoetin Alfa Injection
(e poe’ e tin)
Why is this medication prescribed?
Epoetin alfa is used to treat anemia (a lower than normal number of red blood cells) in people with serious kidney disease. Epoetin alfa is also used to treat anemia caused by certain medications, including some types of chemotherapy (medications to treat cancer) and zidovudine (Retrovir, in Trizivir, in Combivir), a medication used to treat human immunodeficiency virus (HIV). Epoetin alfa 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 alfa is in a class of medications called erythropoietic 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 the need for transfusion (transfer of one person’s blood to another person’s body)
How should this medicine be used?
Epoetin alfa 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. When epoetin alfa is used to prevent and treat anemia due to surgery, it is sometimes injected once daily for 10 days before surgery, on the day of surgery and for 4 days after surgery, and it is sometimes injected once weekly, beginning 3 weeks before surgery. To help you remember to use epoetin alfa, 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 alfa 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 epoetin alfa and gradually increase or decrease your dose, not more than once every month. Your doctor may also tell you to stop using epoetin alfa for a time. Follow these instructions carefully. If your doctor tells you to stop using epoetin alfa, do not begin using it again until your doctor tells you that you should. It is likely that your doctor will restart your treatment with a lower dose of epoetin alfa than you were using.
Epoetin alfa controls anemia but does not cure it. It may take up to 6 weeks before you feel the full benefit of epoetin alfa. Continue to use epoetin alfa even if you feel well. Do not stop using epoetin alfa without talking to your doctor.
Epoetin alfa injections are usually given by a doctor or nurse. Your doctor may decide that you can inject epoetin alfa yourself or that you may 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 alfa before you use it for the first time at home.
If you are using epoetin alfa 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 alfa in a single use vial, do not put a needle through the rubber stopper of the vial more than once. Throw away the vial after you have used it for one dose, even if it is not empty.
Always inject epoetin alfa in its own syringe; never mix it with any other medication.
If you are injecting epoetin alfa subcutaneously, you can inject it just under the skin anywhere on your upper arms, thighs, or stomach. Do not inject epoetin alfa into a spot that is painful, red, or swollen. Choose a new spot at least one inch away from spots you have already used each time you inject epoetin alfa. Write down the date, time, dose of epoetin alfa, and the spot where you injected your dose in a record book.
To prepare a dose of epoetin alfa, follow these steps:
- Do not prepare your dose until just before you are ready to use it.
- Wash your hands well with soap and water.
- Remove the vial of epoetin alfa from the refrigerator, and put it on a flat surface to allow it to come to room temperature. Do not leave the epoetin alfa in direct sunlight, and do not shake the vial.
- Check the date on the epoetin alfa vial to be sure the medication is not expired. Check to be sure the liquid in the vial is clear and colorless. If the expiration date has passed, if the liquid in the vial is discolored, cloudy, frothy, bubbly, or if it 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 alfa has come to room temperature, wash your hands well again with soap and water.
- If you will be injecting epoetin alfa subcutaneously, wipe the spot where you plan to inject the medication with an antiseptic swab. If you will be injecting epoetin alfa intravenously, wipe the venous port of your dialysis tubing with an antiseptic wipe.
- Flip the protective cap off of the epoetin alfa 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.
- 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 alfa 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 alfa liquid. With your other hand, pull the syringe plunger out until it is lined up a little past the number of milliliters for your 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 alfa subcutaneously or intravenously.
To inject epoetin alfa subcutaneously, follow the steps above to prepare your dose from a vial of epoetin alfa, and use the following steps for injecting your dose:
- Hold the syringe in one hand. Pinch up a fold of your skin at the injection spot with your other hand.
- 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 alfa is injected. If blood comes into the syringe, do not inject epoetin alfa. Pull the syringe straight out of the skin. 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 inject the medication. Remember to check for blood again before injecting epoetin alfa.
- 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 alfa, throw it away in the garbage. If you used a multidose vial of epoetin alfa, 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 alfa into your hemodialysis tubing, follow the steps above to prepare your dose from a vial of epoetin alfa, and use the following steps to inject your dose intravenously:
- 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 alfa.
- 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 (buildup 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.
What special precautions should I follow?
Before taking epoetin alfa,
- tell your doctor and pharmacist if you are allergic to epoetin alfa, darbepoetin alfa (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 or plan to take. 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 hormonal contraceptives (birth control pills, patches, rings, injections, or implants); 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 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; a 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 ministroke (TIA); tumors; heart disease, or any disease that affects your brain or nervous system.
- tell your doctor if you have used epoetin alfa or another erythropoietic protein such as darbepoetin alfa (Aranesp) in the past. Be sure to tell your doctor if your anemia worsened during your treatment with one of these medications, or if you were ever told to stop using one of these medications.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using epoetin alfa, call your doctor. If you stopped menstruating (getting your period) because of your anemia, you may begin to menstruate again while you are using epoetin alfa. This may increase the chance that you will become pregnant. 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 using epoetin alfa.
- you should know that epoetin alfa 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 alfa. 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 that you should, 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.
What special dietary instructions should I follow?
If you are following a prescribed special diet because you have kidney disease or high blood pressure, follow it carefully, even if you feel better while using epoetin alfa. Epoetin alfa 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.
What should I do if I forget a dose?
Call your doctor to ask what to do if you miss a dose of epoetin alfa. Do not use a double dose to make up for a missed one.
What side effects can this medication cause?
Epoetin alfa 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 spot where you injected epoetin alfa
- headache
- joint or muscle pain
- upset stomach
- vomiting
- indigestion
- stomach pain
- diarrhea
- constipation
- runny nose
- sneezing
- difficulty falling asleep or staying asleep
Some side effects can be serious. If you experience any of the following symptoms, 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)
- seizures
- weakness, numbness, heaviness, or tingling in arms or legs
- floppiness or loss of muscle tone
- fast heartbeat
- irregular heartbeat
- excessive sweating
- fever, sore throat, chills, cough, and other signs of infection
- rash
- hives
- itching
- swelling of the face, throat, tongue, lips, eyes, hands, arms, feet, ankles or lower legs
- wheezing
- difficulty breathing or swallowing
- hoarseness
- chest pain or tightness
- shortness of breath
- weakness
- extreme tiredness or lack of energy
- feeling cold most of the time
Epoetin alfa and other erythropoietic proteins may increase the risk that you will develop severe or life-threatening heart and blood vessel problems, such as 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, especially if you have heart disease and if your anemia is caused by kidney disease. Talk to your doctor about the risks of using epoetin alfa.
Epoetin alfa may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].
What storage conditions are needed for this medicine?
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 alfa away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Throw away a multidose vial of epoetin alfa 21 days after you first use it. Talk to your pharmacist about the proper disposal of your medication.
When traveling, place epoetin alfa in its original box in a cooler with ice packs. Do not place epoetin alfa 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 alfa in an airplane refrigerator. If you are traveling by airplane, do not put epoetin alfa through airport security x-ray machines. Ask for it to be inspected by hand.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. 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
- fast heartbeat
- irregular heartbeat
- 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
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body’s response to epoetin alfa.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are using epoetin alfa.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
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Last Revised - 04/01/2006