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Erythropoietin Stimulating Agents

Examples

Generic NameBrand Name
darbepoetin alfaAranesp
epoetin alfaEpogen, Procrit

Erythropoietin stimulating agents can be given two ways. They may be injected into a vein with an intravenous (IV) needle or injected under the skin (subcutaneous). Talk to your doctor about which way is best for you.

How It Works

Erythropoietin stimulating agents 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 hormone produced by the kidneys. Injections of erythropoietin stimulating agents replace this hormone.

Why It Is Used

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

  • During hemodialysis. This is the most common use of this therapy. The use of erythropoietin stimulating agents 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 stimulating agents may delay the need to start dialysis. It improves anemia in most people who have not started dialysis.

How Well It Works

Erythropoietin stimulating agents 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 stimulating agent may need to be adjusted so that you can keep a certain red blood cell count or level.

Things that may make this therapy less effective include:

  • Too little iron in the blood (iron deficiency). This is the most common reason that erythropoietin stimulating agents 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).
  • Vitamin deficiencies such as vitamin B12 or folate.
  • Ongoing bleeding from the gastrointestinal tract.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.
  • A seizure.
  • Very high blood pressure.

Call your doctor if you have:

  • Hives.
  • Flu symptoms such as fever, chills, or body aches.
  • Easy bruising.
  • Unusual bleeding, such as from your nose, mouth, vagina, or rectum.

Common side effects of this medicine include:

  • Stomach pain.
  • Skin rash or redness.

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 stimulating agents. They can help improve how well you feel and increase your appetite, energy, and activity levels.

It may be dangerous to use erythropoietin stimulating agents 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.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Credits

By Healthwise Staff
Anne C. Poinier, MD - Internal Medicine
Tushar J. Vachharajani, MD, FASN, FACP - Nephrology
Last Revised August 29, 2013

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