Erythropoietin stimulators

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Erythropoietin stimulators


Generic NameBrand Name
darbepoetin alfaAranesp
epoetin alfaEprex

Erythropoietin stimulators can be given two ways. They may be injected into a vein with an intravenous (IV) needle or injected under the skin (subcutaneous). Talk to your doctor about which way is best for you.

How It Works

Erythropoietin stimulators cause the bone marrow to produce more red blood cells, and they decrease your need for blood transfusions. Anemia often occurs because of a decrease in erythropoietin, a protein produced by the kidneys. Injections of erythropoietin stimulators replace this protein.

Why It Is Used

Erythropoietin stimulators replace the erythropoietin normally made by the kidneys. Therapy with erythropoietin stimulators may be used to treat anemia:

  • During hemodialysis. This is the most common use of this therapy. The use of erythropoietin stimulators in people receiving hemodialysis has almost eliminated the need for blood transfusions.
  • When chronic kidney disease is present but kidney failure has not yet developed. Treatment with erythropoietin stimulators may delay the need to start dialysis. It improves anemia in most people who have not started dialysis.

How Well It Works

Erythropoietin stimulators treat anemia by increasing the number of new red blood cells your body makes. This may decrease your need for blood transfusions. Your dose of an erythropoietin stimulator may need to be adjusted so that you can keep a certain red blood cell count or level.

Things that may make this therapy less effective include:

  • Too little iron in the blood (iron deficiency). This is the most common reason that erythropoietin stimulators may not be effective. Iron deficiency can be treated with oral or intravenous iron (iron therapy) to increase the amount of iron in your blood.
  • Infection.
  • Decreased sensitivity to erythropoietin.
  • High levels of aluminum in your body, which may interfere with your ability to use iron.
  • Dialysis procedures that are not removing enough fluids or wastes from your body (inadequate dialysis).
  • Too little protein in the diet (protein malnutrition).

Side Effects

High blood pressure can develop during treatment with erythropoietin stimulators.

It may be dangerous to use erythropoietin stimulators to increase your red blood cell (hemoglobin) levels above 12 g/dL. Hemoglobin levels that are too high may increase your risk for death, heart failure, heart attack, and stroke. Talk with your doctor about your concerns. And keep all your appointments for blood tests.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Most people do not have problems with erythropoietin stimulators. They can help improve how well you feel and increase your appetite, energy, and activity levels. The use of erythropoietin stimulators may also delay the need for dialysis, improve some heart problems, and increase your lifespan.

Erythropoietin therapy is expensive. Your doctor may need to make adjustments in your dose to find the amount that gives you the most benefit but costs the least.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.


By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Mitchell H. Rosner, MD - Nephrology
Specialist Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Last Revised January 26, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.