Erythropoietin (Eprex®, NeoRecormon®, Aranesp®)

What is Erythropoietin?

Erythropoietin is a type of protein that occurs naturally in the body. It can also be made as a drug. It stimulates the bone marrow to make red blood cells.

Erythropoietin can be given as a treatment for a low red blood cell count (anaemia), as an alternative to a blood transfusion. Our red blood cells contain haemoglobin, which carries oxygen around the body. If your haemoglobin level falls too low after treatment with certain types of chemotherapy or radiotherapy, your doctor may recommend a course of erythropoietin. There are two types of erythropoietin, epoetin and darbepoetin, which work in similar ways.

Why it is given

One of the main side effects of chemotherapy is to slow the production of blood cells by the bone marrow. At first, only white blood cells seem to be affected. This is because red blood cells live much longer in the circulating blood. Therefore it takes longer for the effects of the chemotherapy on red blood cell production to show up in the blood.

Towards the end of your treatment, particularly if you have had a lot of chemotherapy, your red blood cell count may fall. If you have too few red blood cells (anaemia), you will feel very tired and may also be breathless.

Erythropoietin will help your red blood cell count to increase and so can relieve the symptoms of anaemia. It takes about 2–3 weeks for the treatment to begin to raise your red blood cell level. You will have regular blood tests while you are having treatment with erythropoietin, to make sure that your red blood cell levels stay within a normal range.

What it looks like

Erythropoietin is a clear liquid in a small glass bottle or pre-filled syringe.

How it is given

Erythropoietin is normally given by an injection under the skin (subcutaneously), most often in the thigh or abdomen. It can be given from once a day, to one injection every 3 weeks, depending on the type of erythropoietin used and on advice from your doctor. You, or a person caring for you, can be taught how to give the injections so that you can continue the treatment at home, or it may be given by a district nurse or GP practice nurse.

Possible side effects

The amount of erythropoietin that occurs naturally in the body is very small. When erythropoietin injections are given the amount in the body increases greatly. For this reason, it causes side effects, even though it is a naturally occurring substance. However, the side effects  are not usually severe. People react to drugs in different ways, so it is not possible to predict who is going to have side effects or which they will have. The most common side effects are listed below.

If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that they can monitor the effects of the drug. This information should help you discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help.

Some people may have some of the following side effects:

Flu-like symptoms  Some people have flu-like symptoms, such as joint pains, weakness, dizziness and tiredness. These are more likely to occur at the start of your treatment. Your doctor may prescribe a painkiller, such as paracetamol, to help with these symptoms.

Headaches  Some people may develop severe headaches, although this is rare. Let your nurse or doctor know if you develop this side effect.

Skin rash  You may develop a skin rash, which may be itchy.

High blood pressure can occur  Your doctor will closely monitor your blood pressure while you are receiving erythropoietin. Let your doctor know if you take medication for high blood pressure.

Skin irritation may occur at the injection site  This can be reduced by giving the injection in different places.  

Let your doctor or nurse know if you have any side effects.

Length of treatment

EPO can be given before anaemia develops, to help prevent it occurring, or it can be started as soon as your anaemia has been diagnosed. The injections usually continue until one month after your chemotherapy course has finished, or until you are no longer anaemic.

Additional information

• You may be given iron tablets to help with production of new red blood cells.
• Your erythropoietin should be stored in the fridge.

References

This section has been compiled using information from a number of reliable sources including:

• Martindale: The Complete Drug Reference (33rd edition). Sweetman et al. Pharmaceutical Press, 2002.
• British National Formulary (48th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2004.

For further references, please see the general bibliography.