Indications: Anaemia associated with chronic renal failure; Anaemia in adults with non-myeloid malignancies receiving chemotherapy.

Cautions: poorly treated or inadequately controlled blood pressure; sickle cell disease; exclude other causes of anaemia; ischemic vascular disease; thrombocytosis; epilepsy; malignant disease; chronic liver failure; pregnancy; breast feeding.

ContraIndications; pure red cell aplasia; uncontrolled hypertension; patients unable to receive thromboprophylaxis; avoid injection containing benzyl alcohol in neonates.

Side Effects: dose dependent increase in blood pressure or aggravation of hypertension; in isolated patients with normal or controlled blood pressure, hypertensive crisis with encephalopathy like symptoms and generalized tonic clonic convulsions requiring urgent medical attention; headache; dose dependent increase in platelet count; influenza like symptoms; thromboembolic events; peripheral oedema; injection site pain; isolated reports of pure red cell aplasia. antagonism of hypotensive effect and increased risk of hyperkalaemia when given with ACE inhibitors or angiotensin-II receptor antagonists.

Dose Anaemia associated with chronic renal failure in patients on dialysis: ADULT and CHILD over 11 years, by subcutaneous or intravenous injection, initially 450 nanograms/kg once weekly, adjusted according to response by approx. 25% of initial dose at intervals of at least 4 weeks; maintenance dose (when haemoglobin concentration of 11 g/100ml achieved), given once weekly or once every 2 weeks.

Anaemia associated with chronic renal failure in patients not on dialysis: ADULT and CHILD over 11 years, by subcutaneous or intravenous injection, initially 450 nanograms/kg once weekly or by subcutaneous injection, initially 750 nanograms/kg once every 2 weeks; adjusted according to response by approx. 25% of initial dose at intervals of at least 4 weeks; maintenance dose (when haemoglobin concentration of at least 11 g/100ml achieved), given once weekly or once every 2 weeks or once every month.

Note: Reduce dose by 25–50% if haemoglobin rise exceeds 2.5 g/100ml per month; suspend if haemoglobin exceeds 14 g/100ml until it falls below 13 g/100ml and then restart with dose at 25% below previous dose. When changing route give same dose then adjust according to weekly or fortnightly haemoglobin measurements. Adjust doses at 2-week intervals during maintenance treatment. Anaemia in adults with non-myeloid malignancies receiving chemotherapy: by subcutaneous injection, initially 6.75 mcg/kg once every 3 weeks (if response inadequate after 9 weeks further treatment may not be effective) or 2.25 mcg/kg once weekly (if appropriate rise in haemoglobin not achieved after 4 weeks, double initial dose; if response remains inadequate after 4 weeks at higher dose further treatment may not be effective); haemoglobin should not exceed 13 g/100ml; if adequate response obtained or if rise in haemoglobin greater than 2 g/100ml in 4 weeks, reduce dose by 25–50%; continue for approx. 4 weeks after chemotherapy.