Epoetin Question

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Specializes in Community Health, Med-Surg, Home Health.

I am told that patients taking this medication have to be monitored for severe elevation of blood pressure. I am trying to understand how this happens. I have not administered this medication myself, but but I was told that there is a policy in my clinic (one that I, of course, cannot find) that says that after administering this medication, the client must wait for 1/2 hour for nurse monitoring. My drug guide doesn't say anything about this, but speaks of hypertensive encephalopathy/hypertension. What is the reason of this increase in blood pressure?

Thanks!

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I dose Epogen for chronic hemodialysis patients and have never heard of this happening. My first thought on this would be that kidney patients (if that is your population) already struggle with HTN and an increase in blood viscocity could affect vascular pressure over time as the Hgb/Hct increase.

I looked in my drug book and it stated that Epo does not have a direct vasopressor effect, but that BP may rise as Hct rises. It goes on to say that hypertensive encephalopothy and seizures have occurred in pts with chronic renal failure who are treated with Epo. However....I've been in renal for ~4 years and have never seen anything like that.

Hope this helps~ :paw:

Sarah

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Specializes in Community Health, Med-Surg, Home Health.
I dose Epogen for chronic hemodialysis patients and have never heard of this happening. My first thought on this would be that kidney patients (if that is your population) already struggle with HTN and an increase in blood viscocity could affect vascular pressure over time as the Hgb/Hct increase.

I looked in my drug book and it stated that Epo does not have a direct vasopressor effect, but that BP may rise as Hct rises. It goes on to say that hypertensive encephalopothy and seizures have occurred in pts with chronic renal failure who are treated with Epo. However....I've been in renal for ~4 years and have never seen anything like that.

Hope this helps~ :paw:

Sarah

:bowingpur Yes, this actually helps a great deal! Just knowing that the viscocity of the blood may become increased actually brings the picture together for me. Thank you so much!:yeah:

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Specializes in ER, Renal Dialysis.

Second that. I've been administering epo for patients with BP as high as 180/100 with no visible effects so far - not that I don't care. These patients have already had their kidney failed due to HPT - witholding epo for reason of elevated BP will deprive them of this medication even if it is on the high region.

The leaflet tells of this too, but so far in practice I had no effects of it occuring (hopefully it stays that way).

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My 2 cents: Could the increase in BP and viscosity be due to an overproduction of red blood cells?

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I used to administer epo on a regular basis. I was told it can temporarily raise the BP after receiving the shot. We had a protocol to ask the physician prior to administering if the BP was too high.

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why would viscosity increase immediately though? EPO stimulates production of rbc's which takes time...

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I didn't know it was an immediate increase.

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I am told that patients taking this medication have to be monitored for severe elevation of blood pressure. I am trying to understand how this happens. I have not administered this medication myself, but but I was told that there is a policy in my clinic (one that I, of course, cannot find) that says that after administering this medication, the client must wait for 1/2 hour for nurse monitoring. My drug guide doesn't say anything about this, but speaks of hypertensive encephalopathy/hypertension. What is the reason of this increase in blood pressure?

Thanks!

Gloria,

This is the part I was confused about.

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I don't know either. I'll do a little research on this mystery.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

medlineplus drug information: epoetin alfa injection

info added as black box warning label for medication nov 2007:

epoetin alfa increases the risk of serious and life-threatening events, including heart attack, heart failure, stroke, tia (ministroke) or cerebrovascular accident (blood clot to the brain), pulmonary embolus (blood clot to the lung), deep vein thrombosis (blood clot to the blood vessels), and death when treatment results in a higher than recommended amount of hemoglobin (red blood cells) in the blood..

epoetin alfa may increase the chance of death when used in people with cancer who are not receiving chemotherapy or radiation therapy at the same time they are using epoetin alfa. in people with cancer, epoetin alpha may cause a tumor to grow faster when the amount of hemoglobin (red blood cells) in the blood is higher than recommended....

use of medications similar to epoetin alpha in people just before major surgery increases the risk of blood clots.

nejm -- correction of anemia with epoetin alfa in chronic kidney ...background anemia, a common complication of chronic kidney disease, usually develops as a consequence of erythropoietin deficiency.

methods in this open-label trial, we studied 1432 patients with chronic kidney disease, 715 of whom were randomly assigned to receive a dose of epoetin alfa targeted to achieve a hemoglobin level of 13.5 g per deciliter and 717 of whom were assigned to receive a dose targeted to achieve a level of 11.3 g per deciliter. the median study duration was 16 months. the primary end point was a composite of death, myocardial infarction, hospitalization for congestive heart failure (without renal replacement therapy), and stroke.

results a total of 222 composite events occurred: 125 events in the high-hemoglobin group, as compared with 97 events in the low-hemoglobin group (hazard ratio, 1.34; 95% confidence interval, 1.03 to 1.74; p=0.03). there were 65 deaths (29.3%), 101 hospitalizations for congestive heart failure (45.5%), 25 myocardial infarctions (11.3%), and 23 strokes (10.4%). seven patients (3.2%) were hospitalized for congestive heart failure and myocardial infarction combined, and one patient (0.5%) died after having a stroke. improvements in the quality of life were similar in the two groups. more patients in the high-hemoglobin group had at least one serious adverse event.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

manufacturers now have have letter out under fda safety advice due to above black box warning label notice:

indications and usage section - addition of a statement that in patients with

cancer, epogen®/procrit®/aranesp® has not been demonstrated in controlled clinical trials to improve symptoms of anemia, quality of life, fatigue, or patient well-being.

pdf_icon_tiny.gif download letter to healthcare professionals (pdf, 52 kb)

[color=#007ec0]amgen announces update to u.s. prescribing information for aranesp® (darbepoetin alfa) and epogen® (epoetin alfa)

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