Indication |
- Treatment of symptomatic anaemia associated with chronic kidney disease (CKD)
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Preparations |
- Injection: Mircera®, prefilled syringe 30, 50, 75, 100, 120, 150, 200, 250, 360 micrograms
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Contraindications |
- Hypersensitivity to the active substance or to any of the excipients
- Uncontrolled hypertension
- Patients who develop pure red cell aplasia (PRCA) following treatment with erythropoietin
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Cautions |
- Monitor FBC (aim Haemoglobin 10-12 g/dl) - avoid a sustained haemoglobin level of greater than 12 g/dl
- Monitor BP
- Ensure patients have sufficient iron stores. Keep ferritin >100 ng/ml and TSAT >20%
- Pure Red Cell Aplasia caused by anti-erythropoietin antibodies has been reported in association with all ESAs, including Mircera®. These antibodies have been shown to cross-react with all ESAs, and patients suspected or confirmed to have antibodies to erythropoietin should not be switched to Mircera®
- Mircera® is less effective when the patient is deficient in vitamin B12, iron, folic acid, during periods of infection, inflammatory or traumatic episodes, underlying haematologic diseases, severe aluminium toxicity
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Side-effects |
- Hypertension
- Hb > 12 g/dl increased risk of cardiovascular events, CVA and death
- Thrombosis (eg fistula)
- PRCA
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Dose |
- Mircera®: Starting dose of 0.6 microgram/kg every 2 weeks, increase by 25% according to response (e.g. if the rate of rise in Hb is less than 1.0 g/dl over a month) every 4 weeks until target Hb is obtained. Once stable – change to monthly dosing. Reduce dose if Hb rises too quickly or above target. Rise in Hb should not exceed 2 g/dl per month
- Target Hb = 10-12 g/dl
- No dose adjustments based on age or hepatic function
- Normally give injections SC
- Equivalent dose IV vs SC – monitor response
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Dose in renal impairment |
- As in normal renal function, not dialysed
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Interactions |
- If given with ACEi or ARB, there is an increased risk of hyperkalaemia
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How to Prescribe |
View Details |
Patient comment |
- Target Hb = 10-12 g/dl
- Store in a refrigerator
- If a dose is missed give as soon as possible and then restart at your normal (prescribed) frequency
- Rotate the injection sites and inject slowly to avoid discomfort at the site of injection
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