Epoetin Alfa (Procrit®, Epogen®)

About This Drug

Epoetin alfa is used to treat anemia. It helps your body make more red blood cells. It can be given in the vein (IV) or as an injection under your skin (subcutaneously).

Possible Side Effects 

  • Decrease in the number of white blood cells. This may raise your risk of infection.
  • Nausea and vomiting (throwing up)
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Difficulty swallowing
  • Blood sugar levels may increase. If you are diabetic, changes may need to be made to your diabetes medication.
  • Electrolyte changes
  • Weight loss
  • Bone, muscle and/or joint pain
  • Headache
  • Depression
  • Trouble sleeping
  • Cough
  • Rash
  • High blood pressure
  • Blood clots- a blood clot in your leg or arm may cause swelling, redness and warmth, and/or cause pain. A blood clot in your lungs may cause difficulty breathing, pain when breathing, and/or chest pain.

Note: Each of the side effects above was reported in 5% or greater of patients treated with epoetin alfa. Not all possible side effects are included above.

Warnings and Precautions 

  • Heart problems. If you are treated with epoetin alfa to increase your red blood cells to near the same level as healthy people, you may get serious heart problems such as heart attack, stroke, or heart failure which could be life-threatening.
  • Blood clots and events such as stroke and heart attack. A blood clot in your leg may cause your leg to swell, appear red and warm, and/or cause pain. A blood clot in your lungs may cause trouble breathing, pain when breathing, and/or chest pain.
  • Seizure. Common symptoms of a seizure can include confusion, blacking out, passing out, loss of hearing or vision, blurred vision, unusual smells or tastes (such as burning rubber), trouble talking, tremors or shaking in parts or all of the body, repeated body movements, tense muscles that do not relax, and loss of control of urine and bowels. There are other less common symptoms of seizures. If you or your family member suspects you are having a seizure, call 911 right away.
  • If you have cancer, your tumor may grow faster and you may die sooner if epoetin alfa is used.
  • Antibodies to epoetin alfa. Your body may make antibodies to epoetin alfa. These antibodies can block or lessen your body’s ability to make red blood cells and can cause you to have severe anemia. This is extremely rare.
  • Allergic reactions, including anaphylaxis are rare but may happen in some patients. Signs of allergic reaction to this drug may be swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way. If this happens, do not take another dose of this drug. You should get urgent medical treatment.
  • Epoetin alfa is made from human blood/albumin (protein) and carries an extremely rare risk of transmitting infectious diseases.
  • Severe allergic skin reaction. You may develop blisters on your skin that are filled with fluid or a severe red rash all over your body that may be painful.
  • Severe high blood pressure

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.

How to Take Your Medication

  • Talk to your doctor, nurse and/or pharmacist for proper preparation, dosing and administration if you are self-injecting.
  • Do not shake the medicine. Do not use if the medicine has been shaken or frozen.
  • Missed dose: If you miss a dose, contact your physician. Do not take 2 doses at the same time and do not double up on the next dose.
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • Storage: Store this medicine in the original package in the refrigerator, between 36°F to 46°F (2°C to 8°C). Do not freeze. Protect from light.
  • Disposal: Discuss with your nurse or your doctor how to dispose of unused medicine/needles

Treating Side Effects 

  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack of water in the body from losing too much fluid).
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help stop or lessen these symptoms.
  • To help with weight loss, drink fluids that contribute calories (whole milk, juice, soft drinks, sweetened beverages, milkshakes, and nutritional supplements) instead of water.
  • Include a source of protein at every meal and snack, such as meat, poultry, fish, dry beans, tofu, eggs, nuts, milk, yogurt, cheese, ice cream, pudding, and nutritional supplements.
  • Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or ½ teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • Manage tiredness by pacing your activities for the day. Be sure to include periods of rest between energy-draining activities.
  • Get regular exercise. If you feel too tired to exercise vigorously, try taking a short walk.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • To help with itching, moisturize your skin several times day.
  • Avoid sun exposure and apply sunscreen routinely when outdoors.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.
  • If you are having trouble sleeping, talk to your nurse or doctor on tips to help you sleep better.
  • If you are feeling depressed, talk to your nurse or doctor about it.
  • If you have diabetes, keep good control of your blood sugar level. Tell your nurse or your doctor if your glucose levels are higher or lower than normal.
  • To decrease the risk of infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.

Food and Drug Interactions 

  • There are no known interactions of epoetin alfa with food.
  • This drug may interact with other medicines. Tell your doctor and pharmacist about all the prescription and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
  • The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms: 

  • Fever of 100.4° F (38° C) or higher
  • Chills
  • A headache that does not go away
  • Blurry vision or other changes in eyesight
  • Wheezing or trouble breathing
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause. If you have any of these symptoms for 2 minutes, call 911.
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Abnormal blood sugar
  • Unusual thirst, passing urine often, headache, sweating, shakiness, irritability
  • Fatigue or extreme weakness that interferes with your daily activities
  • Trouble falling or staying asleep
  • New rash and/or itching
  • Rash that is not relieved by prescribed medicines
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Your leg is swollen, red, warm and/or painful
  • Pain that does not go away, or is not relieved by prescribed medicines
  • Lose interest in your daily activities that you used to enjoy and feeling this way every day, and/or you feel hopelessness
  • Symptoms of a seizure such as confusion, blacking out, passing out, loss of hearing or vision, blurred vision, unusual smells or tastes (such as burning rubber), trouble talking, tremors or shaking in parts or all of the body, repeated body movements, tense muscles that do not relax, and loss of control of urine and bowels. If you or your family member suspects you are having a seizure, call 911 right away.
  • Signs of allergic reaction: swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way. If this happens, call 911 for emergency care.
  • Coughing yellow, green or bloody mucus
  • If you think you may be pregnant

Reproduction Warnings 

  • Pregnancy warning: It is not known if this drug may harm an unborn child. For this reason, be sure to talk with your doctor if you are pregnant or planning to become pregnant while getting this drug.
  • Breastfeeding warning: Women should not breastfeed during treatment and for at least 2 weeks after treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised May 2019

This patient information was developed by Via Oncology, LLC © 2019. This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.

CLIENT acknowledges that the Via Pathways and Via Portal are information management tools only, and that Via Oncology, LLC has not represented the Via Pathways or Via Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The clinical information contained in the Via Pathways and Via Portal are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.