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what might cause Procrit not to work?
Mar 31, 2004

Hey Dr Bob,

Drugs have a habit of not working for me. I'm anemic and will be starting Procrit soon. Does the needle hurt? Anyway, how often doen't it work and what the the most common reasons it fails? I don't mean to sound pessimistic, especially to you-this world's most optimistic angel. Anemic Fan-man

Response from Dr. Frascino

Hello Anemic Fan-Man,

You haven't even tried Procrit yet and you are wondering why it might not work? You and I need to have a talk about whether the espresso cup is half full or half empty!

Does the needle hurt? No, it's a tiny needle and the injection is self-administered just under the skin. This is very different from a not-so-pleasant intramuscular injection, like the one you got the last time you had syphilis or those uncomfortable testosterone butt injections. (Actually, I have no idea if you've ever had syphilis or testosterone shots. I'm just trying to give an example or two.)

How often does Procrit not work? That's a pessimistic question to which I'll give an optimistic response. The frequency of non-response to Procrit is extremely low when Procrit is appropriately used. The "appropriately used" phrase here is key. Anemic folks who fail to respond to Procrit usually have a type of anemia that should have been treated in other ways in the first place. For instance, anemia due to nutritional deficiencies iron, vitamin B12, or folate should be treated with specific nutritional supplements, not Procrit. Similarly, if someone is anemic because they have an overlooked ongoing blood loss (say from a "bleeding ulcer" or abnormally heavy menstrual flow, etc.), the appropriate treatment would be to stop the blood loss! Unrecognized disease states certain opportunistic infections, for instance can also have anemia as a key component. Appropriate therapy would be to treat the underlying cause.

Other potential causes for lack of response (or inadequate response) to Procrit include insufficient time for response, inadequate dose, and/or inadequate iron stores. Some folks have been lead to believe that Procrit would correct their anemia within the first or second dose. Unfortunately, that's a false assumption. Procrit stimulates the bone marrow to make additional new red blood cells, and this process takes time. The amount of time it actually takes for the hemoglobin to rise significantly varies from patient to patient, and is usually between two and six weeks. The optimal dose of Procrit also varies from patient to patient. The dose is adjusted, based on an individual's response to the treatment. Lack of sufficient iron can also limit or delay an optimal response, because iron is a key component of hemoglobin, which is a key component of red blood cells. If we push up the rate new red blood cells are being formed with Procrit, we need to make sure all the necessary individual components (particularly iron) are available for the increased production rate. Iron supplies can be evaluated and monitored with a simple blood test. I could also describe for you incredibly rare conditions, like aluminum intoxication and osteitis fibrosa cystica, as other causes of potential non-response, but that's way more information than anyone would ever want to know.

So, to be true to my "optimistic angel" persona, I can tell you that in my personal experience of prescribing this drug for over ten years, I have never seen Procrit not work when it was appropriately prescribed.

Hopefully now you'll agree with me that the espresso cup is indeed still half-full, and that you should be looking forward to beginning your Procrit therapy with high expectations for success!

Good luck!

Dr. Bob

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