Treatment of anemia in patients with chronic renal failure,
F / k or in / in. With iv administration, the solution should be administered within 2 minutes, patients on hemodialysis through the arteriovenous shunt at the end of the dialysis session. Patients who are not on hemodialysis, preferably enter the drug sc, to avoid puncture of peripheral veins.
The goal of the treatment is to achieve a level of hematocrit equal to 30-35%, or elimination of the need for blood transfusion. The weekly increase in hematocrit should not exceed 0.5%. Do not exceed his level of 35%. In patients with arterial hypertension, cardiovascular and cerebrovascular diseases, the weekly increase in hematocrit and its targets should be determined individually, depending on the clinical picture. For some patients, the optimal hematocrit value is below 30 %.
Treatment with erythropoietin is carried out in 2 stages:
Initial therapy (correction stage). With n / k introduction, the initial dose is 20 IU / kg body weight 3 times a week. If there is insufficient increase in hematocrit (less than 0.5% per week), the dose can be increased monthly by 20 IU / kg of body weight 3 times a week. The total weekly dose can also be divided into daily injections in smaller doses or administered at one time.
With iv administration of the drug, the initial dose is 40 IU / kg body weight 3 times a week. If the hematocrit is not increased enough, the dose can be increased to 80 IU / kg 3 times a week in a month. If there is a need to further increase the dose, it should be increased by 20 IU / kg 3 times a week at a monthly interval. Regardless of the method of administration, the highest dose is not more than 720 IU / kg body weight per week.
Supportive therapy.
To maintain hematocrit at 30-35%, first dose should be reduced by half from the dose in the previous injection. Subsequently, the maintenance dose is selected individually, with an interval of 1-2 weeks. With n / to the introduction of a weekly dose can be administered once or for 3-7 injections per week.
In children, the dose depends on age (usually the smaller the age of the child, the higher the dose of epoetin beta it needs).However, since it is not possible to predict an individual response, it is advisable to begin with the recommended regimen.
Treatment with erythropoietin is carried out, as a rule, for life. If necessary, it can be interrupted at any time.
Prevent anemia in premature newborns.
S / w in a dose of 250 IU / kg body weight 3 times a week. Treatment with epoetin beta should begin as soon as possible, preferably from 3 days of life and last for 6 weeks.
Prevention and treatment of anemia in patients with solid tumors.
P / to, dividing the weekly dose into 3-7 injections.
Patients with solid tumors receiving chemotherapy with platinum drugs, treatment with erythropoietin is indicated at a hemoglobin level before chemotherapy is not higher than 130 g / l. The initial dose is 450 IU / kg of body weight per week. If after 4 weeks the hemoglobin level does not increase enough, the dose should be doubled. Duration of treatment - no more than 3 weeks after the end of chemotherapy.
If during the first cycle of chemotherapy the hemoglobin level, despite epoetin beta treatment, decreases by more than 10 g / l, further use of the drug may not be effective.
It should avoid increasing hemoglobin by more than 20 g / l per month or up to a level above 140 g / l. When the hemoglobin increases by more than 20 g / L per month, the dose of epoetin beta should be reduced by 50%. If the hemoglobin level exceeds 140 g / l, the drug is canceled until it falls to <120 g / l, and then resumes therapy at a dose that is half the previous week.
Treatment of anemia in patients with myeloma, non-Hodgkin's lymphoma of a low degree of malignancy or chronic lymphocytic leukemia.
In patients with myeloma, low-grade non-Hodgkin's lymphoma or chronic lymphocytic leukemia, inadequacy of endogenous erythropoietin is usually noted. It is diagnosed by the ratio between the degree of anemia and the inadequate concentration of erythropoietin in the serum.
Relative erythropoietin insufficiency takes place:
| At a level of hemoglobin, g / l | Concentration of erythropoietin in serum, IU / ml |
| > 90 <100 | < 100 |
| > 80 < 90 | <180 |
| <80 | <300 |
The above parameters should be determined not earlier than 7 days after the last blood transfusion and the last cycle of cytotoxic chemotherapy.
The drug is administered sc; a weekly dose can be divided into 3 or 7 injections. The recommended initial dose is 450 IU / kg body weight per week. If after 4 weeks the hemoglobin level rises by at least 10 g / l, the treatment is continued at the same dose. If after 4 weeks the hemoglobin rises by less than 10 g / l, you can increase the dose to 900 IU / kg body weight per week. If after 8 weeks of treatment the hemoglobin level did not increase by at least 10 r/ l, the positive effect is unlikely, and the drug should be canceled.
Clinical studies have shown that chronic lymphocytic leukemia response to therapy with epoetin beta occurs at 2 weeks later than in patients with multiple myeloma, non-Hodgkin's lymphoma and solid tumors. Treatment should continue until 4 weeks after the end of chemotherapy.
The highest dose should not exceed 900 IU / kg of body weight per week.
If for 4 weeks of treatment the hemoglobin level increases by more than 20 g / l, the dose of Erythropoietin should be reduced by half. If the hemoglobin exceeds 140 g / l, treatment of drug necessary to reduce an interrupt to <130 g / l, after which treatment is resumed at a dose at half the previous week.Treatment should be resumed only if the most likely cause of anemia is the failure of Erythropoietin.
Preparation of patients for the collection of donor blood for subsequent autohemotransfusion.
In / in or n / to twice a week for 4 weeks. In those cases when the hematocrit indicator in a patient (> 33%) allows for blood sampling, epoetin beta Enter at the end of the procedure. Throughout the course of treatment, the hematocrit should not exceed 48%.
The dose of the drug is determined by the transfusiologist and the surgeon individually, depending on how much blood is taken from the patient and from his erythrocyte reserve. The amount of blood that will be taken from the patient depends on the estimated blood loss, available methods of blood preservation and the general condition of the patient; it should be sufficient to avoid transfusion of blood from another donor. The volume of blood that will be taken from the patient is expressed in units (one unit is equivalent to 180 ml of erythrocytes).
The possibility of donation depends mainly on the volume of blood in this patient and the initial hematocrit.Both indices determine the endogenous red blood cell reserve, which can be calculated using the following formula:
endogenous red blood cell = blood volume (ml) x (hematocrit-33): 100
women: blood volume (ml) = 41 (ml / kg) x body weight (kg) + 1200 (ml)
men: blood volume (ml) = 44 (ml / kg) x body weight (kg) + 1600 (ml) (with body weight> 45 kg).
Indications for use Erythropoietin and its single dose are determined from nomograms, based on the required volume of donor blood and endogenous red blood cell.
The highest dose - with IV administration no more than 1600 IU / kg body weight per week; with n / to the introduction - 1200 IU / kg body weight per week.