| Three times weekly dosing | Weekly dosing | |
| Epoetin alfa | ||
| Starting dose (adults): | 150 units/kg SC three times weekly | 40,000 units SC* |
| Reduce dose by 25% if: | Hemoglobin reaches a level needed to avoid transfusion or increases >1 g/dL in any two-week period. | |
| Withhold dose if: | Hemoglobin exceeds a level needed to avoid RBC transfusion; restart at 25% below the previous dose when the hemoglobin approaches a level where transfusions may be required. | |
| Increase dose: | To 300 units/kg SC three times weekly if response is not satisfactory (rise in hemoglobin <1 g/dL after four weeks of therapy and it remains below 10 g/dL) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion. | To 60,000 units SC weekly if response is not satisfactory (rise in hemoglobin <1 g/dL after four weeks of therapy and it remains below 10 g/dL) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion. |
| Discontinue if: | After completion of the chemotherapy course, or if after eight weeks of therapy, there is no response as measured by hemoglobin levels or transfusions are still required. | |
| Weekly dosing | Once every three weeks dosing | |
| Darbepoetin alfa | ||
| Starting dose (adults): | 2.25 microgram/kg SC once weekly | 500 micrograms SC every three weeks |
| Reduce dose by 40% if: | Hemoglobin exceeds a level needed to avoid transfusion or increases >1 g/dL in any two-week period. | |
| Withhold dose if: | The hemoglobin exceeds a level needed to avoid RBC transfusion; restart at 40% below the previous dose when the hemoglobin approaches a level where transfusions may be required. | |
| Increase dose: | To 4.5 microgram/kg if response is not satisfactory (no reduction in transfusion requirements or rise in hemoglobin <1 g/dL after six weeks of therapy in the absence of RBC transfusion) to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion. | N/A |
| Discontinue if: | After completion of the chemotherapy course, or if after eight weeks of therapy, there is no response as measured by hemoglobin levels or transfusions are still required. | |
SC: subcutaneously; RBC: red blood cell; N/A: not applicable.
* If initial therapy is tolerated and effective, extended dosing schedules may be used (eg, 80,000 units every two weeks or 120,000 units every three weeks).
