Hemax

Anemia of chronic renal failure in adult & ped patients on dialysis (end-stage renal failure) including in those not requiring dialysis; in HIV-infected patients on zidovudine-induced anaemia; cancer patients w/ metastases of non-myeloid malignancies on chemotherapy-induced anaemia; preterm infants w/ body wt between 750-1,500 g at birth & gestational age <34 wk.

Anemia in chronic renal failure patients Adult Initially 50-100 IU/kg 3x a wk IV or SC. Correct dose according to Hb level increase after 4 wk of treatment: ≥1 g/dL increase: Maintain same dose, <1 g/dL increase: May increase dose by approx 25%. Maintenance dose: Individualised dose. Ped patients Initial dose: Same as adult dose. Maintenance dose: Childn weighing >30 kg 30-100 IU/kg 3x wkly, 10-30 kg 60-150 IU/kg 3x wkly, <10 kg 75-150 IU/kg 3x wkly. Anemia in HIV-infected patients (zidovudine-induced) Initially 100 IU/kg 3x wkly for 8 wk. May be escalated by 50 IU/kg increases to max 300 IU 3x wkly if no satisfactory response is obtained. Anemia in cancer patients on chemotherapy Adult Initially 150 U/kg/dose 3x a wk SC. May be increased by 50 U/kg/dose each time up to max 300 U/kg 3x wkly if no response after 4 wk. Reduce dose by 25% if Hb level reaches 12 g/dL or increases >1 g/dL w/in 2 wk. Single wkly administration: Initially 40,000 IU SC once a wk. May be increased to 60,000 IU if Hb did not increase 1 g/dL in 4 wk (free of transfusions). Reduce dose by 25% if Hb increase >1 g/dL in 2 wk. Ped patient 6 mth to 18 yr 25-300 IU/kg IV or SC 3-7x wkly. Anemia of prematurity 250 IU/kg 3x a wk SC. Start treatment as soon as possible & should last for 6 wk.

Hypersensitivity to human albumin & products derived from mammalian cells. Uncontrolled arterial HTN, epoetin-related pure red cell aplasia. Pregnancy & lactation.

Discontinue treatment in case pure RBC aplasia (PRCA) occurs. Not indicated for HIV-infected patients w/ anaemia of other aetiology (Fe or folate deficiency, haemolysis, GI haemorrhage); in patients receiving hormone therapy, biological products or RT w/o concomitant bone marrow suppressive chemotherapy, & chemotherapy when anticipated outcome is to cure. Not to be administered as emergency transfusion substitute in patients requiring immediate correction of severe anaemia. Increased risk of HTN, lack of efficacy & PRCA; mortality & occurrence of serious CV events; tumor progression or recurrence in patients w/ breast, head & neck, lymphoid, & cervical cancer, & NSCLC. Increased DVT in patients on erythropoiesis stimulating agents (ESA) not receiving prophylactic anticoagulation. History & exacerbation of porphyria. Patients w/ pre-existing risk factors for thrombotic vascular events (TVEs) including obesity & prior history of TVEs eg, DVT, pulmonary embolism & cancer patients. Ab-mediated PRCA in chronic renal failure patients w/ long term use & in patients w/ hepatitis C w/ concomitant interferon & ribavirin use. Fe deficiency, underlying infections, inflammatory processes or neoplasia, occult blood loss, underlying haematologic diseases (thalassaemia, myelodysplasia), haemolysis, Al overload, vit deficiencies (vit B₁₂ or folic acid), cystic fibrosis, PRCA, bone marrow fibrosis & suppression from uremia, hyperparathyroidism/osteitis fibrosa cystica, erythrocyte enzyme abnormalities. Food indigestion; increased K level. Use lowest dose needed to avoid RBC transfusion & Hb should not be >12 g/dL. Obtain reticulocyte count in chronic renal failure patients developing sudden lack of efficacy w/ decrease Hb & need for transfusion. Perform anti-erythropoietin Abs & bone marrow testing in case reticulocyte index <20,000 µL or <0.5% w/ normal platelets & WBCs. Consider prophylactic anticoagulation when ESA including epoetin is indicated to reduce number of allogeneic transfusions. Fe supplementation in patients w/ not enough Fe stores due to frequent transfusions. Not to be used during pregnancy & lactation.

Arterial HTN, headaches, oedema, low back pain, polycythemia, thrombotic complications, fever, hyperkalemia, breathing difficulties, tachycardia, seizures, arthralgias; skin rash, urticaria.

Increased BP w/ antihypertensives. Concomitant use w/ heparin; Fe supplements.

Haematopoietic Agents / Supportive Care Therapy

B03XA01 - erythropoietin ; Belongs to the class of other antianemic preparations. Used in the treatment of anemia.

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