gastrointestinal upset, constipation, and black stools. Warn the patient about these
possible side effects.
b. Iron Dextran (InFed). This drug is also used to treat iron deficiency anemia.
Side effects associated with this agent include gastrointestinal upset, constipation, and
black stools. Extreme caution should be observed with this product because it is
administered parenterally and some patients have demonstrated an anaphylactic type
reaction to the drug. This product is used on an inpatient basic and is administered by
injection. Iron dextran should not be administered concurrently with oral iron
preparation because the side effects mentioned above will be potentiated.
c. Cyanocobalamin, Vitamin B12 (Rubesol-1000). Cyanocobalamin is used
in the treatment of pernicious anemia. Pernicious anemia is a condition characterized
by a progressive decrease in the number and an increase in the size of red blood cells.
Patients who have this condition are usually very weak and have various gastro-
intestinal disturbances. This condition results from a lack of Vitamin B12. This occurs
because of the lack of intrinsic factor, an element that is needed in the intestine in order
to effectively absorb Vitamin B12. Thus, cyanocobalamin is used to replace the Vitamin
B12 that was not absorbed. Cyanocobalamin should be protected from light. It is
available in injectable or tablet form.
d. Folic Acid (Folate). Folic acid is used in combination with other drugs to
treat pernicious anemia because it causes an increase in the number of red blood cells.
If the drug is administered alone to treat pernicious anemia, it will mask the symptoms
of that condition. This is potentially dangerous because if the symptoms are masked,
the condition might flourish and cause irreversible neurologic damage. Folic acid is
available in both tablet and injectable dosage forms.
e. Erythropoetin; EPO; Epoten alfa (Epogen, Procrit). Erythropoetin is a
protein naturally produced in the kidney that stimulates red blood cell production. It is
administered in a variety of chronic anemia states (cancer, renal failure, dialysis, and
HIV infection). It may also be used prophylactically to reduce the need for a blood
transfusion in patients scheduled for major surgery. The major side effect of
erythropoetin is hypertension, especially if the hematocrit rises above 36%.
Erythropoetin is administered subcutaneously 1-3 times weekly. Single dose vials
MUST be disposed of immediately after use. Multidose vials are discarded 21 days
after initial entry. Erythopoetin requires refrigeration.
Section V. STIMULATING FACTORS
Stimulating factors are naturally occurring substances which promote the
proliferation of blood components. Similar to the effects of erythropoetin, stimulating the