RECORMON

Indications

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Hypertension
• Heart Failure
• Cardiac Arrhythmias

Dosage

Children: Refer to the BNF for Children for appropriate dosing

Adults: Refer to the BNF for specific dosing guidelines based on the condition being treated and the formulation of the drug used.

Mechanism of action

Beta-adrenergic agonists stimulate beta-adrenergic receptors, leading to increased intracellular cAMP levels, which causes relaxation of bronchial smooth muscle and dilation of the airways. This mechanism is particularly important in the treatment of asthma and COPD, where airway constriction is a major issue. Beta-blockers, on the other hand, inhibit the effects of catecholamines on beta receptors, resulting in decreased heart rate and myocardial contractility, which is beneficial in managing hypertension and certain types of cardiac arrhythmias.

Pharmacodynamics

The pharmacodynamics of beta drugs vary depending on whether they are agonists or antagonists. Agonists lead to a dose-dependent bronchodilation and increased heart rate, while antagonists decrease heart rate and myocardial oxygen demand. The effects of these drugs can be influenced by patient-specific factors such as receptor sensitivity, presence of comorbid conditions, and concurrent medications.

Pharmacokinetics

The pharmacokinetics of beta drugs can differ substantially. Agonists are typically rapidly absorbed and distributed, with onset of action occurring within minutes. They may have short half-lives, necessitating multiple doses throughout the day. Beta-blockers, in contrast, may have longer half-lives and can be administered once or twice daily. Metabolism usually occurs in the liver, and renal excretion is common for both classes, affecting their dosing in patients with renal impairment.

Interactions

• betablockers, selective + aminophylline: Severe (increases risk of bronchospasm)
• dacomitinib + betablockers, selective: Severe (increases exposure)
• mexiletine + betablockers, selective: Severe (increases risk of cardiovascular adverse effects)
• betablockers, selective + theophylline: Severe (increases risk of bronchospasm)
• beta 2 agonists + linezolid: Severe (increases risk of elevated blood pressure)
• mao-b inhibitors + beta: Severe (increases risk of severe hypertension)
• verapamil + betablockers, non-selective: Severe (increases risk of cardiovascular adverse effects)
• cobicistat + beta: Severe (increases exposure)
• dacomitinib + betablockers, non-selective: Severe (increases exposure)
• idelalisib + beta: Severe (increases exposure)

Indications

• Anemia associated with chronic kidney disease
• Anemia in patients receiving chemotherapy for cancer
• Anemia in patients with HIV receiving zidovudine
• Anemia due to myelodysplastic syndromes
• Anemia in patients undergoing elective surgery

Dosage

Children: Refer to the BNF for Children

Adults: Refer to the BNF for specific dosing recommendations based on the condition being treated and patient characteristics.

Mechanism of action

Epoietin acts by binding to the erythropoietin receptor on the surface of erythroid progenitor cells in the bone marrow. This binding activates a series of intracellular signaling pathways, including the JAK2/STAT5 pathway, which promotes the survival, proliferation, and differentiation of these progenitor cells into mature red blood cells. Additionally, epoietin stimulates the release of reticulocytes from the bone marrow into the bloodstream, enhancing overall erythropoiesis.

Pharmacodynamics

The pharmacodynamic effects of epoietin include increased hemoglobin levels and improved oxygen-carrying capacity of the blood. The onset of action is typically observed within 1 to 2 weeks after initiation of therapy, with maximum effects seen after 2 to 6 weeks, depending on the dose and the underlying condition being treated. Epoietin can also influence iron metabolism, as adequate iron stores are necessary for effective erythropoiesis.

Pharmacokinetics

Epoietin has a half-life of approximately 4 to 13 hours, depending on the route of administration and the formulation used. It is predominantly eliminated by renal excretion. Following subcutaneous administration, peak plasma concentrations are reached within 12 to 24 hours. The pharmacokinetics may vary in patients with renal impairment, necessitating dose adjustments to avoid potential toxicity.

Contra-indications

• Uncontrolled hypertension
• Pure red cell aplasia
• Hypersensitivity to epoietin or any component of the formulation

Adverse effects

• Hypertension
• Headache
• Nausea
• Fatigue
• Injection site reactions
• Thromboembolic events
• Seizures

Interactions

• Antihypertensive agents may require adjustment due to the potential for increased blood pressure
• Other agents affecting erythropoiesis should be used with caution

Precautions

• Monitor hemoglobin levels closely to avoid excessive increases
• Use with caution in patients with a history of cardiovascular disease
• Ensure adequate iron levels prior to initiation and during treatment

Pregnancy

Epoietin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Safety in pregnancy has not been established.

Breast-feeding

It is not known whether epoietin is excreted in human milk. Caution should be exercised when administering to a nursing mother.

Storage

Store in the refrigerator at 2-8°C. Do not freeze. Protect from light.

Formulations

• Epoietin alfa injection
• Epoietin beta injection