Brief introduction.

Epoetin is an artificially generated substance by recombinant technique in human cells. It carries out the role of erythropoietin which is naturally produced by the kidneys in any healthy individual. Epoetin is used when erythropoietin is not being produced appropriately. Epoetin is administered to the patient’s body by injection. 

Recombinant DNA technology is carried out on the human cells to produce erythropoietin. This process is controlled and synthetic in nature. Produced erythropoietin is then processed and used as injection medication in patients who has less RBC production.

There are two forms of epoetin, epoetin Alfa and epoetin beta.

How does epoetin work in the body?

It works the same way as the erythropoietin. 

• It acts as a precursor for RBC production.
• It stimulates the bone marrow to enhance the production of RBC.
• It stimulates erythropoiesis and the maturation of RBC.
• Hence, cells of the body receive oxygen that is carried by the hemoglobin present in RBC.
• RBC production leads to hemoglobin production and therefore weakness, malaise, and other anemia symptoms are controlled.

When is epoetin used in patients?

• Patients with kidney disease which lead to reduced or abnormal production of erythropoietin by the kidney.
• The patient who is anemic.
• The patient who is not on dialysis.
• Chronic Kidney disease of long duration.
• Other hormonal complications.
• The patient who is undergoing chemotherapy as a treatment for cancer.
• Patients who are on zidovudine to treat AIDS or HIV infection.

How is epoetin administered in the patient and when does it show results?

• An injection is administered intradermally or intravenously.
• With all the aseptic precautions the specific calculated dose is administered.
• On an average, it takes 4 weeks to see enhanced erythropoiesis and betterment in the patient’s condition. But it majorly depends on the patient and his/ her body’s response to the medication.
• It shows good results.

How is the dose of epoetin injection decided?

• In anemia, due to chemotherapy, the dose given is thrice a week or a dose of 40000 units once a week in adults until the chemotherapy lasts. It is given subcutaneously. In children, the dose differs.
• When hemoglobin in the body starts increasing the dose is reduced by 20 to 25% depending on the body response of the patient.
• In chronic renal failure cases a dose between 60 to 100 units thrice a week can be given intravenously or transdermally.
• Dose differs and changes in all the other conditions such as pre or post surgery anemia, cancer, pediatric population, liver abnormalities, etc.

Drug and disease interaction with epoetin.

• Alcohol: alcohol in interaction with epoetin leads to hypertensive crisis in the patient. This medication is not the good option if the patient is an alcoholic. 
• Other drug interactions include belzutifen, captopril, enalapril, cyclosporine, ibuprofen.
• Diseases: epilepsy ( seizures), hypertensive patients, cardiac disease patients ( embolism, thrombosis).

What are the adverse effects that a patient can face after taking an epoetin injection?

• Respiratory system: Upper respiratory tract infections are common in patients. Breathlessness, cough, and congestion in the lungs are other effects.
• Skin: Rashes and discoloration on the dermis or skin are a frequent complaints from the patient. Blanching and peeling are very rare.
• Body fluids: low iron or ferritin content in the blood.
• Joints: arthralgia or joint pain.
• Gastrointestinal symptoms: unusual appetite, diarrhea, stomach pain, bloating.
• Musculoskeletal system effects: muscle cramps, pain, weakness, etc.
• Nervous system effects: seizures, headache, paraesthesia, etc.
• Non-specific symptoms like malaise, nausea, and vomiting, headache, irritation, dizziness, and drowsiness are experienced.
• Irritation at the injection site.
• Psychological effects: social withdrawal, depression, anxiety, fear, etc. May be seen.

Risks that a patient can face after using Epogen.

• The patient may get uncontrolled hypertension.
• Thromboembolic changes in the major vessels which may lead to stroke, cardiac failure, or other organ damage.
• Edema can occur.
• Cardiovascular risk factors can be a serious issue for epoetin.

Contraindication of epoetin.

• Uncontrolled hypertension.
• Thromboembolic changes in the blood vessels.
• Atherosclerosis.
• Patient with a known case of seizures of any type.
• Allergy to any of the content of Epogen.
• Pregnancy and breastfeeding are still under study.
• A patient who is consuming alcohol is a partial contraindication.

What is the difference between epoetin alpha and epoetin beta?

• Epoetin beta has more molecular weight than epoetin alpha.
• Epoetin beta has more basic isoforms than epoetin alpha.
• In dialysis patients, epoetin beta has shown better results.
• Pharmacokinetics say both are similar.
• Epoetin delta and omega are now being studied and introduced.

Is epoetin safe and can I buy it?

• It is safe to use. A patient may present with some side effects.
• One cannot buy it in the store without a prescription from a medical professional.
• It is not an on-counter medication.
• Epogen is used for doping or drug abuse by professional sports person, so it is illegal to buy without medical need. 
• It will be available to you only if you have a legal and justified prescription for the same.

How can we naturally enhance erythropoietin and avoid anemia?

• Eat foods that have iron content in them such as groundnut and jaggery.
• Beef, meat including liver, kidney.
• Green leafy vegetables, beans, horse gram, lentils, beetroot salad, carrot, and fruits are good for increasing erythropoietin.
• Keep your kidneys healthy to have adequate erythropoietin. This can be done by maintaining a good and healthy lifestyle, adequate water intake, adequate and timely urination, and maintaining proper blood pressure.
• Egg yolk can be a very good source.
• Maintaining proper BMI.
• Daily exercise and fitness training.
• Avoid junk and food with zero food value.
• Avoiding alcohol, and abusive drugs.
• Reporting to nearby health care centers in case of severe anemia symptoms such as giddiness, weakness, pale skin, etc.
• Pregnancy care such as adequate nutrition, rest, hygiene, and checkup. This prevents mother and child from developing anemia.

What should my nephrologist or doctor know before starting Epogen?

• If you are hypertensive.
• If you take any antihypertensive drugs.
• If you are on dialysis.
• If you are an alcoholic.
• If you have previously received this treatment.
• If you have been operated on before, your history of illness, and all the other information.
• If you have been taking any medication or tablets for other conditions.