From the Guidelines
Retacrit (epoetin alfa) is contraindicated in patients with uncontrolled hypertension, pure red cell aplasia following prior erythropoietin therapy, and known hypersensitivity to the drug or its components. The use of epoetin alfa should be carefully considered in patients receiving chemotherapy, as it may increase the risk of mortality and tumor progression, particularly when the anticipated outcome is cure 1. According to the American Society of Clinical Oncology and American Society of Hematology guidelines, epoetin alfa should only be used in patients with chemotherapy-associated anemia and a hemoglobin concentration less than 10 g/dL, with the goal of decreasing transfusions 1.
Key Considerations
- Patients with cancer should receive the lowest dose of epoetin alfa needed to avoid red blood cell transfusions, with careful monitoring of hemoglobin levels to avoid excessive increases 1.
- For chronic kidney disease patients, treatment with epoetin alfa should be initiated when hemoglobin is less than 10 g/dL, with a target range of 10-11 g/dL, not exceeding 11 g/dL 1.
- The starting dose is typically 50-100 units/kg three times weekly for adults, adjusted based on hemoglobin response 1.
- Blood pressure should be controlled before and during therapy, as hypertension is a common side effect, and iron status should be evaluated before and during treatment, with supplementation as needed 1.
- Retacrit carries a boxed warning for increased mortality, serious cardiovascular events, thromboembolic events, and stroke, and must be carefully monitored to prevent excessive hemoglobin levels which increase cardiovascular risks 1.
Monitoring and Dose Adjustment
- Hemoglobin levels should be monitored regularly to avoid excessive increases, and the dosage of epoetin alfa should be titrated to maintain a hemoglobin level of 10-11 g/dL 1.
- Patients who do not respond to epoetin alfa should be investigated for underlying tumor progression or iron deficiency, and consideration should be given to discontinuing the medication 1.
From the FDA Drug Label
4 CONTRAINDICATIONS
The contraindications for Retacrit (epoetin alfa) are not explicitly listed in the provided drug label section. However, the label does mention several warnings and precautions, including:
- Increased mortality, myocardial infarction, stroke, and thromboembolism
- Increased mortality and/or increased risk of tumor progression or recurrence in patients with cancer
- Hypertension
- Seizures
- Lack or loss of hemoglobin response to PROCRIT
- Pure red cell aplasia
- Serious allergic reactions
- Severe cutaneous reactions
- Risk of serious adverse reactions due to benzyl alcohol preservative
- Risk of infectious diseases due to albumin (human) content 2
Based on the available information, it is not possible to provide a complete list of contraindications for Retacrit (epoetin alfa).
From the Research
Contraindications for Retacrit (Epoetin Alfa)
- Retacrit is contraindicated in patients with a history of hypersensitivity to epoetin alfa or any other component of the formulation 3
- It is also contraindicated in patients with pure red cell aplasia that has occurred following treatment with any erythropoietin-stimulating agent 4
Usage Guidelines
- Retacrit should be used with caution in patients with a history of cardiovascular disease, as it may increase the risk of cardiovascular events 5
- The dosage of Retacrit should be individualized to achieve and maintain hemoglobin levels within the target range 6
- Patients with chronic kidney disease should be monitored regularly for signs of iron deficiency and iron supplementation should be provided as needed 4
- In patients with chemotherapy-induced anemia, iron supplementation may be necessary to achieve optimal response to Retacrit 7
Special Considerations
- Patients who have developed a hypersensitivity reaction to epoetin alfa may undergo desensitization to allow for continued use of the medication 3
- Retacrit should be used with caution in patients with cancer, as it may increase the risk of tumor progression 4
- The use of Retacrit in patients with diabetic retinopathy should be carefully evaluated, as it may worsen the condition 4