epo choices

[cruelworld]

i know the basic differences of the 3 epos. ive got to try and get my doc to prescribe me some. he likes aranesque and ive heard here  that it has more side effects than procrit. i dont care about injection frequency but i want are the easiest side effects. what about neulasta?   anyone used all three or at least two for a side by side comparison?

[FlGuy]

neulastsa and procrit are used for different reasons. Neulasta is the peglated version of Neupogen it increase anc's (a type of white blood cell).

Procrit is used to enhance hemoglobin and encourage the development of red blood cells.  Ananesp, though different from procrit, seerves the same purpose.

Neulasta (used it) is nasty. I'd rather have more frequent shot of Neupogen (used it).  And, I think, Neupogen is more economical (my opinion) even though Neulasta last longer.  I've noticed only slight sx's from Neupogen.

I used Aranesp, not procrit.  No problems with it. But it's expensive.

[GrandOak]

I only used Procrit, but from others I've talked to who did use both there does not seem to be much difference in which brand name is used for anemia.

Now for neutropenia, I agree with FLGuy that the more frequent shots of quick boosts verses the less frequent but more drawn out shot is preferable as I would rather get the marrow aches out of the way sooner that over a longer period of time.

[Proactive]

Funny you should mention this, just came back from my monthly visit with my hepdoc's NP...My hgb is still dropping. After 46 completed weeks (shot tomorrow) hgb has gone from 17.8 to 11.2 this morning and I feel it ...Been dropping about 8/10ths a month the last few months.No need yet, but she did mention procrit might be needed down the road during the last 26 weeks,and to try and avoid major exertion( I said to her, like picking up the remote?[g])...She said I have to remember that the lower the hgb goes, the more the heart is screaming for oxygen and working harder...onward and forward...;^)Pro
PS: I told her I wasn't much interested in any dose lowering(riba), she chuckled and said neither is the doc

[Tallahassee]

I ditto FLGuy - Neupogen is easier to tolerate than Neulasta (plus I think it is easier to adjust the required dose).  I don't know anything about Procrit.

All the best!

[pigeonca]

I felt no sides from procrit, whereas the sides from anemia were intense.

Proactive, if you're 11.2 and still dropping, I would beg for procrit now, because it can take up to a month to be effective.

[dogsledder]

I have been on Procrit for 17 wks (once per week). My hgb was approaching 10 and my doc did not want to dose reduce (I was in a clinical trial). Hgb has been between 10 - 11.1, don't want to go over 12 (FDA Black Box Warning).  I'm surprised you hgb remained as high as it did for length of time in tx.  Only side effect I noticed, was occassional diaharrea two days after the shot. I am still very fatigued at times, but push it to feel worthy.

[cruelworld]

just saw doc a few minutes ago, was hoping to get EPO.  3 weeks ago my hemo was  9.8 and i felt really bad. went for another hemo a few days ago (afraid it was dropping further) and it came back 10.3 and i still feel bad. unfortunately my doc said this was a
"comfortable" level and would not prescribe EPO!  i do hate to take any more drugs than absolutely necessary but i hope this wave of hard sides diminishes  soon.
my doc says he wont prescribe until the hemo drops to near 8!  if these hemo levels continue to punish me i may have to find another doc. it seems like everyone around here gets EPO at hemo 10 or so. i guess the riba overdose is finally catching up
to me. proactive, be carefull the riba levels continue to build up in your system
over time, keep an eye on your hemo because it will catch you off guard.

[Proactive]

"riba levels continue to build up in your system over time" thank goodness I only have to take a total of 3892 riba and not 4000 (LOL!) I figured the 1600mg/day would catch up to me sooner or later...well, later appears to be now (G) My Doc uses "10" as the pivot point for epo, as well as my insurance prescript coverage...so we plug along.....;^(

[goldyn]

Please dont let it go to 8 ..when I was at 10 i felt like a fish out of water..I was lucky i only had to take it for 3 months....and iwas only taking 15,000 and it kept it at around 11 but it made my blood pressure go up......what week are you?

[cruelworld]

39 out of 72, still a long way to go. ill give myself another few weeks to see if i can adjust, if not im off to a new doctor. i dont know why my doc is so careful with epo
but he is. i think i can maintain 10 - 10.5 hemo and maybe live with it. so far its very bad though. i didnt expect it to be so bad so im hoping ill get used to it. also, i already have high blood pressure so that scares me too. oh well, never a dull moment for the warriors.

[wyntre9]

My HgB is about 11 now, a drop of 4+ points over the past 9 months since beginning TX.

I have a real SOB problem, too.  I'm wondering if being a wind player (like you) maybe we feel it a bit more?

Anyway, my solution to the breath and weakness issue is to do as little as possible.  Groping for the remote is a major workout for me.  *LOL*

Like you, I'm at week 39 with 33 more to go.

BTW, I've been on neupogen since the first month coz WBC and ANC dropped 75% in the first couple of weeks.

The levels haven't gone up past 50% but at least the neup seems to keep them from falling further.  if they get too low Docs may want to reduce your meds or even take you off altogether.

I agree, the sx are just getting worse, although i did have a couple of near normal day this week, the first in months.

wyntre

[goldyn]

I wasnt on blood pressure meds when it started really rising the nurses would say..oh hell prob put you on meds but he never did ..he was hopeful that it would go down after tx but it didnt so he quiclkly got me started on high blood pressure meds my last reading before meds was 176/105..since you are on blood pressure med..i think...you probably wont have such a rise.....

[cruelworld]

seems like you might have had fewer good days than any of us. what a deal eh?
i could always count on one or two good days a week. looks like those days may be gone and i can join your club. what an honor it is! "the bad and getting worse 72 death marchers anonymous"
as far as the collapsed lung syndrome, its not as bad as it used to be for me.
all things being equal it seems the white blood cell fight is harder than the red  but
luckily i havent had either until now. im getting used to having to fight my doc for everything that others get naturally! (epo, high riba). glad to see your hangin tough even if some times its only by a thread.

[sfbaygirl]

I used aranesp and it worked really well for me. As Flguy explained it is peg form of procrit and you only get it evey other week. For me after a few months I didn't need it at all!!! I didn't have to go throught the procrit weekly for the whole tx. I only had to go a few months before me HGB was back up, not to normal, enough for me  not to need ANY procrit or aranesp for the rest of tx. That was great. For some reason I think it works better, of course my opinion. I didn't have any sides from it. Now Neulasta as Flguy and I will testify was BRUTAL.  Perhaps just me,  but the sx from it were really bad.  I liked the Aranesp though. Don't worry about it,  check it out.  

[jools57]

I do shot # 16 this friday, and my hgb is at 10.5...i work with kids in a before and after school program, most days, i feel ok, but then wham...feel like i'm tipping sideways...my dr. won't prescribe procrit til i'm under 10...so i plug on....never thought i could feel so weak and spacey...hang in there...I hope you're feeling good today(or at least tolerable!)

[jmjm530]

I'd go with whatever epo your doctor has more experience using. The advantage of Ananesp is that it's once every other week. But I also see that as a disadvantage in that it might be easier to 'tweak' Procrit, since it only lasts a week. I often did "X" amount of Procrit one week and "Y" the next, or sometimes injected every five days instead of seven, or conversly every nine days. Don't have any experience with Ananesp but would think it would be harder to tweak like that. In short, I'd go for Procrit.

-- Jim

[FlGuy]

I agree with Jim that regulating and tweaking might be easier with procrit.  The effects of the 'lag' that might be experienced sort of depends on the hgb target level. For many, it seems that the target is in the vcinity of about 10 and that lots of people feel the effects of anemia at that neighborhood  which can result (from what I read here over the years) the real anemia struggles.  Luckily, the target my doc had was between 11 and 12, fairly aggressive.  Using Aranesp on a regular cycle through tx it was managed fairly tightly in the range.  With the higher target range, even with a dip below target, the low would be in the high 10's, keeping me away from the tough throes of anemia and giving me a little wiggle room.  The target range was also in consideration of insurance coverage which was another consideration for the doc to consider in the timing/dose consideration.

A few months back there were articles and discussion around dangers of 'epo' products at higher levels and a black box warning.  My doc was not too concened about it.  Although I never tested at 12 during tx, he realized that even if I did the effect of the riba over the course of a few days or a week wold drepress it back down to the middle of the target area.