Epoetin Alfa Injection

Epogen ®, Procrit ®
Other name(s): EPO; Erythropoietin Human Glycoform alpha (Recombinant); rHuEPO-alpha Logo

Brand name(s): Epogen ®, Procrit ®
Other name(s): EPO; Erythropoietin Human Glycoform alpha (Recombinant); rHuEPO-alpha

How should this medicine be used?

Epoetin comes as a solution (liquid) to inject subcutaneously (just under the skin) or intravenously (into a vein). It is usually injected one to three times weekly. Epoetin may be injected once daily for 10 days before surgery, on the day of surgery and for 4 days after surgery. Epoetin may also be injected once weekly, beginning 3 weeks before surgery. To help you remember to use epoetin, mark a calendar to keep track of when you are to receive a dose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use epoetin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor may start you on a low dose of erythropoietin and gradually increase or decrease your dose, not more than once every month. Your doctor may also tell you to stop using epoetin for a time. Follow these instructions carefully. If your doctor tells you to stop using epoetin, do not begin using it again until your doctor tells you that you should. It is likely your doctor will restart your treatment with a lower dose of epoetin than you were using.

Epoetin controls anemia but does not cure it. It may take up to 6 weeks before you feel the full benefit of epoetin. Continue to use epoetin even if you feel well. Do not stop using epoetin without talking to your doctor.

Epoetin injections are usually given by a doctor or nurse. Your doctor may decide that you can inject epoetin yourself, or have a friend or relative give the injections.Your doctor will train the person who will be injecting the medication, and will test him to be sure he can give the injection correctly. Be sure that you and the person who will be giving the injections read the manufacturer's information for the patient that comes with epoetin before you use it for the first time at home.

If you are using epoetin at home, you will need to use disposable syringes to inject your medication. Your doctor or pharmacist will tell you what type of syringe you should use. Do not use any other type of syringe because you may not get the right amount of medication.

Use a disposable syringe only once. Throw away used syringes in a puncture-resistant container, out of the reach of children. Talk to your doctor or pharmacist about how to throw away the puncture-resistant container. There may be special state and local laws for throwing away used needles and syringes.

If your doctor has prescribed epoetin in a single use vial, the vial cannot be used more than once. Do not put a needle through the rubber stopper of a single use epoetin vial more than once. Throw away the vial after you have used it for one dose, even if it is not empty.

If your doctor has prescribed epoetin in a multidose vial, the vial may be used to inject several doses as prescribed by your doctor, but should be thrown away 21 days after you first use it.

You should prepare doses of epoetin just prior to use. Epoetin solution comes ready to use. Never shake a vial of epoetin solution, and never mix it with any other medication.

If you are injecting epoetin subcutaneously, you can inject it just under the skin anywhere on your upper arms, thighs, or stomach.

Choose a new spot at least one inch away from spots you have already used each time you inject epoetin. Write down the date, time, dose of epoetin, and the spot where you injected your dose in a record book. Do not inject epoetin into a spot that is painful, red, or swollen.

To prepare a dose of epoetin, follow these steps.

• Wash your hands well with soap and water.
• Remove the vial of epoetin from the refrigerator and put it on a flat surface to allow it to come to room temperature. Do not leave the epoetin in direct sunlight, and do not shake the vial.
• Check the date on the epoetin vial to be sure the medication is not expired. If the medication is expired, do not use it and call your pharmacist. Check to be sure the liquid in the vial is clear and colorless. If the liquid in the vial is discolored, cloudy, frothy, bubbly, or contains lumps, flakes, or particles, do not use it and call your doctor or pharmacist.
• Set out the following supplies for your injection: antiseptic swabs, disposable syringe, and puncture-proof needle disposal container.
• Once the epoetin has come to room temperature, wash your hands well again with soap and water.
• Flip the protective cap off of the epoetin vial without removing the rubber stopper. Be careful not to touch the rubber stopper. Use an antiseptic swab to wipe the top of the rubber stopper.
• Choose a spot where you will inject your medication from those suggested, and clean it with an antiseptic swab.
• Take the syringe out of its package. Pull out the syringe plunger until the black tip reaches the line (milliliters or mL) that marks your dose.
• Remove the protective needle cover from the syringe by pulling it straight off. Make sure the needle does not touch anything. If it does, throw that syringe away in the proper container and start with a new syringe.
• Put the needle straight through the rubber stopper on top of the epoetin vial. Push the syringe plunger all the way in to push air into the vial.
• Keep the needle in the vial and turn the vial upside down with one hand. Make sure the tip of the needle is in the epoetin liquid. With your other hand, pull the syringe plunger out until it is lined up a little past the number of milliliters for your correct dose.
• Keep the needle in the vial and check the syringe for air bubbles. If you see air bubbles trapped in the syringe, lightly tap on the syringe to make all the bubbles go toward the needle. Then slowly push the plunger toward the needle to remove the bubbles. Adjust the plunger so that it is lined up for your correct dose in milliliters.
• Double-check your dose. Remove the needle from the vial. Do not let the needle touch anything while it is uncovered. Follow the steps below to inject epoetin subcutaneously or intravenously.

To inject epoetin subcutaneously, follow the steps above to prepare your dose from a vial of epoetin, but use the following steps for injecting your dose:

• Hold the syringe in one hand and carefully pull off the needle cap with the other. Pinch up a fold of your skin at the injection spot.
• While holding the syringe like a pencil, insert the needle with a quick dart-like motion just under your skin at a 90-degree angle (straight up and down).
• After the needle is inserted, let go of the skin. Pull the syringe plunger back slightly. If no blood appears, slowly push the plunger all the way down until your dose of epoetin is injected. If blood comes into the syringe, do not inject epoetin. Pull the syringe straight out of the skin and throw away the syringe in the puncture-proof container. Press an antiseptic swab over the injection spot for a few seconds to stop any bleeding. Repeat the steps to choose and clean a new injection spot and prepare a new dose. Remember to check for blood again before injecting epoetin.
• Cover the injection site with an antiseptic swab. Gently press, but do not rub. If a little blood appears, apply a small adhesive bandage.
• Throw away the syringe in the puncture-proof container. If you used a single dose vial of epoetin, throw it away in the garbage. If you used a multi dose vial of epoetin, put it back in the refrigerator until it is time for your next dose.

If you are being treated with hemodialysis and your doctor has told you to inject epoetin into your hemodialysis tubing, follow the steps above to prepare your dose from a vial of epoetin, but use the following steps for injecting your dose intravenously:

• Clean the venous port of your hemodialysis tubing with an antiseptic swab.
• Insert the needle of the syringe containing your prepared dose into the cleaned venous port and push the plunger all the way down to inject all the epoetin.
• Remove the syringe from the venous port.
• Throw away the syringe in a puncture-proof container.

Last Revised: 01/01/2005

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