What is the recommended dose of Procrit (Epoetin alfa) for a 220-pound male?

Dosing of Procrit (Epoetin alfa) for a 220-pound Male

For a 220-pound (100 kg) male, the recommended initial dose of Procrit (Epoetin alfa) is 150 U/kg three times weekly, which equals approximately 15,000 units per week divided into three doses of 5,000 units each. 1

Dosing Calculation

The recommended dosing for Procrit is weight-based and depends on the administration route:

• Subcutaneous (SC) administration (preferred):

  • Initial dose: 80-120 U/kg/week (typically 6,000 units/week) 1, 2
  • For a 100 kg patient: 8,000-12,000 units/week

• Intravenous (IV) administration:

  • Initial dose: 120-180 U/kg/week (typically 9,000 units/week) 1
  • For a 100 kg patient: 12,000-18,000 units/week

Administration Schedule Options

The American Society of Clinical Oncology and American Society of Hematology guidelines recommend the following administration schedules:

1. Standard schedule (strongest evidence): 150 U/kg three times weekly 1

   • For a 100 kg patient: 15,000 units/week (5,000 units three times weekly)

2. Alternative schedule (common clinical practice): 40,000 units once weekly 1

   • This is supported by less strong evidence but offers greater convenience

Route of Administration Considerations

• Subcutaneous administration is preferred for patients not on dialysis as it:

  • Provides more favorable pharmacodynamics 1
  • Requires approximately 15-50% lower doses than IV administration 1
  • Maintains elevated blood levels longer than IV administration 1

• Intravenous administration may be preferred for hemodialysis patients for convenience during dialysis sessions 2

Monitoring and Dose Adjustments

• Monitor hemoglobin weekly until stabilized, then monthly during maintenance 2
• Target hemoglobin range: 10-12 g/dL 2
• If no response after 4 weeks (hemoglobin increase <1 g/dL), consider dose escalation to 300 U/kg three times weekly 1
• Reduce dose by 25-40% if hemoglobin increases >1 g/dL over a 2-week period 2

Important Safety Considerations

• Do not exceed target hemoglobin of 12 g/dL due to increased cardiovascular risks 2, 3
• Monitor blood pressure regularly, as hypertension is a common side effect 4, 5
• Higher doses (>10,095 units/week) have been associated with increased cardiovascular events regardless of hemoglobin achieved 3
• Ensure adequate iron stores before and during treatment (transferrin saturation >20%, serum ferritin >100 mcg/L) 5

Extended Dosing Options

For patients with stable hemoglobin levels, less frequent dosing may be considered:

• Every 2 weeks: 20,000 units 6, 7
• Every 3-4 weeks: 30,000-40,000 units 7

These extended dosing schedules have shown efficacy in maintaining hemoglobin levels in stable patients, with approximately 90% of patients dosed every two weeks maintaining target hemoglobin levels 7.