Last update Jan. 23, 2021

Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta)

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Epoetins alfa, beta, lambda, theta, and zeta are recombinant human erythropoietins with the same pharmacological actions as endogenous erythropoietin (EPO). It is produced in the kidney and stimulates the production of red blood cells.
Like natural EPO, epoetins are glycoproteins with a sequence of about 165 amino acids. They differ from each other in their degree and type of glycosylation. Alpha is identical to natural EPO and zeta is a biosimilar to alpha.
Epoetins are indicated in anemia secondary to kidney failure, chemotherapy or other treatments and for the prevention of anemia of prematurity. They differ from each other in their degree and type of glycosylation. E. Alpha is identical to natural erythropoietin, and E. zeta is a biosimilar to E. alfa.
Subcutaneous or intravenous administration.

Since the last update we have not found any published data on its excretion in breast milk.

Its very high molecular weight makes transfer into breastmilk in clinically significant quantities unlikely.

Erythropoietin is a normal component of human milk (Lawrence 2016 p 139, 147 y 150, Juul 2000, Kling 1998).

Due to its protein nature, it is inactivated in the gastrointestinal tract, and is not absorbed, (it has virtually no oral bioavailability), which hinders or prevents its transfer from breastmilk to infant.
Plasma levels of EPO and hematocrit did not increase significantly in premature infants treated with oral epoetin (Pasha 2008, Juul 2003).

No problems have been observed in infants of mothers treated with epoetin (Makrydimas 1998).

The use of this mediation is authorized for preterm infants (Aher 2020, Ema 2007, Reiter 2000).

Experts authors and expert consensus, consider the use of this medication to be safe during breastfeeding (Hale (accessed 01.2021), Briggs 2015, Pistilli 2013).

Alternatives

We do not have alternatives for Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta) since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta) is also known as


Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta) in other languages or writings:

Group

Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta) belongs to this group or family:

Tradenames

Main tradenames from several countries containing Epoetin (Alfa, Beta, Beta pegylated, Lambda, Theta or Zeta) in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. ≈ 0. (sc: 10-42) %
Molecular weight 18.236 - 40.000 daltons
VD 0.06 - 0.1 l/Kg
Tmax sc: 6 - 28 hours
sc: 13 - 41; iv: 2.5 -13 hours

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. Aher SM, Ohlsson A. Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2020 Feb 11;2:CD004865. Abstract
  3. Janssen. Epoetina Alfa (Esprex). Ficha técnica. 2019 Full text (in our servers)
  4. Janssen. Epoetin Alfa (Eprex). Drug Summary. 2017 Full text (in our servers)
  5. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  6. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013 May;39(3):207-11. Abstract
  7. Pasha YZ, Ahmadpour-Kacho M, Hajiahmadi M, Hosseini MB. Enteral erythropoietin increases plasma erythropoietin level in preterm infants: a randomized controlled trial. Indian Pediatr. 2008 Jan;45(1):25-8. Abstract
  8. EMA. Epoetin Beta (NeoRecormon). Drug Summary. 2007 Full text (in our servers)
  9. Juul SE, Christensen RD. Absorption of enteral recombinant human erythropoietin by neonates. Ann Pharmacother. 2003 Jun;37(6):782-6. Abstract
  10. Juul SE. Enterally dosed recombinant human erythropoietin does not stimulate erythropoiesis in neonates. J Pediatr. 2003 Sep;143(3):321-6. Abstract
  11. Reiter PD, Rosenberg AA, Valuck RJ. Factors associated with successful epoetin alfa therapy in premature infants. Ann Pharmacother. 2000 Apr;34(4):433-9. Abstract
  12. Juul SE, Zhao Y, Dame JB, Du Y, Hutson AD, Christensen RD. Origin and fate of erythropoietin in human milk. Pediatr Res. 2000 Nov;48(5):660-7. Abstract
  13. Kling PJ, Sullivan TM, Roberts RA, Philipps AF, Koldovský O. Human milk as a potential enteral source of erythropoietin. Pediatr Res. 1998 Feb;43(2):216-21. Abstract
  14. Makrydimas G, Lolis D, Lialios G, Tsiara S, Georgiou I, Bourantas KL. Recombinant human erythropoietin treatment of postpartum anemia. Preliminary results. Eur J Obstet Gynecol Reprod Biol. 1998 Oct;81(1):27-31. Abstract

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