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Revision as of 12:17, 15 February 2012 editBeetstra (talk | contribs)Edit filter managers, Administrators172,031 edits Saving copy of the {{drugbox}} taken from revid 476545288 of page Epoetin_alfa for the Chem/Drugbox validation project (updated: 'UNII', 'ChEMBL').		Latest revision as of 01:12, 1 September 2024 edit GreenC bot (talk | contribs)Bots2,545,858 edits Move 1 url. Wayback Medic 2.5 per WP:URLREQ#cbsnews.com/numeric
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			{{Short description|Pharmaceutical drug}}
	{{ambox | text = This page contains a copy of the infobox ({{tl|drugbox}}) taken from revid of page ] with values updated to verified values.}}
			{{Use dmy dates|date=July 2024}}
	{{Drugbox
			{{cs1 config |name-list-style=vanc |display-authors=6}}
			{{Infobox drug
	| Verifiedfields = changed		| Verifiedfields = changed
	| verifiedrevid = 461094242		| verifiedrevid = 476993050
			| image =
	| IUPAC_name =
			| width =
			| alt =
			| caption =
	<!--Clinical data-->		<!-- Clinical data -->
			| pronounce = {{IPAc-en|ɛ|ˈ|p|oʊ|.|ᵻ|t|ᵻ|n}}
	| tradename =
			| tradename = Epogen
	| Drugs.com = {{drugs.com|monograph|epoetin_alfa}}		| Drugs.com = {{drugs.com|monograph|epoetin_alfa}}
	| MedlinePlus = a692034		| MedlinePlus = a692034
			| DailyMedID = Epoetin alfa
	| pregnancy_category = Unknown
			| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
			| pregnancy_AU_comment =
			| pregnancy_category =
			| routes_of_administration = ], ]
			| class =
			| ATC_prefix = B03 <!-- Scheduled to be B03XA09 in 2025 -->
			| ATC_suffix = XA01
			| ATC_supplemental =
			| biosimilars = epoetin alfa-epbx, Abseamed,<ref name="Abseamed EPAR" /><ref>{{cite web | title=Abseamed | website=Union Register of medicinal products | url=https://ec.europa.eu/health/documents/community-register/html/h412.htm | access-date=14 January 2021}}</ref> Binocrit,<ref name="Binocrit EPAR" /> Epoetin Alfa Hexal,<ref name="Epoetin Alfa Hexal EPAR" /> Retacrit<ref name="Retacrit FDA label">{{cite web | title=Retacrit- epoetin alfa-epbx injection, solution | website=DailyMed | date=29 January 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3af26b0d-8ad0-44e1-a538-8bdb5ab39374 }}</ref><ref>{{cite web | title=Retacrit- epoetin alfa-epbx injection, solution | website=DailyMed | date=26 June 2024 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e6e4dd0c-25ca-40b2-ba6b-6138a68621fe | access-date=25 July 2024}}</ref>
			<!-- Legal status -->
			| legal_AU = S4
			| legal_AU_comment =
			| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F -->
			| legal_BR_comment =
			| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->
			| legal_CA_comment =
			| legal_DE = <!-- Anlage I, II, III or Unscheduled -->
			| legal_DE_comment =
			| legal_NZ = <!-- Class A, B, C -->
			| legal_NZ_comment =
			| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->
			| legal_UK_comment =
	| legal_US = Rx-only		| legal_US = Rx-only
			| legal_US_comment = <ref name="Epogen FDA label">{{cite web | title=Epogen- epoetin alfa solution | website=DailyMed | date=25 July 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1f2d0b28-9cc5-4523-80b8-637fdaf3f7a5 }}</ref>
	| legal_status =
			| legal_EU = Rx-only
	| routes_of_administration = IV or subcutaneous
			| legal_EU_comment =
			| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
			| legal_UN_comment =
			| legal_status = <!-- For countries not listed above -->
	<!--Pharmacokinetic data-->		<!-- Pharmacokinetic data -->
	| bioavailability =		| bioavailability =
	| protein_bound =		| protein_bound =
	| metabolism =		| metabolism =
			| metabolites =
	| elimination_half-life =
			| onset =
			| elimination_half-life =
			| duration_of_action =
			| excretion =
	<!--Identifiers-->		<!-- Identifiers -->
			| CAS_number_Ref = {{cascite|changed|CAS}}
	| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
			| CAS_number = 11096-26-7
	| ChemSpiderID = NA
			| PubChem =
	| CAS_number_Ref = {{cascite|correct|??}}
			| IUPHAR_ligand =
	| CAS_number = 113427-24-0
	| ATC_prefix = B03
	| ATC_suffix = XA01
	| ATC_supplemental =
	| PubChem =
	| DrugBank_Ref = {{drugbankcite|correct|drugbank}}		| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
	| DrugBank = DB00016		| DrugBank = DB00016
			| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
			| ChemSpiderID = none
	| UNII_Ref = {{fdacite|changed|FDA}}		| UNII_Ref = {{fdacite|changed|FDA}}
	| UNII = <!-- blanked - oldvalue: 64FS3BFH5W -->		| UNII = 64FS3BFH5W
			| KEGG = D03231
			| ChEBI =
	| ChEMBL_Ref = {{ebicite|changed|EBI}}		| ChEMBL_Ref = {{ebicite|changed|EBI}}
	| ChEMBL = <!-- blanked - oldvalue: 1201565 -->		| ChEMBL = 1201565
	| C=815 | H=1317 | N=233 | O=241 | S=5		| NIAID_ChemDB =
			| PDB_ligand =
	| molecular_weight = 18396.1 g/mol
			| synonyms =
			<!-- Chemical and physical data -->
			| IUPAC_name =
			| C=815 | H=1317 | N=233 | O=241 | S=5
	}}		}}
			'''Epoetin alfa''', sold under the brand name '''Epogen''' among others, is a human ] produced in cell culture using ].<ref name="Epogen FDA label" /><ref name="isbn0-415-26368-9">{{cite book | vauthors = Walsh G, Spada S | title = Directory of approved biopharmaceutical products | publisher = CRC Press | location = Boca Raton | year = 2005 | pages = | isbn = 978-0-415-26368-9 | chapter = Epogen/Procrit | chapter-url = https://archive.org/details/directoryofappro00spad/page/39 }}</ref> Epoetin alfa is an erythropoiesis-stimulating agent.<ref name="Epogen FDA label" /> It stimulates ] (increasing ] levels) and is used to treat ], commonly associated with ] and cancer ]. Epoetin alfa is developed by ].<ref name="Epogen FDA label" />
			It is on the ].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> It was approved for medical use in the European Union in August 2007,
			== Medical uses ==
			Epoetin alfa is ] for the treatment of anemia due to chronic kidney disease; zidovudine in people with human immunodeficiency virus; HIV infection; the effects of concomitant myelosuppressive chemotherapy; reduction of allogeneic red blood cell transfusions.
			=== Anemia caused by kidney disease ===
			For people who require ] or have ], iron should be given with erythropoietin, depending on some laboratory parameters such as ] and ] saturation.<ref name="pmid8914038">{{cite journal | vauthors = Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE | title = A randomized controlled study of iron supplementation in patients treated with erythropoietin | journal = Kidney International | volume = 50 | issue = 5 | pages = 1694–9 | date = November 1996 | pmid = 8914038 | doi = 10.1038/ki.1996.487 | doi-access = free }}</ref>
			Erythropoietin is also used to treat anemia in people, and cats and dogs, with chronic kidney disease who are not on dialysis (those in Stage 3 or 4 disease and those living with a kidney transplant). There are two types of erythropoietin for people, and cats and dogs, with anemia due to chronic kidney disease (not on dialysis).<ref>{{cite web| publisher=Tanya's Feline CKD Website | title= Erythropoiesis Stimulating Agents (ESAs) for Severe Anaemia | vauthors = Fitzsimons H | date=14 November 2020| url=https://www.petplace.com/article/drug-library/drug-library/library/erythropoietin-epogen-procrit-for-dogs-and-cats| accessdate=17 September 2023}}</ref><ref>{{cite web| publisher=PetPlace| title=Erythropoietin (Epogen®, Procrit®) for Dogs and Cats| vauthors = Ruben D | date=6 August 2015| url=https://www.petplace.com/article/drug-library/drug-library/library/erythropoietin-epogen-procrit-for-dogs-and-cats| accessdate=17 September 2023}}</ref>
			=== Anemia in critically ill people ===
			Erythropoietin is used to treat people with anemia resulting from critical illness.
			In a ],<ref name="pmid17804841">{{cite journal | vauthors = Corwin HL, Gettinger A, Fabian TC, May A, Pearl RG, Heard S, An R, Bowers PJ, Burton P, Klausner MA, Corwin MJ | title = Efficacy and safety of epoetin alfa in critically ill patients | journal = The New England Journal of Medicine | volume = 357 | issue = 10 | pages = 965–76 | date = September 2007 | pmid = 17804841 | doi = 10.1056/NEJMoa071533 | doi-access = free }}</ref> erythropoietin was shown to not change the number of blood transfusions required by critically ill patients. A surprising finding in this study was a small mortality reduction in patients receiving erythropoietin. This result was ] after 29 days but not at 140 days. The mortality difference was most marked in patients admitted to the ] for trauma. The authors provide several hypotheses for potential etiologies of this reduced mortality, but, given the known increase in thrombosis and increased benefit in trauma patients as well as marginal nonsignificant benefit (adjusted hazard ratio of 0.9) in surgery patients, it could be speculated that some of the benefit might be secondary to the procoagulant effect of erythropoietin. Regardless, this study suggests further research may be necessary to see which critical care patients, if any, might benefit from administration of erythropoietin.
			== Adverse effects ==
			Epoetin alfa is generally well tolerated. Common side effects include high blood pressure, headache, disabling cluster migraine (resistant to remedies), joint pain, and clotting at the injection site. Rare cases of stinging at the injection site, skin rash, and ] (joint and muscle pain) have occurred within a few hours following administration. More serious side effects, including allergic reactions, seizures and thrombotic events (e.g., heart attacks, strokes, and pulmonary embolism) rarely occur. Chronic self-administration of the drug has been shown to cause increases in blood ] and ] to abnormally high levels, resulting in ] and abdominal pain.<ref>{{cite book | last=Baselt | first=Randall Clint | title=Disposition of Toxic Drugs and Chemicals in Man | publisher=Biomedical Publications | publication-place=Foster City, CA | date=2008 | isbn=978-0-9626523-7-0 | page= 547-549 }}</ref>
			Erythropoietin is associated with an increased risk of adverse cardiovascular complications in patients with kidney disease if it is used to target an increase of ] levels above 13.0 g/dl.<ref name="pmid17108342">{{cite journal | vauthors = Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A | title = Normalization of hemoglobin level in patients with chronic kidney disease and anemia | journal = The New England Journal of Medicine | volume = 355 | issue = 20 | pages = 2071–84 | date = November 2006 | pmid = 17108342 | doi = 10.1056/NEJMoa062276 | doi-access = free }}</ref>
			Early treatment (before an infant is 8 days old) with erythropoietin correlated with an increase in the risk of ] in premature and anemic infants, raising concern that the angiogenic actions of erythropoietin may exacerbate retinopathy.<ref name=":0" /><ref name=":1" /> Since anemia itself increases the risk of retinopathy, the correlation with erythropoietin treatment may be incidental.<ref name="pmid27346390">{{cite journal | vauthors = Chou HH, Chung MY, Zhou XG, Lin HC | title = Early Erythropoietin Administration does not Increase the Risk of Retinopathy in Preterm Infants | journal = Pediatrics and Neonatology | volume = 58 | issue = 1 | pages = 48–56 | date = February 2017 | pmid = 27346390 | doi = 10.1016/j.pedneo.2016.03.006 | doi-access = free }}</ref>
			=== Safety advisories in anemic cancer patients ===
			Amgen advised the ] (FDA) regarding the results of the ] 10 clinical trial. The DAHANCA 10 data monitoring committee found that three-year loco-regional cancer control in subjects treated with Aranesp was significantly worse than for those not receiving Aranesp (p=0.01).<ref>{{cite journal | vauthors = Wauters I, Pat K, Vansteenkiste J | title = Flexible dosing with Darbepoetin alfa for the treatment of chemotherapy-induced anemia | journal = Therapeutics and Clinical Risk Management | volume = 2 | issue = 2 | pages = 175–186 | date = June 2006 | doi = 10.2147/tcrm.2006.2.2.175 | doi-access = free | pmid = 18360591 | pmc = 1661657 }}</ref>
			In response to these advisories, the FDA released a Public Health Advisory<ref>{{cite web|url=https://www.fda.gov/cder/drug/advisory/RHE2007.htm |title=FDA Public Health Advisory: Erythropoiesis-Stimulating Agents (ESAs): Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp) |website=] |access-date=5 June 2007 |archive-url=https://web.archive.org/web/20070528103823/https://www.fda.gov/cder/drug/advisory/RHE2007.htm |archive-date=28 May 2007 |url-status=dead }}</ref>
			on 9 March 2007, and a clinical alert<ref>{{cite web|url=https://www.fda.gov/cder/drug/InfoSheets/HCP/RHE2007HCP.htm |title=Information for Healthcare Professionals: Erythropoiesis Stimulating Agents (ESA) |website=] |access-date=5 June 2007 |archive-url=https://web.archive.org/web/20070515034509/https://www.fda.gov/cder/drug/InfoSheets/HCP/RHE2007HCP.htm |archive-date=15 May 2007 |url-status=dead }}</ref> for doctors in February 2007, about the use of erythropoiesis-stimulating agents (ESAs) such as ] and ]. The advisory recommended caution in using these agents in cancer patients receiving chemotherapy or off chemotherapy, and indicated a lack of clinical evidence to support improvements in quality of life or transfusion requirements in these settings.
			Several publications and FDA communications have increased the level of concern related to adverse effects of ESA therapy in selected groups. In a revised black box warning, the FDA notes significant risks, advising that ESAs should be used only in patients with cancer when treating anemia specifically caused by chemotherapy, and not for other causes of anemia. Further, the warning states that ESAs should be discontinued once the patient's chemotherapy course has been completed.<ref name="urlMedWatch - 2007 Safety Information Alerts">{{cite web|url=https://www.fda.gov/medwatch/safety/2007/safety07.htm#ESA2 |title=Erythropoiesis Stimulating Agents: Aranesp (darbepoetin alfa), Epogen (epoetin alfa), and Procrit (epoetin alfa) |date=3 January 2008 |work=MedWatch - 2007 Safety Information Alerts |publisher=U.S. Food and Drug Administration |access-date=9 April 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090409003452/https://www.fda.gov/MedWatch/safety/2007/safety07.htm |archive-date=9 April 2009 }}</ref><ref name="urlwww.fda.gov_ Procrit">{{cite web|url=https://www.fda.gov/cder/foi/label/2007/103234s5158lbl.pdf |title=Procrit (Epoetin alfa) for injection |date=11 August 2007 |publisher=U.S. Food and Drug Administration |archive-url=https://web.archive.org/web/20090118031036/https://www.fda.gov/cder/foi/label/2007/103234s5158lbl.pdf |archive-date=18 January 2009 |access-date=9 April 2009 |url-status=dead }}</ref><ref name="urlwww.fda.gov_ Aranesp">{{cite web|url=https://www.fda.gov/cder/foi/label/2007/103951s5164lbl.pdf |title=Aranesp (darbepoetin alfa) for Injection |date=8 November 2007 |publisher=U.S. Food and Drug Administration |archive-url=https://web.archive.org/web/20090118031507/https://www.fda.gov/cder/foi/label/2007/103951s5164lbl.pdf |archive-date=18 January 2009 |access-date=9 April 2009 |url-status=dead }}</ref><ref name="urlInformation on Erythropoiesis Stimulating Agents (ESA) (marketed as Procrit, Epogen, and Aranesp)">{{cite web | url = https://www.fda.gov/cder/drug/infopage/RHE/default.htm | title = Information on Erythropoiesis Stimulating Agents (ESA) (marketed as Procrit, Epogen, and Aranesp) | date = 26 January 2009 | publisher = U.S. Food and Drug Administration | access-date = 9 April 2009}}</ref>
			== Interactions ==
			Drug interactions with erythropoietin include:
			* '''Major''': ]—risk of ]
			* '''Moderate''': ]—risk of high blood pressure may be greater in combination with EPO. EPO may lead to variability in blood levels of cyclosporine.
			* '''Minor''': ] and ] may interfere with hematopoiesis, possibly by decreasing the synthesis of endogenous erythropoietin and decreasing bone marrow production of red blood cells.<ref name=Cheungpasitporn2015>{{cite journal | vauthors = Cheungpasitporn W, Thongprayoon C, Chiasakul T, Korpaisarn S, Erickson SB | title = Renin-angiotensin system inhibitors linked to anemia: a systematic review and meta-analysis | journal = QJM | volume = 108 | issue = 11 | pages = 879–884 | date = November 2015 | pmid = 25697787 | doi = 10.1093/qjmed/hcv049 | doi-access = free }} {{open access}}</ref>
			==Society and culture==
			The publication of an editorial questioning the benefits of high-dose epoetin was canceled by the marketing branch of a journal after being accepted by the editorial branch highlighting concerns of conflict of interest in publishing.<ref>{{cite journal | vauthors = Hardell L, Walker MJ, Walhjalt B, Friedman LS, Richter ED | title = Secret ties to industry and conflicting interests in cancer research | journal = American Journal of Industrial Medicine | volume = 50 | issue = 3 | pages = 227–33 | date = March 2007 | pmid = 17086516 | doi = 10.1002/ajim.20357 | doi-access = free }}</ref>
			In 2011, author ] published a book, '']: The Man Who Blew the Whistle on One of the Deadliest Prescription Drugs Ever'',<ref>{{cite web | vauthors = Napoli M |title=Whistleblower's story: New book reviewed |date=5 October 2011 | work = Center for Medical Consumers |url=http://medicalconsumers.org/2011/10/05/whistleblowers-story-new-book-reviewed/ |access-date=12 February 2012 |archive-url=https://web.archive.org/web/20120105140525/http://medicalconsumers.org/2011/10/05/whistleblowers-story-new-book-reviewed/ |archive-date=5 January 2012 |url-status=dead }}</ref>
			alleging drug maker ] encouraged doctors to prescribe epoetin in high doses, particularly for cancer patients, because this would increase sales by hundreds of millions of dollars. Former sales representatives Mark Duxbury and Dean McClennan, claimed that the bulk of their business selling epoetin to hospitals and clinics was Medicare fraud, totaling {{US$|3}}{{nbsp}}billion.<ref name="cbs">{{cite news | vauthors = Edwards J | date=17 August 2009 | title=Drug Rep in $3B Procrit Case: "80% of My Sales Were Medicare Fraud"; Carried $400K in "Cash" | work=CBS news | url=https://www.cbsnews.com/news/drug-rep-in-3b-procrit-case-80-of-my-sales-were-medicare-fraud-carried-400k-in-cash/ | access-date=12 February 2012 }}</ref>
			=== Economics ===
			The average cost per patient in the US was {{US$|8,447}} in 2009.<ref name="pmid19828525">{{cite journal | vauthors = Engelberg AB, Kesselheim AS, Avorn J | title = Balancing innovation, access, and profits--market exclusivity for biologics | journal = The New England Journal of Medicine | volume = 361 | issue = 20 | pages = 1917–9 | date = November 2009 | pmid = 19828525 | doi = 10.1056/NEJMp0908496 }}</ref>
			Epoetin alfa has accounted for the single greatest drug expenditure paid by the US ] system; in 2010, the program paid {{US$|2 billion}} for the medication.<ref name="GAO">{{cite web |url=http://www.gao.gov/assets/660/655608.pdf |title=Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives.] Medicare. Information on Highest-Expenditure Part B Drugs. |work=United States Government Accountability Office (GAO) |date=28 June 2013|access-date=29 June 2015}}</ref><ref name="JAMA">{{citation |title=Capitol Health Call: High-Cost Drugs Account for Most of Medicare Part B Spending |journal=JAMA |volume=310 |issue=6 |pages=572 |date= 14 August 2013 |doi=10.1001/jama.2013.192555| vauthors = Mitka M }}</ref>
			===Biosimilars===
			{{see also|Biosimilars}}
			In August 2007, Binocrit, Epoetin Alfa Hexal, and Abseamed were approved for use in the European Union.<ref name="Binocrit EPAR">{{cite web | title=Binocrit EPAR | website=] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/binocrit | access-date=2 April 2020}}</ref><ref name="Epoetin Alfa Hexal EPAR">{{cite web | title=Epoetin Alfa Hexal EPAR | website=] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/epoetin-alfa-hexal | access-date=2 April 2020}}</ref><ref name="Abseamed EPAR">{{cite web | title=Abseamed EPAR | website=] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/abseamed | access-date=2 April 2020}}</ref>
			== Research ==
			=== Neurological diseases ===
			Erythropoietin has been hypothesized to be beneficial in treating certain neurological diseases such as schizophrenia and stroke.<ref>{{cite journal | vauthors = Ehrenreich H, Degner D, Meller J, Brines M, Béhé M, Hasselblatt M, Woldt H, Falkai P, Knerlich F, Jacob S, von Ahsen N, Maier W, Brück W, Rüther E, Cerami A, Becker W, Sirén AL | title = Erythropoietin: a candidate compound for neuroprotection in schizophrenia | journal = Molecular Psychiatry | volume = 9 | issue = 1 | pages = 42–54 | date = January 2004 | pmid = 14581931 | doi = 10.1038/sj.mp.4001442 | s2cid = 22595839 | doi-access = free }}</ref> Some research has suggested that erythropoietin improves the survival rate in children with ], which is caused by the malaria parasite's blockage of blood vessels in the brain.<ref name="pmid19008152">{{cite journal | vauthors = Casals-Pascual C, Idro R, Picot S, Roberts DJ, Newton CR | title = Can erythropoietin be used to prevent brain damage in cerebral malaria? | journal = Trends in Parasitology | volume = 25 | issue = 1 | pages = 30–6 | date = January 2009 | pmid = 19008152 | doi = 10.1016/j.pt.2008.10.002 }}</ref><ref name="pmid21044627">{{cite journal | vauthors = Core A, Hempel C, Kurtzhals JA, Penkowa M | title = Plasmodium berghei ANKA: erythropoietin activates neural stem cells in an experimental cerebral malaria model | journal = Experimental Parasitology | volume = 127 | issue = 2 | pages = 500–5 | date = February 2011 | pmid = 21044627 | doi = 10.1016/j.exppara.2010.09.010 }}</ref><ref>{{cite news | url = https://www.theguardian.com/science/2008/feb/17/medicalresearch.health1 | title = Kidney drug could save children from malaria brain damage | work = The Guardian | location=London | vauthors = McKie R | date=17 February 2008}}</ref> However, the possibility that erythropoietin may be neuroprotective is inconsistent with the poor transport of the chemical into the brain<ref>{{cite journal | vauthors = Banks WA, Jumbe NL, Farrell CL, Niehoff ML, Heatherington AC | title = Passage of erythropoietic agents across the blood-brain barrier: a comparison of human and murine erythropoietin and the analog darbepoetin alfa | journal = European Journal of Pharmacology | volume = 505 | issue = 1–3 | pages = 93–101 | date = November 2004 | pmid = 15556141 | doi = 10.1016/j.ejphar.2004.10.035 }}</ref> and the low levels of erythropoietin receptors expressed on neuronal cells.
			'''<big>Psychiatric diseases</big>'''
			Randomized clinical control trials have shown promising results of EPO in improving cognition which is often intractable with the current treatment of mood disorders and schizophrenia.These domains include speed of complex cognitive processing across attention,memory and executive function.<ref>{{cite journal | vauthors = Ott CV, Vinberg M, Kessing LV, Miskowiak KW | title = The effect of erythropoietin on cognition in affective disorders - Associations with baseline deficits and change in subjective cognitive complaints | journal = European Neuropsychopharmacology | volume = 26 | issue = 8 | pages = 1264–1273 | date = August 2016 | pmid = 27349944 | doi = 10.1016/j.euroneuro.2016.05.009 | s2cid = 2335208 }}</ref>
			=== Preterm infants ===
			Infants born early often require transfusions with red blood cells and have low levels of erythropoietin. Erythropoietin has been studied as a treatment option to reduce ] in preterm infants. Treating infants less than 8 days old with erythropoietin may slightly reduce the need for red blood cell transfusions, but increases the risk of ]. Due to the limited clinical benefit and increased risk of retinopathy, early or late erythropoietin treatment is not recommended for preterm infants.<ref name=":0">{{cite journal | vauthors = Ohlsson A, Aher SM | title = Early erythropoiesis-stimulating agents in preterm or low birth weight infants | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD004863 | date = February 2020 | pmid = 32048730 | pmc = 7014351 | doi = 10.1002/14651858.CD004863.pub6 }}</ref><ref name=":1">{{cite journal | vauthors = Aher SM, Ohlsson A | title = Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 2 | pages = CD004865 | date = February 2020 | pmid = 32048729 | pmc = 7014632 | doi = 10.1002/14651858.CD004865.pub4 }}</ref>
			== References ==
			{{reflist}}
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