For those on NxStage, do you give yourselves IV meds or must you go in-center?
Hi
I’m on next since and the only meds I give are heprin (everyday 5cc I’m on on a cath) in the blue post on filter and epo same way 3x aweek.
I go to center once a month for iron shot.
bobeleanor 
No I.V. medications here…
Hi
That was me who post on meds I’m on nxstage
sorry
bobeleanor :oops:
The center decides if you are allowed to give iron or hectoral or whatever. Machine makes no difference.
Cathy
One of the IV iron companies told me that it doesn’t recommend that people self-administer IV iron. I think this is because the package insert cautions about reactions. However, I believe Pierre gives himself iron – but Pierre is in Canada and rules may be different there. Pierre?
I give my own iron and aranesp IV on machine. Once you have had iron a couple of times, its pretty unlikely that you would have any reactions to it. We either give it in 20ml over 10 minutes as a push, 10ml over one hour in the syringe pump.
Obviously I do my own heparin, its part of dialysis.
Same as amba here.
We do our own IV iron.
Re giving meds IV in home programs, are there any state or federal regulations that say it can not be given IV as Medicare will not pay?
I’ve been giving myself Venofer once a month since I started home hemo, exactly the same way it’s done at the dialysis centres.
Pierre
Are there any risks to giving epo IV? What is the reason for some programs wanting it given sub Q?
As far as I know theres no difference if its given IV or subcut. This was one of the first questions I asked when I started hemo. And it also means one less needle you are jabbed with.
I have heard many say that sub q is more effective, but wasn’t this disproved by a recent study? There has to be a reason why some programs strictly want it given sub q.
Between 1998 and 2004, there were 191 cases worldwide of a very rare condition called pure red cell aplasia (PRCA) that occurred in patients on dialysis getting 3 different EPO products – 175 patients took Eprex, 11 took Neorecormon, and 5 took Epogen (Epoietin alfa). Most of these cases occurred in France, Canada, UK, and Spain. The search was on to find out why. People suggested differences in the manufacturing process, how the drug was handled, stored, or administered (IV vs. subcutaneous).
In May 2005, researchers from Johnson & Johnson reported that they had discovered the cause and it was that non-coated rubber stoppers in pre-filled syringes leached into the Eprex causing PRCA. Eprex prefilled syringes now are coated with fluoro-resin. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15882278
In the U.S. most clinics use multi-dose vials of EPO so that may explain why so few people in the U.S. developed PRCA. In spite of the J&J discovery that the uncoated rubber stoppers caused PRCA, recently published K/DOQI anemia guidelines recommend IV administration to those on in-center HD to reduce the chances of PRCA.
Research isn’t conclusive about whether administering EPO IV requires a higher dose – I’ve seen studies saying that giving it IV requires 20% more EPO and others that say the differences in dosage is insignificant. Obviously, this is something that needs further study. Drug safety and cost effectiveness and both important considerations with EPO and any other drug.
BTW, a number of drugs can cause PRCA, not just EPO, and PRCA can be treated effectively and some patients who developed resistance to EPO can even benefit from EPO later.
Beth, Interesting!..similiar to what was happening with me on heparin!..yuck those parabens!
Here’s more research on EPOGEN…
http://content.nejm.org/cgi/content/abstract/339/9/578
I was swapped from Eprex to Aranesp by my previous neph and I trusted it was the right thing to do as he is a brilliant doctor.
Hi people, here’s another article on why SubQ is the way to go…
http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupan_iv.html
What about aranesp? My Hb has gone from 70 whilst on PD and giving it subcut, to 90-120 since giving it IV.