Intravenous versus subcutaneous dosing of epoetin: a review of the literature.

Recombinant human erythropoietin (epoetin) is approved to be administered by the intravenous (i.v.) or subcutaneous (SC) route. Several studies have been conducted and published that compare the relative pharmacokinetics and efficacy of the IV and SC routes. An analysis of the methodology and results of these studies reveals that the data have been somewhat contradictory and highly variable. However, most investigations have concluded that the SC route is associated with a decreased dose requirement in the correction and/or maintenance phase. To justify a switch from the i.v. to the SC route, it is important to consider the practical implications, including patient and staff acceptance, as well as the financial aspects. Regardless of the route of administration, dose titration must be individualized based on the patient's response to epoetin therapy, red blood cell turnover rate, and iron status. More studies are needed to develop a standardized cost-effective method for epoetin dosing in patients on dialysis.