Treatment
Table 2. ESA Adult Dosing
Dose and
Modifications Epoetin Alfa
a
Darbepoetin Alfa
Initial Dose
b
150 U/kg SC
TIW
c
40,000 U SC
weekly
d
2.25 µg/kg SC
weekly
c
500 µg SC
Q3W
d
Dose Increases Increase dose
to 300 U/kg
SC TIW if,
hemoglobin
increases by
<1 g/dL and
remains below
10 g/dL aer
4 weeks of
therapy
Increase dose
to 60,000 U
SC weekly if
hemoglobin
increases by
<1 g/dL and
remains below
10 g/dL aer
4 weeks of
therapy
Increase dose to
4.5 µg/kg weekly
if hemoglobin
increases by
<1 g/dL and
remains below
10 g/dL aer 6
weeks of therapy
N/A
Dose
Reductions
Decrease dose by 25% when Hb
reaches a level needed to avoid
transfusion or Hb increases >1 g/dL
in 2 weeks
Decrease dose by 40% when Hb
reaches a level needed to avoid
transfusion or Hb increases >1 g/dL
in 2 weeks
Dose
Withholding
If Hb exceeds a level needed to
avoid transfusion; restart dose at
25% below previous dose when
Hb approaches a level where
transfusion may be required
If Hb exceeds a level needed to
avoid transfusion; restart dose at
40% below previous dose when
Hb approaches a level where
transfusion may be required
Discontinue Following completion of CT
course or if no response aer 8
weeks of therapy (measured by
Hb levels or continuing need for
transfusions).
e
Following completion of CT course
or if no response aer 8 weeks of
therapy (measured by Hb levels or
continuing need for transfusions).
e
a
Including epoetin alfa-epbx
b
Initiate only if hemoglobin is <10 g/dL and there is a minimum of two additional months of planned
chemotherapy. Use and dosing differs in patients with myelodysplastic syndromes.
c
Weight-based dose
d
Fixed dose
e
Patients who do not respond to ESA treatment should be re-evaluated for underlying tumor
progression, iron deficiency, or other etiologies for anemia
Source: FDA product labels accessed on June 8, 2018 for epoetin https://www.accessdata.fda.gov/
drugsatfda_docs/label/2017/103234s5363s5366lbl.pdf , and darbepoetin https://www.accessdata.fda.
gov/drugsatfda_docs/label/2017/103951s5374lbl.pdf.
