Anemia in cancer patients on chemotherapy

Adverse reactions-

CNS-    asthenia    12%     dizziness  4%     parathesia   10%

GI -       diarrhea   20%   nausea  15%        vomiting  15%

Respiratory -    shortness of breath  12%    upper respiratory tract infection  10%

Miscellaneous -  edema   15%    fatigue   12%   pyrexia  27%   trunk pain  2%

Uncontrolled hypertension

Special Precautions/Warnings-

Increased mortality , serious  cardiovascular and thromboembolic reactions-
Cancer patients- an increased incidence of thrombotic events has been observed in patients treated with  cancer with erythropoetic agents

Chronic  renal failure- patients with CRF experienced greater risk of death ansd serious
CV reactions when administered ESAs to target higher versus lower haemoglobin levels.

Surgery patients - an increased risk incidence of deep vein thrombosis in patients receiving epoetin alfa undrgoing surgical orthopedic procedures has been observed

Chronic renal procedures- seizures have occurred in patients with CRF participitating
in epoetin alfa clinical trials

Hematologic effects - exacerbation of porphyria has been observed rarely in patients with
CRF  treated with epotin alfa. Use epoetin alfa with caution in patients with known porphyria  

Bone marrow fibrosis - bone marrow is a known complications  of CRF in humans and may  be related to secondary hyperparathyroidism

Iron evaluation- during epoetin alfa therapy, absolute or funtional iron deficiency may develop. Proir  to and during epoetin alfa therapy evaluate patients iron status, including transferrin saturation ( serum iron divided by iron binding capacity ) and serum ferritin.

Chronic renal failure-  Diet- reinforce the importance of compliance with dietary and dialysis prescriptions

Hypersensitivity reactions- there have been rare reports of potentially serious allergic
reactions, including urticaria, with associated respiratory symptoms or circumoral edema
or urticaria alone.

Renal function impairment- in adult patients with CRF not on dialysis closely monitor renal function and fluid  electrolyte balance.

Pregnancy-  only use epoetin alfa during pregnancy if the potential benefit justifies the
potential risk to the fetus.

Lactation- excercise caution when epoetin alfa is administered to a breast feeding woman.

Children- excercise caution while administering epoetin alfa  to children.

Elderly- individualize dose selection and adjustment  for an elderly patient to acheive
and maintain hematocrit target.

Monitoring- take special care and closely monitor  and aggresively control blood
pressure in patients treated with epoetin alfa , particularly in patients with a underlying
history of hypertension or CV disease, or who are in preoperative period

Indication-

Anemia in cancer patients on chemotherapy

Dosage-
Maximum dose

Children-
 60,000 units once weekly for the treatment of anemia in cancer patients on
 chemotherapy

Adults-
initial dose - 150units/kg subcutaneously 3 times a week or 40.000 units subcutaneously
weekly

1. Inform patients of the increased risks of mortality, serious CV reactions, thromboembolic
reactions, and increased risk of tumor progressionor recurrence

2.Inform patients of the possible adverse reactions of epoetin alfa and of the signs and
symptoms of allergic drug reaction, and advice them of appropiate actions.

3. If home use is precscibed for dialysis patients, throughly instruct them the importance of
proper disposal and caution them against the reuse of needles , syringes, or drug product.

4. A puncture resistent container for the disposal of used syringes and needles should be
aviailable to the patient. Provide guidance on the disposal of full container

5. In some women, menses have resumed following eportin alfa therapy. Discuss the
possibilty of pregnancy and the need for contraception evaluation

6. Caution patients to avoid potentially hazardous activities such as driving, or
operating heavy machinery, during this period.

Pregnancy- 
Only use epoetin alfa during pregnancy if the potential benefit justifies the
potential risk to the fetus.

Lactation-
Excercise caution when epoetin alfa is administered to a breast feeding woman.

Children-
Excercise caution while administering epoetin alfa  to children.

Elderly-
Individualize dose selection and adjustment  for an elderly patient to acheive
and maintain hematocrit target.