Treatment of anemia in chronic renal failure:
Nipotin should be administered intravenously or subcutaneously in patients with renal insufficiency or chronic renal failure. In patients maintained on hemodialysis, Nipotin should always be administered after completion of dialysis.

Adults:
For patients with CKD on dyalysis: The recommended starting dose of Nipotin (rch) is 50-100 IU/kg, three times per week administered over 1-5 minutes. For hemodialysis patient, intravenous route of administration is preferred.
For patients with CKD not on dialysis: The recommended starting dose of Nipotin (rch) is 50-100 IU/kg, three times per week, administered as I.V. or S.C. injection over 1-5 minutes.
Further dose increments should depend upon the initial response (proposed rate < 20 g/l per month). Because of the length of time required for erythropoiesis - several days for erythroid progenitors to mature and be released into the circulation - a clinically significant increase in haematocrit is usually not observed in less than 2 weeks and may require up to 6 weeks in some patients. If required, dose increments in steps of 25 IU/kg in intervals of four weeks are recommended. If the rate of haemoglobin (Hb) rise exceeds 20 g/l per month at 50 IU/kg, three times per week, downward dosage adjustments should be made in the amount administered in each dose and by omitting one of the weekly doses. Similar downward dose adjustments should be made if the Hb level exceeds 120 g/l. Maximum dose should generally not exceed 200 IU/kg 3 times per week. When a target haemoglobin concentration of 100-120 g/l has been achieved, maintenance dose should be individualized for each patient. In patients undergoing dialysis, the median maintenance dose is 75 IU/Kg, three times a week, with a range from 12.5 to 525 IU/kg three times a week as directed by the physician. In CRF patients not on dialysis, maintenance dose is 75 to 150 IU/kg per week.

Erythropoietin should not be used in patients with-
-Uncontrolled hypertension.
-Pure red cell aplasia that begins after treatment with Erythropoietin or other Erythropoietin protein drugs.
-Serious allergic reactions to Erythropoietin.
-Use of the multi-dose vials in neonates, infants, pregnant women, and nursing mothers.
 

Myocardial infarction, stroke, and thromboembolism: Using erythropoietin to target a hemoglobin level of greater than 1.1 g/l increases the risk of serious adverse cardiovascular reactions and has not been shown to provide additional benefit. Use caution in patients with coexistent cardiovascular disease and stroke.
Increased mortality and/or increased risk of tumor progression or recurrence in patients with cancer, hypertension: Control hypertension prior to initiating and during treatment with erythropoietin.
Seizures: erythropoietin increases the risk for seizures in patients with CKD. Increase monitoring of these patients for changes in seizure frequency or premonitory symptoms.
Pure red cell aplasia (PRCA): If severe anemia and low reticulocyte count develop during erythropoietin treatment, withhold erythropoietin and evaluate for pure red cell aplasia (PRCA).

The most common side effects during treatment with erythropoietin are myocardial infarction, stroke, and thromboembolism, increased mortality and/or increased risk of tumor progression or recurrence in patients with cancer, hypertension, seizures, serious allergic reactions etc.

There are no known clinically significant medicine interactions, but the effect of erythropoietin (rch) may be potentiated by the simultaneous therapeutic administration of a haematinic agent. Drugs that decrease erythropoiesis may decrease the response to erythropoietin (rch).

Pregnant woman: There are no controlled studies of erythropoietin in pregnant women. Therefore, erythropoietin should be used during pregnancy only if erythropoietin is clearly needed.

Nursing mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when erythropoietin is administered to a nursing woman.

Nipotin 2000 Injection: Each pack contains 1 pre-filled syringe of recombinant erythropoietin 2000 IU/0.2 ml in blister pack.
Nipotin 3000 Injection: Each pack contains 1 pre-filled syringe of recombinant erythropoietin 3000 IU/0.3 ml in blister pack.
Nipotin 4000 Injection: Each pack contains 1 pre-filled syringe of recombinant erythropoietin 4000 IU/0.4 ml in blister pack.
Nipotin 5000 Injection: Each pack contains 1 pre-filled syringe of recombinant erythropoietin 5000 IU/0.5 ml in blister pack.
Nipotin 10000 Injection: Each pack contains 1 pre-filled syringe of recombinant erythropoietin 10000 IU/1 ml in blister pack.