Initial Dosing of Procrit (Epoetin Alfa) by Weight for Dialysis Patients
The initial intravenous (IV) dose of Procrit for dialysis patients should be 50-100 Units/kg three times weekly, with a typical starting dose of 50 Units/kg. 1
Route of Administration and Dosing Considerations
For hemodialysis patients, Procrit can be administered either intravenously or subcutaneously:
Subcutaneous administration is 15-50% more efficient than intravenous administration, requiring lower doses to achieve the same hemoglobin response 3, 4
When injecting into the venous line during hemodialysis, avoid injection into the venous drip chamber as this can result in "trapping" and incomplete mixing with the patient's blood 2
Pediatric Dosing
For pediatric dialysis patients, the initial dose is 50 Units/kg intravenously or subcutaneously three times weekly 1
Pediatric peritoneal dialysis patients typically require a median weekly dose of 136 Units/kg/week to maintain target hematocrit levels 2
Children under 5 years of age may require higher doses than older children 2
Dose Titration and Target Hemoglobin
The goal is to achieve the target hemoglobin within a 2-4 month period through slow, steady increase of hemoglobin 2
FDA clinical studies show the following average rates of hemoglobin rise in 2 weeks: 1
- 50 Units/kg three times weekly: 0.5 g/dL increase
- 100 Units/kg three times weekly: 0.8 g/dL increase
- 150 Units/kg three times weekly: 1.2 g/dL increase
Dose adjustments should be made based on hemoglobin response, with careful monitoring every 2-4 weeks during initial therapy 2
Special Considerations
For patients switching from IV to SC administration who have not yet achieved target hemoglobin, the total weekly IV dose should be administered SC in 2-3 divided doses 2
For patients switching from IV to SC administration who have already achieved target hemoglobin, reduce the weekly dose to two-thirds of the IV dose 2, 3
When SC administration is not feasible for peritoneal dialysis patients, intraperitoneal administration may be considered, but should be done into a dry abdomen or with minimal dialysate to improve absorption 2
Rotate injection sites between upper arm, thigh, and abdominal wall to minimize local reactions 3
Common Pitfalls and Caveats
Inadequate iron stores can limit response to Procrit therapy. Ensure iron supplementation with a goal of maintaining transferrin saturation >20% and serum ferritin >100 μg/L 3, 5
Avoid targeting hemoglobin levels above 12 g/dL due to increased cardiovascular risks 1
For patients with inadequate response, evaluate for iron deficiency, infection, inflammation, blood loss, or development of antibodies to erythropoietin 3
In the maintenance phase, the median dose necessary to maintain hemoglobin between 10-12 g/dL is approximately 75 Units/kg three times weekly for most patients 1