Introduction and five important points about Mircera.

• Mircera is a drug or medication that is used in a patient who has haemoglobin lower than the normal values for them or in patients who have less blood volume.
•  It has the compound methoxy polyethylene glycol epoetin beta.
• It acts as an erythropoietin receptor stimulator.
• It is a drug given by intravenous or subcutaneous injection.
• It has to be used only when prescribed by your nephrologist as it is illegal and an offence to use it for enhancing aerobic capacity and hence muscle power.

The following points are described in detail.

How does mircera increase RBC in the body?

1. Mircera is an erythropoietin receptor stimulator. It reaches the bone marrow and encourages the erythropoietin receptors to bind with the erythropoietin molecules.
2. The inactive receptors are now activated by the Mircera. This leads to the binding of the substrate to the receptor forming a substrate and receptor complex. 
3. It then leads to the synthesis of the protein in turn producing red blood cells ( RBC). 
4. This increases the RBC in the body which increases the blood volume and haemoglobin.
5. It thus treats anaemia and hypovolemia in the patient.

In what diseases is mircera used in?

• Chronic Kidney disease: kidney is the organ that produces erythropoietin in the body. If the kidney is affected for a longer period of time it leads to diminished functioning of this organ. One of its functions is to produce erythropoietin. Mircera enhances the interaction between the receptor and erythropoietin to produce RBC. Anaemia is a common complaint in CKD, mircera overcomes this problem.
• Renal failure: when kidneys stop functioning, it generates the need for dialysis and erythropoietin production hormone. Mircera is the epoetin beta that acts on the bone marrow and produces RBC.
• Avoid blood transfusion in CKD : the last treatment to treat anaemia is transfusion of blood. To avoid the need for it, mircera is advised to the patient. It takes away the need for transfusion and maintains the blood haemoglobin levels.
• Cancer: Cancer is a condition that has a lot of secondary complications which are more of a concern. One of the complications of cancer is anaemia. It can be due to cancer treatment or sure if cancer or metastasis. To maintain the required blood haemoglobin, mircera is advised. 
• It is the drug of choice for chronic Kidney disease patients who are on dialysis or not on dialysis. It is used in patients above the age of 5 years.

What are the side effects of mircera use?

• Respiratory system: the patient may feel breathlessness, cough, lung congestion, chest pain, and difficulty in chest expansion.
• Cardiovascular effects: the patient may feel discomfort in the chest, pain in the left upper chest radiating to the arm, arrhythmias, hypertension, embolism, and thrombosis.
• Musculoskeletal system: muscle cramps, pain, weakness, myalgia, bone resorption, etc. 
• Neurological issues: drowsiness, headache, mental confusion, slurring.
• Dermatological effects: rashes, discoloration of the skin, blisters.
• Eye issues: the blurring of the vision, burning sensation, irritation.
• Nose bleeding, redness, etc.
• Ear pain, infections, etc. Can be seen.
• Pain at the site of injection.
• Balance and coordination issues.
• Swelling on body parts, fainting, myalgia, and nausea are other effects.

How to use mircera?

• Mircera is available in syringe form itself. You don’t have to fill in the medicine.
• Take proper aseptic precautions like the use of alcohol based cleaning swabs to clean the area of injection.
• Do not keep the syringe open and insert the medicine later. It should be opened only when the medication is to be administered.
• It is usually given intravenously or subcutaneously as directed by the doctor.
• After the needle is introduced into the body, slowly push the plunge with the thumb. Hold the syringe with forefingers.
• The dose and directions are given by the nephrologist and should be followed strictly.

What is the dose and frequency of mircera injection use?

• Mircera can be administered by the patient himself/ herself or can be administered by caregivers. 
• The dose depends on the patient’s condition and age.
• The frequency should not cross beyond 1-2 times a week.
• Mircera should be used just like an agent which keeps the blood cells level up to the mark so as to avoid any blood transfusion. It should be used as guided by your nephrologist.
• The effect can be seen after 3-4 doses.
• The frequency of the dose should not be changed frequently as it can lead to undesired effects.
• Frequent haemoglobin monitoring is important to track the need for mircera and to maintain its dosage.

What are the desired effects of Mircera?

• Mircera increases the red blood cell count.
• It reduces anaemia symptoms and improves the haemoglobin level.
• It improves oxygen supply to the cells of the body.
• It carries out the function of the kidney of initiating erythropoiesis.
• It avoids the need for blood transfusion.
• The effect is quite satisfactory and comparatively quick.

Can mircera be used in pregnancy and lactation?

• It is recommended not to use mircera in the pregnancy related anaemia. It should be taken care of by nutritional supplementation and other medical supplements.
• Lactating mothers are also not considered suitable for use of Mircera.
• The study is being conducted to give a proper conclusion but it has not yet been proven to be safe for pregnant and breastfeeding women.

Summary for the patient on mircera:

• Mircera is administered or injected to increase RBC and therefore blood in the body.
• It can cause various side effects Which on excessive exacerbation should be notified to your nephrologist or your doctor.
• Results will be seen after the initial few doses.
• It should only be taken as guided by your nephrologist or doctor strictly.
• Dose and frequency should be considered properly.
• Do not use the medicine if you see any kind of clots, suspension, or abnormal coloration in the syringe.
• Dose Should be increased or reduced only when a medical professional recommends you to do so.