ESA adult dosing
| Dose and modification initial dose . | Epoetin alfa . | Darbepoetin alfa . | ||
|---|---|---|---|---|
| Initial dose* of 150 U/kg SC TIW . | Initial dose* of 40,000 U SC weekly . | Initial dose* of 2.25 μg/kg SC weekly . | Initial dose* of 500 μg SC Q3W . | |
| Dose increase | Increase dose to 300 U/kg TIW if no reduction in transfusion requirements or increase in Hb after 4 weeks of therapy to achieve and maintain lowest Hb level sufficient to avoid need for RBC transfusion | Increase dose to 60,000 U SC weekly if no increase in Hb by ≥ 1 g/dL after 4 weeks of therapy, in the absence of a RBC transfusion to achieve and maintain lowest Hb level sufficient to avoid need for RBC transfusion | Increase dose up to 4.5 μg/kg if there is a < 1 g/dL increase in Hb after 6 weeks of therapy | NA |
| Dose reduction | 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% of previous dose 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 | After completion of CT course or if no response after 8 weeks of therapy (measured by Hb levels or continuing need for transfusions) | After completion of CT course or if no response after 8 weeks of therapy (measured by Hb levels or continuing need for transfusions) | ||
| Dose and modification initial dose . | Epoetin alfa . | Darbepoetin alfa . | ||
|---|---|---|---|---|
| Initial dose* of 150 U/kg SC TIW . | Initial dose* of 40,000 U SC weekly . | Initial dose* of 2.25 μg/kg SC weekly . | Initial dose* of 500 μg SC Q3W . | |
| Dose increase | Increase dose to 300 U/kg TIW if no reduction in transfusion requirements or increase in Hb after 4 weeks of therapy to achieve and maintain lowest Hb level sufficient to avoid need for RBC transfusion | Increase dose to 60,000 U SC weekly if no increase in Hb by ≥ 1 g/dL after 4 weeks of therapy, in the absence of a RBC transfusion to achieve and maintain lowest Hb level sufficient to avoid need for RBC transfusion | Increase dose up to 4.5 μg/kg if there is a < 1 g/dL increase in Hb after 6 weeks of therapy | NA |
| Dose reduction | 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% of previous dose 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 | After completion of CT course or if no response after 8 weeks of therapy (measured by Hb levels or continuing need for transfusions) | After completion of CT course or if no response after 8 weeks of therapy (measured by Hb levels or continuing need for transfusions) | ||
NOTE. Changes from the 2007 American Society of Hematology/American Society of Clinical Oncology ESA guideline dosing table are noted in italics. Data from US Food and Drug Administration.60,61
Abbreviations: ESA, erythropoiesis-stimulating agent; SC, subcutaneous; TIW, three times per week; Q3W, every 3 weeks; Hb, hemoglobin; NA, not applicable; CT, chemotherapy.
Therapy should not be initiated at Hb levels ≥ 10 g/dL.