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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Erythropoietin: administration Erythropoietin: administration EPO is available as vials containing 1–10000 units per ml, as larger volume multidose vials, as pre-filled syringes with 1–10000 units per syringe, and in the form of a multidose injecting ‘pen’. EPO is relatively unstable at room temperature and must be kept in a fridge at 4°C. Stability varies somewhat between the main preparations. Multidose vials in particular should not be left warm for very long, and pen injectors (containing multidose cartridges) should be carried only for short periods with cooled inserts. Route of administration Subcutaneous administration has historically been shown to allow a 35% (15–50%) reduction in dosing for a given Hb response (compared with intravenous route). More recently, however, only a small increase in dose has been needed in patients transferring from the subcutaneous to intravenous routes. The subcutaneous route has been the preferred route, until the advent of pure red cell aplasia (PRCA). Patients should be taught to self-administer where possible. The injection site should be changed at each injection. Some patients report stinging with injection probably induced by the citrate buffer in some preparations. The presence of benzyl alcohol (as a preservative) in other EPO preparations acts as a local anaesthetic and minimizes stinging. Patients usually require doses two to three times each week; daily dosing is no better and should not be used, but weekly dosing may be sufficient in some patients (especially predialysis). EPO can also be given intraperitoneally (rarely used), but higher doses are required, and it should ideally be given into a dry abdomen. Because of the risk of PRCA (see later) due to the production of anti-EPO antibodies, predominantly with Eprex (the European brand of EPO-α), only EPO-β and darbepoietin are now licensed for subcutaneous administration in Europe. Eprex is limited to intravenous use, and is thus restricted to patients on HD.

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