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Erythropoietin Stimulating Agents


Generic NameBrand Name
darbepoetin alfaAranesp, Epogen, Procrit
epoetin alfaAranesp, Epogen, Procrit

Erythropoietin stimulating agents can be given two ways. They may be injected into a vein with an intravenous (IV) needle or injected under the skin (subcutaneous). Talk to your doctor about which way is best for you.

How It Works

Erythropoietin stimulating agents cause the bone marrow to produce more red blood cells, and they decrease your need for blood transfusions. Anemia often occurs because of a decrease in erythropoietin, a hormone produced by the kidneys. Injections of erythropoietin stimulating agents replace this hormone.

Why It Is Used

Erythropoietin stimulating agents replace the erythropoietin normally made by the kidneys. Therapy with erythropoietin stimulating agents may be used to treat anemia:

  • During hemodialysis. This is the most common use of this therapy. The use of erythropoietin stimulating agents in people receiving hemodialysis has almost eliminated the need for blood transfusions.
  • When chronic kidney disease is present but kidney failure has not yet developed. Treatment with erythropoietin stimulating agents may delay the need to start dialysis. It improves anemia in most people who have not started dialysis.

How Well It Works

Erythropoietin stimulating agents treat anemia by increasing the number of new red blood cells your body makes. This may decrease your need for blood transfusions. Your dose of an erythropoietin stimulating agent may need to be adjusted so that you can keep a certain red blood cell count or level.

Things that may make this therapy less effective include:

  • Too little iron in the blood (iron deficiency). This is the most common reason that erythropoietin stimulating agents may not be effective. Iron deficiency can be treated with oral or intravenous iron (iron therapy) to increase the amount of iron in your blood.
  • Infection.
  • Decreased sensitivity to erythropoietin.
  • High levels of aluminum in your body, which may interfere with your ability to use iron.
  • Dialysis procedures that are not removing enough fluids or wastes from your body (inadequate dialysis).
  • Too little protein in the diet (protein malnutrition).
  • Vitamin deficiencies such as vitamin B12 or folate.
  • Ongoing bleeding from the gastrointestinal tract.

Side Effects

High blood pressure can develop during treatment with erythropoietin stimulating agents.

It may be dangerous to use erythropoietin stimulating agents to increase your red blood cell (hemoglobin) levels above 12 g/dL. Hemoglobin levels that are too high may increase your risk for death, heart failure, heart attack, and stroke. Talk with your doctor about your concerns. And keep all your appointments for blood tests.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Most people do not have problems with erythropoietin stimulating agents. They can help improve how well you feel and increase your appetite, energy, and activity levels.

Erythropoietin therapy is expensive. Your doctor may need to make adjustments in your dose to find the amount that gives you the most benefit but costs the least.

Complete the new medication information form (PDF)Click here to view a form.(What is a PDF document?) to help you understand this medication.


ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerMitchell H. Rosner, MD - Nephrology
Last RevisedSeptember 15, 2011

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