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Epogen (erythropoietinEPO) on Steroids Rx.com

Physiology

Epogen Injectables EPO is a glycoprotein (protein-sugar conjugate) that has been shown to regulate the synthesis of red blood cells in the bone marrow. When released from the kidneys it directs it activity in the bone marrow and helps stimulate the differentiation of stem cells into red blood cells. It is a normal body chemical which control hemoglobin synthesis and red blood cell concentration. Human EPO is a medium sized molecule (30,400-dalton) and contains 165 amino acids which are coupled to a few carbohydrate and sialic acid residues. There are several sub classes of EPO in the body- they only differ in the carbohydrate content.
At birth, EPO is manufactured in the liver but shortly afterwards the kidneys become the primary source of EPO. The regulation of EPO is based on the concentration of oxygen in the blood crossing the kidneys. When the kidneys sense a low oxygen concentration in the blood, EPO synthesis is increased. Human Epogen was isolated from the urine nearly 40 years ago. Since then we have developed recombinant DNA methods to produce EPO in the laboratory. The drug is made by Amgen and widely available globally. Development of Epogen

History

In the 1980s, it was realized that Epogen could make a significant difference in the hematocrit when administered to patients with anemia. This was followed up by its use to treat anemia in cancer patients and HIV patients treated with Zidovudine. Epogen is only administered 1-2 times a week to maintain a normal hematocrit. While many advocate that EPO should be given for other anemias, the overall consensus is that not only is EPO expensive but it may be more harmful when given empirically for other medical disorders.

Epogen has been around for at least 3 decades and has been widely used in millions of individuals. Its safety and efficacy have been well documented. It is mainly used to treat anemia in patients who have chronic renal failure. When Epogen is administered, the body starts to make red blood cells and this can be monitored by measuring the hemoglobin or hematocrit levels. Numerous studies have shown that Epogen can reduce the need for blood transfusions. Because of its expense, EPO is not given to every patient. Only after appropriate evaluation and consultation is EPO given to certain patients. 

Indications

Epogen is a prescription drug used to treat the following medical conditions:
 
  • anemia of chronic renal failure
  • anemia caused by potent chemotherapeutic drugs/cancer
  • anemia caused by Zidovudine in HIV patients
  • preoperative treatment of some patients undergoing elective surgery

Mode of action

 

Epogen is very similar to the hormone erythropoietin which is normally made in the kidneys. The role of erythropoietin is to help manufacture red blood cells from the bone marrow. Once the EPO is released from the kidneys it directs it action on the bone marrow stem cells. The red cell precursors are stimulated and over a few weeks the concentration of red blood cells increases in the circulation. This is also associated with an increase in hemoglobin and an improved oxygen carrying capacity.

 

Dosing

Epogen Injectible

EPO is only given 1-2 times a week. The drug can only be given by an injection- preferably subcutaneously. Most patients receive their Epogen injection from a nurse/physician but in some rare cases, the individual can be taught to inject him/her self. It should never be injected intravenously or taken orally. The drug comes as a liquid and should be handled with care.

 

EPO is a very fragile molecule and can be easily destroyed if it is not stored properly. It should never be exposed to excess heat or frozen. It should always be kept in the refrigerator and away from sunlight. EPO is available in single use vials and in multi use vials. Once the multi use vial has been opened up, the EPO will last for about 3 weeks. The dose of EPO is generally about 100 units/kg.

 

Once the EPO is administered, one can monitor the hematocrit over the next several weeks to see if it is working. Most doctors also recommend supplementing the body with iron tablets to compliment Epogen. A single vial of Epogen containing 1-2,000 units can cost anywhere from $100-$200, depending on where you buy and from whom you buy it. And the purity of the product is never guaranteed if it is bought over the internet.

 

Side effects & Complications

 

Epogen is generally a very safe drug and has a few minor side effects which include:

 

Side Effects of Epogen
  • nausea
  • constipation
  • fatigue
  • fever
  • pain or tenderness at the injection site

 

All the side effects resolve when the EPO injections are stopped.

 

Complications from EPO are rare but do occur. The most serious complications include stroke and congestive heart failure. There are also reports that some patients have developed blood clots in the legs and others have had worsening of their coronary artery disease.

Blood doping

 

EPO has had a long history of doping. It is widely believed that the first doping scandal occurred in the 70s. Over the past few decades almost every sport has had an athlete who has been caught doping with EPO. EPO doping has occurred in endurance sports, long distance running, cross country skinning and  even billiards. Since EPO can increase the hemoglobin and oxygen carrying capacity, it has been a favorite drug of abuse among individuals who participate in endurance events. The EPO is injected for a few weeks and the results are obvious in less than a month. Most athletes inject the EPO a few months prior to a sporting event. The injections are then stopped at least a few weeks prior to the actual meeting to avoid detection. There have also been isolated cases of complications in athletes who have abused EPO for prolonged periods. The reason for the complication is use of excessively high doses of EPO. The EPO continues to stimulate the red blood cells which than clog up blood vessels in the brain and the heart. This can lead to a stroke or a heart attack. Most of the EPO available today for illegal use is either stolen from pharmacies or obtained from Mexico or Europe. In some cases, it is illegally prescribed by physicians over the internet.

In the 1990s, EPO was finally banned by all sporting organizations. Newer and more sensitive tests have been developed to identify EPO in the urine and blood. In any sports, the urine is first checked for EPO. If there is a hint that EPO is present in the urine, the blood is tested for confirmation. The tests for EPO today are extremely sensitive and widely accepted by the scientific community. There is absolutely no risk of getting a falsely positive test.

References

 

Bartlett C, Clancy GJ, Cowan DA, et al. Detection of the Administration of Human Erythropoietin (HuEPO) to Canines. J Anal Toxicol 2006; 30(9):663-669.

 

Boldrini E, Cristani A Blood doping. Recenti Prog Med 1997 Dec; 88(12):559-61.

 

Cushner FD, Foley I, Kessler D, et al. Blood management in revision total knee arthroplasty. Clin Orthop Relat Res 2002 Nov; (404):247-55.

 

Gaudard A, Varlet-Marie E, Bressolle F, et al. Drugs for increasing oxygen and their potential use in doping: a review. Sports Med 2003; 33(3):187-212.

 

Hahn AG, Gore CJ The effect of altitude on cycling performance: a challenge to traditional concepts. Sports Med 2001; 31(7):533-57.

 

Lacina NC Exercise tolerance before and after correction of anemia with epoetin alfa.
Am J Kidney Dis 1991 Feb; 17(2):245.

 
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