Eprex

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Your doctor has recommended a medication called Eprex as treatment for your fatigue & anaemia. This page provides extra information about your medicine, summarises the rational for its administration and risks of rare side effects.

If you have anaemia, your body does not have enough red cells to carry the oxygen you need. The symptoms of anaemia can include:-

There are several causes of anaemia. The most common cause associated with cancer especially chemotherapy is called "anaemia of chronic disorders". In this condition the body does not utilise the stores of iron, fails to make enough red cells and the signal from the kidney to the red cell factory (the bone marrow) is impaired.

Traditionally blood transfusions are given to correct anaemia but an alternative method to correct anaenia is to inject  a hormone called Epoetin alpha (EPREX). Eprex is the purified form of the signal chemical from the kidney's to the bone marrow called erythropoetin. Regular administration of eprex overcomes the  kidney's failure to pick up the low levels of oxygen in the blood stream by directly stimulating the bone marrow to make more red cells.  Eprex has been used in many cancer patients (and those with renal failure) in the United Kingdom and throughout the world.

Both blood transfusions and eprex are successful in correcting anaemia. Early trials suggest that eprex has an advantage of improving the energy levels and quality of life over the whole chemotherapy course compared to blood transfusion. Ongoing trials are underway to confirm this and establish its cost against blood transfusion.

How is Eprex given? Each injection of Eprex contains 10,000 units of epoetin alpha. They require injection under the skin into the fat (subcutaneously) three times a week, usually Monday, Wednesday and Friday. The Eprex comes in a ready made up pack containing all that is needed for a single injection. You will usually be given a diary card to record your injection days. Data from a single hospital outpatient setting has recently showed that over 60% of patients were comfortable with injecting the eprex themselves within two weeks (see self injection). Don't worry if you feel unable to self inject your clinic can arrange administered by the district nurse. Either way you will be given enough eprex to last to your next cycle of chemotherapy. This should be kept in the fridge. Each time you return for chemotherapy your  Haemoglobin will be checked if it has not risen the dose of eprex may need to be increased, if it has risen too much the dose may be reduced.

Are there side effects? Eprex is generally very well tolerated but like any drug there some possible side effects. Rare side effects include:-

• A rise in blood pressure.
• Shivers immediately following an injection
• Itching or swelling at the injection site.

Very rare side effects include:-

• A marked rise in blood pressure associated with fitting. (This has only occurred in patients with chronic renal failure).
• Allergic reaction including skin rash and itching.
• An increase in the risk of thrombosis (clots in the veins). (This has only occurred in patients undergoing surgery).

How long is it taken? Usually for the duration of chemotherapy plus another month. Your doctor,  who monitors you very carefully, may recommend you stop it at any stage during you treatment.  In a recent UK trial the average duration of eprex treatment was 3.5 months.

Who gets Eprex? At the present time in the UK trials are undergoing comparing the cost of eprex compared to blood transfusion. Many hospitals do not routinely prescribe it outside these clinical trials which are supported by Orthobiotec. Some but not all private health insurance companies will pay for eprex. It may be worth asking your GP to share the cost of eprex with the hospital within a shared care programme.  It must be stressed they have no obligation to do this. More about fatigue, anaemia and eprex

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.