procrit injections How much is enough? To much?

[his3707]

Im getting nervous about the procrit.   my vial says 40,000 units and they initally wanted me to hit that every 3rd day.  Then within the first week I got a call saying twice a week Sundays and Wednesdays or Thursdays.   No one even discussed side effects, my blood pressure to be monitored closely, etc.   The only thing they are doing is looking at my blood work once a week or a little more often than that.  What should I be asking this Friday when I go for my 6 week blood work.   My HGB  is 8.7 as of yesterday up from 8.5.  Dont know what it is today.   Just took my 3rd injection of 40,000 units of Procrit.   I started last Thursday, Sunday and now today Wed.  my next shot  is scheduled for Sunday.  I know Im getting another prescription but not sure if the unit amount will be changed.  I feel like right now Im just blindly following orders.  They have lowered riba to 600mg from 1000mg and interferon from 185mcg to 135mcg ,    They better know what their doing.  Right?  I suppose I have no choice at this juncture other than to drop out of trial if they are being reckless or somthing.  I hear Procrit is a problem in itself and nothing to be fooled around with.  Its hard to  believe I can not get a sedative from the  vet for my dog but they are just handing me over needles and powerful drugs and saying just take this and that do this and that and see me in the am.  

[his3707]

Thanks again for all the encouragement!  and wonderful information!
NYgirl..  I am looking forward to this absolutely great feeling.  This anemia which is apparently what is causing most of my fatigue? has been there since day 2 and I am starting week 7 tomorrow.  My son asked me yesterday if my personality was going to stay this way forever.  Ugggg   slugggg   :(     So  come on Procrit!  let roll it up to 10.5!!  

[nygirl7]

I took 40,000 x 2 a week and it made my hemo too high (went into the 12s we are supposed to stay under that) so we dropped it back to every five days and it stabilized at about 10.5

Now 10.5 feels really crummy on the way down but when you are going back up it's amazing that 10.5 feels just absolutely great.

it takes a while to work but it does a fantastic job you will feel so much better!

[his3707]

Thanks It all helps me tremendously

[HectorSF]

In case you don't already have this information, here are a few links to Procrit resources.

MEDICATION GUIDE
PROCRIT®
(PRO’-KRIT)
(epoetin alfa)

http://www.procrit.com/sites/default/files/shared/OBI/PI/MedGuide.pdf

Full Prescribing Information

http://www.procrit.com/sites/default/files/shared/OBI/PI/ProcritBooklet.pdf#page=1

Included in the above is dosage information -

Although no specific serum erythropoietin level has been established which predicts which patients would be unlikely to respond to PROCRIT® therapy, treatment of patients with grossly elevated serum erythropoietin levels (eg, > 200 mUnits/mL) is not recommended. Therapy should not be initiated at hemoglobin levels  ≥ 10 g/dL. The hemoglobin should be monitored on a weekly basis in patients receiving PROCRIT® therapy until hemoglobin becomes stable. The dose of PROCRIT® should be titrated for each patient to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for blood transfusion (see recommended Dose Modifications, below).

Recommended Dose: The initial recommended dose of PROCRIT®
in adults is 150 Units/kg SC TIW or 40,000 Units SC Weekly.

Dose Modification
TIW Dosing

Starting Dose:
Adults 150 Units/kg SC TIW

Reduce Dose by 25% when:
Hemoglobin reaches a level needed to avoid transfusion or increases > 1 g/dL
in any 2-week period.

Withhold Dose if:
Hemoglobin exceeds a level needed to avoid 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 TIW if: Response is not satisfactory (no reduction in transfusion requirements or rise in hemoglobin) after 4 weeks
to achieve and maintain the lowest hemoglobin level sufficient to avoid the need for RBC transfusion.

Discontinue:  If after 8 weeks of therapy there is no response as measured by hemoglobin
levels or if transfusions are still required.

Weekly Dosing
Starting Dose: Adults 40,000 Units SC

Reduce Dose by 25% when:
Hemoglobin reaches a level needed to avoid transfusion or increases > 1 g/dL
in any 2-weeks.

Withhold Dose if:
Hemoglobin exceeds a level needed to avoid transfusion and restart at 25% below the previous dose when the hemoglobin approaches a level where transfusions may be required.

Increase Dose if: Response is not satisfactory (no For Adults: 60,000 Units increase in hemoglobin by ≥ 1g/dL SC Weekly after 4 weeks of therapy, in the
For Pediatrics: absence of a RBC transfusion) to 900 Units/kg IV achieve and maintain the lowest (maximum hemoglobin level sufficient to avoid 60,000 Units) if: the need for RBC transfusion.

Discontinue:  If after 8 weeks of therapy there is no response as measured by hemoglobin
levels or if transfusions are still required.


Hope this helps.
Hector

[his3707]

Thanks for the replies!  I'll ask on Friday what the plan is say,  if my count comes up if they will keep me on procrit and go back up on the drugs or what.  

[spectda]

In my boceprevir anemia trial the max allowed was 60,000 units per week which is 40,000 every 4.5 days. My doc started me at 40,000 unit once per week and increased to 60,000 units after three weeks because I didn't have enough of a response.

Procrit can take several weeks to work. I believe that they are now generally more conservative since the fda issued a black box warning with it that includes the increased risk of heart attacks and strokes . The doctor will generally back off the procrit if you get above 11, it is not recommended over 12 as this is when the danger is most likely to occur.

Many of us like yourself are unable to treat without procrit. You are right though, this is serious medication with the possibility of serious repercussions if not managed properly. Good luck to you and hopefully your hgb will get to the point where you can increase riba and feel a bit better.
-Dave

procrit info:
http://procrit.com/

[uncledudeness]

if i didn't know better, i would say you copied one of my posts ( i know you didn't). i too, am on 40,000 units of procrit (sunday and wednesday). my hgb was down to 8.7 too. after about 6 weeks of taking procrit with no improvement in my hgb, they reduced my riba to 600 from 1200, and interferon to 135. i did that for 2 weeks and my cbc's shot right up. i almost felt normal again. and here i am on the forum waiting for my procrit to warm up so i can take it. i have to say i don't think the procrit is doing much for me, but i really don't know that for sure. it sounds like your med team is right on the money with you evaluation.

now i am struggling with low wbc's again and a brutal bronchial infection for about a month. goin in for my 24 week blood work and evaluation this friday......half way, yep half way i am...it's all down hill from here..

hang in there and believe it's gonna work for you. i was UD at 12 weeks.

ps: i didn't feel much of the sides fromf the procrit, but that's me.

good luck.

[can-do-man]

It took a few weeks to start working, my HGB got as low as 8. It finally got back up in the 9's, once it started working i felt alot better. I was in a boceprevir (victrelis) trial which is know to increase anemia.

My first treatment on just SOC i was also put on 40,000 twice a week but after a month it was reduced to just once a week....... Both times it was a lifesaver for me, i would have never been able to finish tx without it, never had to dose reduce. Relapsed my first time but got SVR on my second treatment.

Do anything you can to gain SVR the first time, treatment is something i wish nobody has to go through more then once......

[his3707]

Can-do, How did your hgb  stabilize  while on procrit?  How did you feel while on it?  How long did it take to kick in?  
Thanks

[can-do-man]

One more thing, its great your in a trial that allows procrit and have a doctor that will use it.

[can-do-man]

I was also on 40,000 procrit twice a week for the most of my last tx, never had much in side effects from it. Once a week blood work is the normal when on it. Make sure you let it warm to room temp. and inject it slowly, helps take the sting out of it. To bad they didn't start it sooner instead of dose reducing the riba..... Besides that it sounds like they are doing the right thing.
Good luck

cando