What is the initial dosing of Procrit (Epoetin alfa) for anemia?

Initial Dosing of Procrit (Epoetin alfa) for Anemia

The initial dosing of Procrit (Epoetin alfa) for anemia in chronic kidney disease should be 80-120 units/kg/week (typically 6,000 units/week) administered subcutaneously in 2-3 divided doses per week. 1

Route of Administration and Initial Dosing

Subcutaneous (SC) Administration (Preferred)

• Adult patients: 80-120 units/kg/week (typically 6,000 units/week) in 2-3 divided doses 2
• Pediatric patients ≥5 years: Similar to adult dosing
• Pediatric patients <5 years: Often require higher doses (300 units/kg/week) 1

Intravenous (IV) Administration

• Hemodialysis patients: 120-180 units/kg/week (typically 9,000 units/week) in 3 divided doses 2, 1
• IV administration requires approximately 50% higher doses than SC administration for equivalent effect 1

Expected Response Rates

The FDA label for Procrit indicates the following expected hemoglobin increases based on starting doses when administered intravenously 3 times weekly 3:

• 50 Units/kg: 0.5 g/dL increase in 2 weeks
• 100 Units/kg: 0.8 g/dL increase in 2 weeks
• 150 Units/kg: 1.2 g/dL increase in 2 weeks

Dosing Considerations by Patient Population

Chronic Kidney Disease (CKD) Patients on Dialysis

• SC administration is more efficient than IV, requiring approximately 33% less drug for the same effect 2, 1
• For hemodialysis patients, SC administration is preferred when possible, but IV administration during dialysis is common and convenient 1
• Median maintenance dose to maintain hemoglobin between 10-12 g/dL is approximately 75 Units/kg 3 times weekly 3

CKD Patients Not on Dialysis

• SC administration is strongly preferred to preserve veins for potential future dialysis access 2
• Alternative dosing: 10,000 units once weekly SC has been shown effective for initiating treatment 4
• Extended dosing of 20,000 units every 2 weeks can also be effective for initiating treatment 5

Pediatric CKD Patients

• Initial dose: 50 Units/kg IV or SC 3 times weekly 3
• Children <5 years may require higher doses (300 units/kg/week) 2, 1
• Hemodialysis patients typically need higher maintenance doses than peritoneal dialysis patients (167 vs. 76 Units/kg/week) 3

Monitoring and Dose Adjustments

• Monitor hemoglobin weekly during initiation phase and monthly during maintenance 2
• Target hemoglobin level: 10-12 g/dL 1
• Reduce dose by 25% if hemoglobin increases by >1 g/dL in any 2-week period 1
• Increase dose if inadequate response (hemoglobin increase <1 g/dL) after 4-6 weeks 1
• Consider withholding therapy if hemoglobin increases rapidly (>8 percentage points in a month) 1

Important Safety Considerations

• Ensure adequate iron stores before and during therapy (transferrin saturation >20% and ferritin >100 ng/mL) 1
• Higher hemoglobin targets (>12 g/dL) have been associated with increased stroke risk in CKD patients 1, 6
• Monitor blood pressure regularly during initiation of therapy 7
• Rotate SC injection sites to minimize discomfort 1

Converting Between Administration Routes

• When switching from IV to SC administration after achieving target hemoglobin, the initial weekly SC dose should be two-thirds the weekly IV dose 2
• When switching from SC to IV, increase the dose by approximately 50% 1

By following these dosing guidelines, approximately 90% of patients will achieve the target hemoglobin level within 2-4 months of initiating therapy 2, 3.