Indications & Dose: ANEMIA OF CRF IV/SC Adult Initially 50-100U/kg thrice weekly. If Hb reaches 12g/dL reduce dose by 25%. Discontinue therapy temporarily if Hb continues to increase. Increase dose by 25% if Hb is <10g/dL & does not increase by 1g/dL after 4 wk of therapy. MD: Predialysis 50-100U/kg/wk max 600U/kg in 3 divided doses, HD: 75-300U/kg/wk in 3 divided doses, PD: 50-10OU/kg/wk in 2 divided doses Child Initially 50U/kg thrice weekly. If Hb reaches 12g/dL, reduce dose by 25%. Discontinue therapy temporarily if Hb continues to increase. Increase dose by 25% if Hb is <10g/dL & does not increase by 1g/dL after 4 wk of therapy. MD (in 3 divided doses): <10 kg: 225-450U/kg/wk, 10-30 kg: 180-450U/kg/wk, >30 kg: 90-300U/kg/wkincluding HD patients & those not on dialysis | CANCER PATIENT ON CHEMOTHERAPY IV Child 600 units/kg/wk, max 40, 000 units, may increased upto 900 units/kg/wk, max 60, 000 units if there is no increase in Hb after 4 wks in absence of RBC transfusion. Reduce dose by 25% if Hb increases >1g/dL in any 2 wk period or Hb reaches a level sufficient to avoid RBC transfusion. Discontinue drug if there is no response after 8 wks | SC Adult Initially 150U/kg thrice weekly or 40, 000 units/wk, if no satisfactory response increase dose to 300U/kg thrice weekly q4wk. Reduce dose by 25% if Hb increases >1g/dL in any 2 wk period or Hb reaches a level sufficient to avoid RBC transfusion. Discontinue drug if there is no response after 8 wk | HIV PATIENTS ON ZIDOVUDINE THERAPY IV/SC Adult 100U/kg thrice weekly 8 wk. Increase dose in increments of 50-100U/kg thrice weekly. If no adequate response after 8 wk, then evaluate response q4-8 wk thereafter & adjust the dose accordingly by 50-100U/kg increments administered thrice weeklywith serum erythropoietin levels <500 mU/mL and zidovudine doses <4.2g/wk | INCREASE AUTOLOGOUS BLOOD YIELD IV Adult 600U/kg given twice weekly starting 3 wk before surgery | TO REDUCE ALLOGENEIC BLOOD TRANSFUSION NEED SC Adult 600U/kg/wk starting 3 wk before surgery with 4th dose given on the day of surgery

Precautions: Cancer patients, CRF, HTN, CVD, perisurgery patients, porphyria, seizures, severe anemia/blood loss, hematologic diseases, thrombocytosis, chronic hepatic impairment, ischemic vascular disease, malignant tumours

ADR: Serious: Seizures, hyperkalemia, hematologic diseases, HTN, increased clotting of arteriovenous grafts, edema, Others: Inj site pain, nausea, vomiting, diarrhea, hyperuricemia, hyperphosphatemia, joint pain, cough, dyspnea, rash, fever, headache, paresthesia, fatigue, dizziness, asthenia

DDI: Serious ARBs/ACEIs reduces antihypertensive effect by drug, Thalidomide risk of thrombosis increases

Diet:

Monitor: BP, CBC with DC & platelets, transferrin saturation & ferritin, serum chemistry (CRF patients)