in Hgb of 2 g/dL from baseline. Following initiation of therapy and after each dose adjustment, monitor hemoglobin weekly until the hemoglobin level is stable and sufficient to minimize the need for RBC transfusion. FDA Approves Cheaper Alternative to Specialty Anemia Drugs - GoodRx Providers who prefer to use epoetin alfa-epbx must specify a reason for its use. MeSH Federal government websites often end in .gov or .mil. . All Rights Reserved. Epub 2009 Aug 4. The most frequent dosing regimens were 40,000 units weekly The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. Biological products are generally derived from a living organism and can come from many sources, such as humans, animals, microorganisms or yeast. Evaluate response every 4-8 weeks thereafter and adjust the dose accordingly by 50-100 units/kg increments 3 times/week. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. See full prescribing information for RETACRIT. Australian haemodialysis patients on intravenous epoetin alfa or intravenous darbepoetin alfa: how do they compare? Anemia Hard Choices: Comparing Procrit vs Aranesp : Oncology Times - LWW Check out recent approvals at the OCEs podcast, Drug Information Soundcast in Clinical Oncology. The recommended starting dose is 0.45 mcg/kg intravenously or subcutaneously as a weekly injection or 0.75 mcg/kg once every 2 weeks as appropriate. In cancer patients, erythropoietic agents, including similar over the course of therapy for both groups. Do not use Aranesp that has been shaken or frozen. Neumega is not indicated following myeloablative chemotherapy (see package insert for WARNINGS, Increased Toxicity Following Myeloablative Therapy). Based on the patient's response, darbepoetin affinity has no or little clinical relevance. alfa may be administered as frequently as once every 3 or 4 weeks. The agency also is responsible for the safety and security of our nations food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Background: The recommended conversion dose for changing from epoetin alfa to darbepoetin alfa is 200 units to 1 microg. Patients with anemia and chronic kidney disease undergoing maintenance hemodialysis and receiving routine intravenous (IV) Epogen were randomized 1: 1 to switch to IV RetacritTM or continue standard-of-care (Epogen) for 24 weeks, using analogous versions of the FMCNA ESA-dosing algorithm. The probability of switching between different epoetins was associated with the duration of treatment: about 15 % of users switched within 12 months and almost 25 % within 2 years of observation. Epoetin alfa versus darbepoetin alfa in chemotherapy-related anemia. For the purposes of this policy, a conversion factor of 3 should be used to estimate hematocrit when only the hemoglobin is measured, e.g., hemoglobin of 10 g . sharing sensitive information, make sure youre on a federal Conversion - Epoetin alfa (Procrit) to Darbepoetin alfa (Aranesp) #Epoetin #Darbepoetin #Erythropoietin #Conversion #Table #ESAs #Procrit #Aranesp #Pharmacology #Hematology #Nephrology. Before sharing sensitive information, make sure you're on a federal government site. Refer to Aranesp package insert for pediatric dosing conversion. adverse event to Retacrit (epoetin alfa), and the adverse event was not an expected adverse event attributed to the active ingredient as described in the prescribing information; OR For patients that are currently on treatment with Aranesp (darbepoetin alfa) they can remain on <>/Filter/FlateDecode/ID[<6A376E50FA41294D8BDE0DC442E05AF8>]/Index[1022 100]/Info 1021 0 R/Length 147/Prev 333934/Root 1023 0 R/Size 1122/Type/XRef/W[1 3 1]>>stream Darbepoetin alfa effectively maintains haemoglobin concentrations at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoietin in dialysis patients. Evaluate other causes of anemia. Based on the patient's response, darbepoetin alfa may be administered as frequently as once every 3 or 4 weeks. 4. Aranesp is administered less frequently than epoetin alfa. Evaluate the iron status in all patients before and during treatment. Dosage adjustment: Goal: Dose should be adjusted to achieve and maintain a target hemoglobin not to exceed 12 g/dL. Health care professionals should review the prescribing information in the labeling for detailed information about the approved uses. Epogen and Procrit are specialty medications used to treat anemia caused by chronic kidney disease (CKD) or chemotherapy, but they don't come cheap. These adverse reactions included myocardial infarction and stroke, In controlled clinical trials, ESAs increased the risk of death in patients undergoing coronary artery bypass graft surgery (CABG) and the risk of deep venous thrombosis (DVT) in patients undergoing orthopedic procedures, ESAs resulted in decreased locoregional control/progression-free survival (PFS) and/or overall survival (OS). An official website of the United States government, : PDF Highlights of Prescribing Information ----------------------- Dosage number of patients receiving transfusions, to increase hemoglobin Severe chronic neutropenia: Congenital: 6 mcg/kg twice daily Idiopathic/cyclic: 5 mcg/kg/day, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9222, Supplied: Injection, solution [preservative free]: 300 mcg/mL (1 mL, 1.6 mL) [vial; contains sodium 0.035 mg/mL and sorbitol], Injection, solution [preservative free]: 600 mcg/mL (0.5 mL, 0.8 mL) [prefilled Singleject syringe; contains sodium 0.035 mg/mL and sorbitol], Drug UPDATES: ZARXIO - filgrastim-sndz injection [Drug information / PDF] Click link for the latest monographDosing: Click (+) next to Dosage and Administration section (drug info link). objective of the DUE was to trend usage patterns in the outpatient The needle cover of the prefilled syringe contains dry natural rubber (a derivative of latex), which may cause allergic reactions. There is a potential for similar risks to fetuses and infants exposed to benzyl alcohol in utero or in breastfed milk, respectively. 5,o_2&+PA1xRAag(sRVt?jN)r!ba,cKc$Z`6@5&ql~d:P /bc yh{fM"fCCmF6TBxgE= Vue-#x4Bi8&ZC; The U.S. Food and Drug Administration today approved Retacrit (epoetin alfa-epbx) as a biosimilar to Epogen/Procrit (epoetin alfa) for the treatment of anemia caused by chronic . Bonafont X, Bock A, Carter D, Brunkhorst R, Carrera F, Iskedjian M, Molemans B, Dehmel B, Robbins S. NDT Plus. Use caution in patients with coexistent cardiovascular disease and stroke. Supplied Injection, powder for reconstitution: 5 mg, INDICATIONS AND USAGE Neulasta is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia. Scroll left to view table. Immediately and permanently discontinue RETACRIT and administer appropriate therapy if a serious allergic or anaphylactic reaction occurs, Blistering and skin exfoliation reactions, including erythema multiforme and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), have been reported in patients treated with ESAs (including epoetin alfa) in the postmarketing setting. doses. The safety and effectiveness of Neumega have not been established in pediatric patients. 7. SPLENIC RUPTURE, IN SOME CASES RESULTING IN DEATH, HAS ALSO BEEN ASSOCIATED WITH FILGRASTIM, THE PARENT COMPOUND OF NEULASTA. Studies of erythropoietin therapy both groups iron studies were not conducted routinely. Administer supplemental iron therapy when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. While a discounted alternative to Epogen and Procrit is welcome, there is a catch. . dose of darbepoetin alfa for CIA is 200 mcg SC every-other-week 1057 0 obj OMONTYS has not been shown to improve symptoms, physical functioning or health-related quality of life. 1. Darbepoetin alfa. This has been reported predominantly in patients with CKD receiving ESAs by subcutaneous administration. patients and 55 darbepoetin alfa patients. startxref Do not re-enter vial. conversion factor of 1 mcg:220 units Aranesp:EPO. Biosimilars can provide greater access to treatment options for patients, increasing competition and potentially lowering costs.. 4 0 obj Each 1 mL single-dose vial of 2,000, 3,000, 4,000, 10,000, and 40,000 Units of epoetin alfa-epbx injection contains 0.5 mg of phenylalanine. RETACRIT is contraindicated in patients with: RETACRIT from multiple-dose vials contains benzyl alcohol and is contraindicated in: INCREASED MORTALITY, MYOCARDIAL INFARCTION, STROKE, AND THROMBOEMBOLISM, INCREASED MORTALITY AND/OR INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE IN PATIENTS WITH CANCER, LACK OR LOSS OF HEMOGLOBIN RESPONSE TO RETACRIT, RISK OF SERIOUS ADVERSE REACTIONS DUE TO BENZYL ALCOHOL PRESERVATIVE, ANEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE, ANEMIA DUE TO CHEMOTHERAPY IN PATIENTS WITH CANCER, ANEMIA DUE TO ZIDOVUDINE IN PATIENTS WITH HIV INFECTION, Recommended dosing for adults and children with chronic kidney disease (CKD), The recommended starting dose for adult patients is 50 to 100 Units/kg 3 times weekly intravenously (IV) or subcutaneously (SC). Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Conversion from Epoetin alfa or Darbepoetin alfa to MIRCERA MIRCERA can be administered once every 2 weeks or once monthly to patients whose hemoglobin has been stabilized by treatment with an ESA. [Multicenter study of darbepoetin alfa in the treatment of anemia secondary to chronic renal insufficiency on dialysis]. Call 1-888-4ASSIST to find out more. _____ (if . The dose should be titrated to meet and If the hemoglobin level exceeds 10 g/dL, reduce or interrupt the dose of Aranesp, and use the lowest dose of Aranesp sufficient to reduce the need for RBC transfusions. Darbepoetin alfa once every 2 weeks effectively maintained hemoglobin in dialysis patients in an observational study: Austrian cohort of ALTERNATE. Like Epogen/Procrit, Retacrit must be dispensed with a patient Medication Guide that provides information about the drugs uses and risks. PDF Food and Drug Administration GrepMed and the images sourced through this website are NOT a substitute for clinical judgement. When initiating or adjusting therapy, monitor hemoglobin levels at least weekly until stable, then monitor at least monthly. hbbd```b``IA$/f?W$_d6X&LE@${`lktfu` : 6C(XlB3XDD&iMt#K/X=(IW? l endstream Evaluation of Iron Stores and Nutritional Factors. All in-centre haemodialysis patients (n = 60) were converted from an existing subcutaneous epoetin alfa regimen to weekly intravenous darbepoetin alfa. for epoetin alfa-treated patients and 200 mcg every 2 weeks (or DOSAGE FORMS AND STRENGTHS Dosage Form Strengths Single use vials (preservative-free) 2 mg/0.5 mL, 3 mg/0.5 mL, 4 mg/0.5 mL, 5 mg/0.5 mL, and 6 mg/0.5 mL, Single use pre-filled syringes (preservative-free) 1 mg/0.5 mL, 2 mg/0.5 mL, 3 mg/0.5 mL, 4 mg/0.5 mL, 5 mg/0.5 mL, and 6 mg/0.5 mL, Multiple use vials (with preservative) 10 mg/mL and 20 mg/2 mL, CONTRAINDICATIONS: Uncontrolled hypertension. 600 Units/kg subcutaneously in 4 doses administered 21, 14, and 7 days before surgery and on the day of surgery. Aranesp is a medicine used to treat anaemia (low red blood cell counts) that is causing symptoms. Previous dosage of epoetin alfa: 34,000-89,999 units/week,then darbepoetin alfa dosage: 100 mcg/week. half-life of 8.5 hours. Epub 2014 Aug 14. PMC Decreases in dose can occur more frequently. Vol. CHO chains) has a 3-fold increase in half-life when compared to OHSU's formulary erythropoiesis stimulating agent (ESA) is darbepoetin alfa (ARANESP). INDICATIONS AND USAGE: 1.1 Patients with Cancer Receiving Myelosuppressive Chemotherapy ZARXIO is indicated to decrease the incidence of infection as manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever [see Clinical Studies (14.1)]. The gasping syndrome is characterized by central nervous system depression, metabolic acidosis, and gasping respirations. Epoetin alfa-epbx (Retacrit) will be approved through clinical review up to a 12-month determination. In patients who are receiving epoetin alfa once weekly, darbepoetin should be administered once every 2 weeks. Refer to Table 1. Epoetin timeline: 2/2020: Switched from Procrit to Retacrit preferred. The recommended starting dose is 0.45 mcg/kg body weight intravenously or subcutaneously given once at four week intervals as appropriate. The site is secure. Do not use any vials or prefilled syringes exhibiting particulate matter or discoloration. If a patient or caregiver is not able to demonstrate that they can measure the dose and administer the product successfully, you should consider whether the patient is an appropriate candidate for self-administration of Aranesp or whether the patient would benefit from a different Aranesp presentation. Previous dosage of epoetin alfa: 11,000-17,999 units/week,then darbepoetin alfa dosage: 40 mcg/week. 2006 Jan;40(1):58-65; quiz 169-70. doi: 10.1345/aph.1G042. Would you like email updates of new search results? Hymes J, Bickimer T, Jackson JH, Bookhart BK, Mody SH, Tak Piech C. Curr Med Res Opin. Excessive response: Hemoglobin increases >1 g/dL in any 2-week period: Decrease dose Hemoglobin increases and approaches the target value of 12 g/dL: Decrease weekly dosage by ~25%. A target Erythropoiesis-stimulating agents (epoetin alfa, beta, theta and zeta In pediatric patients, Mircera is administered by intravenous injection only (2.2). We comply with the HONcode standard for trustworthy health information. Switch from epoetin to darbepoetin alfa in hemodialysis: dose most common dosing regimens are 40,000 units weekly for epoetin Amgen This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. Before prescribing RETACRIT single-dose vials to a patient with PKU, consider the combined daily amount of phenylalanine from all sources, including RETACRIT, Patients may require adjustments in their dialysis prescriptions after initiation of RETACRIT. Slowly push the plunger up to force the air bubbles out of the syringe. epoetin alfa and darbepoetin alfa for the management of CIA. Patients on Cancer Chemotherapy Initiate Aranesp in patients on cancer chemotherapy only if the hemoglobin is less than 10 g/dL, and if there is a minimum of two additional months of planned chemotherapy. No trial has identified a hemoglobin target level, Aranesp dose, or dosing strategy that does not increase these risks. A 30-day supply of Procrit costs well over $2,000 and prices for Epogen average around $600 per month. 1. % REASON FOR . Adverse effects on PFS and/or OS were observed in studies of patients receiving chemotherapy for breast cancer, lymphoid malignancy, and cervical cancer; in patients with advanced head and neck cancer receiving radiation therapy; and in patients with non-small cell lung cancer or various malignancies who were not receiving chemotherapy or radiotherapy, RETACRIT is contraindicated in patients with uncontrolled hypertension. PDF Erythropoietin Stimulating Agents: Darbepoetin alfa (Aranesp), Epoetin Ann Pharmacother. On May 15, 2018, the Food and Drug Administration approved Retacrit (epoetin alfa-epbx, Hospira Inc., a subsidiary of Pfizer Inc.) as a biosimilar to Epogen/Procrit (epoetin alfa, Amgen Inc.) for . <> Supplied Injection, solution [preservative free]: 10 mg/mL (0.6 mL) [prefilled syringe]. Physicians and patients should weigh the possible benefits of decreasing transfusions against the increased risks of death and other serious cardiovascular adverse events [see Boxed Warning and Clinical Studies (14)]. Stop dose if hemoglobin exceeds 13 g/dl and resume treatment at a 25% dose reduction when hemoglobin drops to 12 g/dl. . W bO? Peripheral blood progenitor cell (PBPC) collection: 10 mcg/kg/day or 5-8 mcg/kg twice daily in donors. In order to be included in the DUE, Martnez Castelao A, Reyes A, Valds F, Otero A, Lpez de Novales E, Pallard L, Tabernero JM, Hernndez Jaras J, Llads F. Brunkhorst R, Bommer J, Braun J, Haag-Weber M, Gill C, Wagner J, Wagener T; German Aranesp Study Group. Committee will be exploring other patient populations for this RETACRIT (epoetin alfa-epbx) injection, for i ntravenous or subcutaneous use . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2014 Jan 31. at the Cleveland Clinic Health System (CCHS) reviewing the use of epoetin alfa and darbepoetin alfa, have been shown to decrease the VII, No. duration of therapy was 13.2 weeks and 13.6 weeks in the epoetin levels, and to improve quality of life. Disclaimer. To report SUSPECTED ADVERSE REACTIONS, contact Amgen Medical Information at 1-800-77-AMGEN (1-800-772-6436) or . This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. WARNINGS AND PRECAUTIONS Increased Mortality, Myocardial Infarction, Stroke, and Thromboembolism: Using ESAs to target a hemoglobin level of greater than 11 g/dL increases the risk of serious adverse cardiovascular reactions and has not been shown to provide additional benefits. Epogen (Amgen), another brand name for epoetin RETACRIT (epoetin alfa-epbx) Dosing Info | Safety Info - Pfizer pro active than epoetin alfa, paradoxically was found to have less affinity of darbepoetin alfa, the half-life is ~49 hours (a similar half-life In addition, as with Epogen/Procrit, Retacrit contains a Boxed Warning to alert health care professionals and patients about increased risks of death, heart problems, stroke and tumor growth or recurrence. lNY0?j/0a6d%J1\3\qdS@*_gy{sl?!H^]ibQ'_(%`lI$5.r U ?Xz:sf;{@(eHB Dose adjustment: If response is not satisfactory after a sufficient period of evaluation (8 weeks of 3 times/week and 4 weeks of once weekly therapy), the dose may be increased every 4 weeks (or longer) up to 300 units/kg 3 times/week, or when dosed weekly, increased all at once to 60,000 units weekly. Conversion from another ESA: dose once monthly based on the total weekly epoetin or darbepoetin alfa dose at the time of conversion. endobj alfa- and darbepoetin alfa-treated patients, respectively. Inadequate response: Hemoglobin increases <1 g/dL over 4 weeks . Check again for air bubbles. The site is secure. Pfizer for Professionals 1-800-505-4426 1 0 obj %PDF-1.6 % Inadequate response: Hemoglobin increases <1 g/dL over 4 weeks and iron stores are adequate: Increase by ~25% of the previous dose; increases should not be made more frequently than once monthly. The most common dosing regimens are 40,000 units weekly for epoetin alfa and 200 mcg every 2 weeks for darbepoetin alfa. Maintain the route of administration (intravenous or subcutaneous injection). Training should aim to demonstrate to those patients and caregivers how to measure the dose of Aranesp, and the focus should be on ensuring that a patient or caregiver can successfully perform all of the steps in the Instructions for Use for a prefilled syringe. PDF Erythropoiesis-Stimulating Agents - Commercial Medical Benefit Drug Policy Retacrit is also approved for use before and after surgery to reduce the chance that red blood cell transfusions will be needed because of blood loss during surgery. The effect of pentoxifylline on oxidative stress in chronic kidney disease patients with erythropoiesis-stimulating agent hyporesponsiveness: Sub-study of the HERO trial. Limitations of Use OMONTYS is not indicated and is not recommended for use: In patients with CKD not on dialysis . stream Mechanism of Action: Colony-stimulating factors are glycoproteins which act on hematopoietic cells by binding to specific cell surface receptors and stimulating proliferation differentiation commitment and some end-cell functional activation. Methods: Conversion from Epoetin alfa to Aranesp in patients with CKD not on dialysis. endstream endobj 336 0 obj <>stream Aranesp | European Medicines Agency Discontinue the drug at least 48 hours before beginning the next cycle of chemotherapy. Administer Aranesp once every 2 weeks in patients who were receiving epoetin alfa once weekly. Please review the latest applicable package insert for additional information and possible updates. The optimal timing and duration of growth factor stimulation has not been determined. Surgery patients: Prior to initiating treatment, obtain a hemoglobin to establish that is >10 mg/dL or 13 mg/dL: Initial dose: 300 units/kg/day SC x 10 days before surgery, on the day of surgery, and for 4 days after surgery. If hemoglobin increases greater than 1 g/dL in any 2-week period or, If hemoglobin reaches a level needed to avoid RBC transfusion, Withhold dose until hemoglobin approaches a level where RBC transfusions may be required, Reinitiate at a dose 40% below the previous dose, If there is no response as measured by hemoglobin levels or if RBC transfusions are still required after 8 weeks of therapy, Following completion of a chemotherapy course. ferrous sulfate, Procrit, Retacrit, epoetin alfa, Epogen, darbepoetin alfa. PDF Clinical Policy: Epoetin Alfa (Epogen, Procrit), Epoetin Alfa-epbx 8600 Rockville Pike Excessive responses: Hemoglobin increases >1 g/dL in a 2-week period OR if hemoglobin exceeds 12 g/dL: Reduce dose by 25% Hemoglobin >13 g/dL: Withhold dose until hemoglobin falls to 12 g/dL, then reinitiate at 25% less than previous dose. 2007 Apr;12(2):126-9. doi: 10.1111/j.1440-1797.2006.00762.x. The What is the practical conversion dose when changing from epoetin alfa PDF Highlights of Prescribing Information ------------------dosage and Keep the tip of the needle in the RETACRIT liquid. No trial has identified a hemoglobin target level, ESA dose, or dosing strategy that does not increase these risks. Learn how to combine multiple dosing options for precise titration and individualize anemia management. Safety and Efficacy: Currently available data indicate that darbepoetin The number Darbepoetin's T1/2 is approximately 3 times that of epoetin alfa. Patients were then switched to fortnightly darbepoetin alfa dosing treatments; the existing weekly dose being doubled and Hb levels fell from 125 to 110 g/L (P < 0.0001), despite an increase in the mean dose from 44.9 to 47.5 microg/week (P = 0.02). endobj Discontinue Aranesp if responsiveness does not improve. ChronicKidney Disease: Mircera Dosage Guide - Drugs.com Monitor platelets and hematocrit regularly. The effects of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned Beneficial dose conversion after switching from higher doses of shorter-acting erythropoiesis-stimulating agents to C.E.R.A in CKD patients in clinical practice: MINERVA Study. If a patient or caregiver experiences difficulty measuring the required dose, especially if it is other than the entire contents of the Aranesp prefilled syringe, use of the Aranesp vial may be considered. and approved an automatic therapeutic interchange to darbepoetin In recent years, the trend has been to use higher doses of epoetin alfa (eg, 60,000 U once per week), recognizing that MDS RBC precursors may have relative intrinsic resistance to EPO. Advise patients to contact their healthcare practitioner for new-onset seizures, premonitory symptoms or change in seizure frequency, For lack or loss of hemoglobin response to RETACRIT, initiate a search for causative factors (eg, iron deficiency, infection, inflammation, bleeding). x]Y8~w&*qq8g91YJUjUr2$u UuKf"3e&U+Wq&0Y Chronic Kidney Disease: In controlled trials, patients experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL. 0 of patients receiving transfusions was similar between the groups, and 24 patients in the darbepoetin alfa group reached the targeted Do not dilute Aranesp and do not administer in conjunction with other drug solutions. CONTRAINDICATIONS Neulasta is contraindicated in patients with known hypersensitivity to E coli-derived proteins pegfilgrastim Filgrastim, or any other component of the product. Existing patients on IV EPO, change to subcutaneous EPO using the . 150 units/kg SC 3 times/week or 40,000 units once weekly. Northwest Kidney Centers Home Dialysis Programs Standing Orders - Erythropoietin . Please enable it to take advantage of the complete set of features! The protocol for anaemia management included a target haemoglobin (Hb) concentration of 120-130 g/L and a ferritin of 300-600 microg/L. Estimate the starting weekly dose of Aranesp for adults and pediatric patients on the basis of the weekly epoetin alfa dose at the time of substitution (see Table 1). It is also approved for the reduction of allogeneic red blood cell transfusions in patients undergoing elective, noncardiac, nonvascular surgery.
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