Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Epoetin alfa is a man-made, injectable drug
for treating anemia. Erythropoietin is a protein that normally is made in the
body by the kidney. It causes the bone marrow to produce oxygen-carrying red
blood cells. Under normal conditions, when the body senses a decrease in red
blood cells or a deficiency in the supply of oxygen, more erythropoietin is
produced, and this increases the number of red blood cells. When this natural
mechanism is not working, it may become necessary to stimulate the bone marrow
to produce red blood cells. The erythropoietin that is used for therapy, called
epoetin alfa, is man-made. It is a product of the genetic engineering of ovarian
cells of the Chinese hamster and is produced through recombinant DNA technology
in bacteria. It does not cure the underlying cause of the anemia, and unless the
underlying cause can be reversed, treatment with epoetin alfa must be continued
indefinitely.
Epoetin alfa belongs to a class of drugs called colony-stimulating
factors because of their ability to stimulate cells in the bone marrow to
multiply and form colonies of identical cells. Other colony-stimulating factors
include filigrastim (Neupogen) and sargramostim (Leukine). Epogen and Procrit
are both epoetin alfa, but they are marketed by two different pharmaceutical
companies. The FDA approved epoetin alfa in June 1989.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Vials containing liquid for injection: 2000, 3000, 4000,
10000, 20000 and 40000 U/ml as well as 20000 U/2ml
STORAGE: Epoetin alfa should be stored at 2-8 C (36-46 F). It should
not be frozen. Multiple-use vials should be used within 21 days of the first
use.
PRESCRIBED FOR: Epoetin alfa is used to treat anemia that is
associated with
chronic kidney failure in patients who are or will be receiving
renal dialysis. It also is used to treat anemia in patients with
HIV infection
who are receiving zidovudine
(Retrovir) and in patients with cancer who are receiving
chemotherapy and develop anemia. Epoetin alfa may be used to replace
transfusions of red blood cells in patients who are anemic and undergoing
surgery. Epoetin alfa has not been shown to improve fatigue or quality of life
in patients with cancer.
DOSING: Epoetin alfa is administered intravenously or subcutaneously
(under the skin) at 50-100 units/kg of body weight, three times weekly. The dose
is tailored to each patient based on targeted
hemoglobin levels. Adult patients
with cancer receiving chemotherapy may be treated with 40,000 units weekly or
150 units/kg 3 times weekly.
Zidovudine treated patients should receive 100
units/kg 3 times weekly.
Surgery patients should receive 300 units/kg per day
daily for 14 days or 600 units/kg weekly. The smallest effective dose should be
used.
In clinical trials, the risk of death or serious heart problems, and
stroke occurred more often when epoetin alpha was administered to target a
hemoglobin level greater than 11 g/dL. Epoetin alfa vials should not be shaken
since the drug may be damaged, and bubbles may form that prevent some of the
drug from being drawn up into the syringe during injection. Iron stores should
be evaluated before therapy and supplemental iron should be administered if
needed.
DRUG INTERACTIONS: No clinical studies have been done to demonstrate
epoetin alfa drug interactions.
PREGNANCY: There are no studies of epoetin alfa use in
pregnant women. Polyhydramnios and intrauterine growth restriction was reported in a small
number of pregnant women who received epoetin alpha. Multiple dose vials contain
benzyl alcohol and should not be administered to pregnant women.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
The hematocrit is the proportion, by volume, of the blood that consists of red blood cells. The hematocrit (hct) is expressed as a percentage. For example, an hematocrit of 25% means that there are 25 milliliters of red blood cells in 100 milliliters of blood.
How is the hematocrit measured?
The hematocrit is typically measured from a blood sample by an automated machine that makes several other measurements at the same time. Most of these machines in fact do not directly measure the hematocrit, but instead calculate it based on the determination of the amount of hemoglobin and the average volume of the red blood cells. The hematocrit can also be determined by a manual method using a centrifuge. When a tube of blood is centrifuged, the red cells will be packed into the bottom of the tube. The proportion of red cells to the total blood volume can be visually measured.
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