Procrit is a prescription injection used to treat anemia, a condition where your body doesn’t have enough red blood cells. Its active ingredient, epoetin alfa, is a lab-made version of a hormone your kidneys naturally produce to signal your bone marrow to make more red blood cells. The FDA first approved Procrit in 1989, and it now carries approval for four distinct medical uses.
How Procrit Works
Your kidneys produce a hormone called erythropoietin that tells your bone marrow to ramp up red blood cell production. When disease or medication interferes with that process, your red blood cell count drops, leaving you fatigued, short of breath, and weak. Procrit is a synthetic copy of that hormone. Once injected, it binds to the same receptors on bone marrow cells and triggers the same chain of events: more red blood cells enter your bloodstream, your hemoglobin rises, and your tissues get more oxygen.
Procrit is given as an injection, either into a vein or just under the skin. The route, dose, and frequency depend entirely on why you’re taking it.
Anemia From Chronic Kidney Disease
This is the original and most common use for Procrit. Damaged kidneys produce less erythropoietin, so red blood cell production slows. Over time, many people with chronic kidney disease (CKD) develop moderate to severe anemia. Procrit replaces what the kidneys can no longer make in sufficient quantities.
For patients on hemodialysis, Procrit is typically given through the IV line already in place during treatment, usually three times per week. People with CKD who aren’t on dialysis can receive it as a subcutaneous (under the skin) injection on a similar schedule. The goal is to bring hemoglobin levels up to a functional range without pushing them too high. Current guidelines from KDIGO, the leading kidney disease organization, recommend keeping hemoglobin below 11.5 g/dL during treatment. Going higher than that doesn’t add benefit and increases serious risks, which are covered below.
Anemia From Chemotherapy
Certain chemotherapy drugs suppress bone marrow function, reducing your body’s ability to produce red blood cells. When anemia develops during treatment, Procrit can help raise red blood cell counts enough to reduce or avoid blood transfusions. The FDA expanded Procrit’s approval for this use in 1993.
There are important restrictions. Procrit is only appropriate when the chemotherapy regimen causing the anemia will continue for at least two more months. It is not approved for people whose cancer has a high chance of being cured, because of concerns that it may affect tumor outcomes. Once the chemotherapy course ends, Procrit is discontinued.
Anemia in HIV Patients on Zidovudine
Zidovudine, an older antiviral medication for HIV, can suppress red blood cell production as a side effect. Procrit is approved to treat anemia in these patients, but it only works when the body’s own erythropoietin levels are relatively low (500 mUnits/mL or below). If your natural erythropoietin is already above that threshold, Procrit is unlikely to help, because the problem isn’t a lack of the hormone but rather the bone marrow’s inability to respond to it.
Reducing Blood Transfusions Before Surgery
For people scheduled for major elective surgery (excluding heart and blood vessel procedures), Procrit can be given in the weeks leading up to the operation to boost red blood cell counts. The idea is to build up enough of a reserve that you’re less likely to need a transfusion during or after surgery. A common approach involves weekly injections starting three weeks before surgery, with a final dose on the day of the procedure. Studies in patients undergoing hip and knee replacement have shown reduced transfusion needs with this strategy.
Side Effects
The most frequently reported side effect is high blood pressure. In controlled studies of CKD patients, hypertension occurred in 24% of those receiving Procrit compared to 19% on placebo. Joint pain was also more common, affecting 11% of Procrit patients versus 6% on placebo. Some people experience mild stinging at the injection site or brief flu-like symptoms such as muscle aches shortly after a dose, though these tend to be short-lived.
Serious Safety Risks
Procrit carries an FDA black box warning, the most serious type of safety alert. The core concern is that pushing hemoglobin levels too high with Procrit increases the risk of heart attack, stroke, blood clots, and death.
The evidence behind this warning is substantial. In the Normal Hematocrit Study, CKD patients whose hemoglobin was targeted to 14 g/dL had a 35% mortality rate compared to 29% in those targeted to 10 g/dL. The CHOIR trial found that 18% of patients in the higher hemoglobin group experienced a major cardiovascular event (death, heart attack, stroke, or hospitalization for heart failure) compared to 14% in the lower target group. These findings are why current guidelines set a ceiling well below normal hemoglobin levels. The medication is meant to reduce symptoms and transfusion needs, not to normalize blood counts completely.
For cancer patients, the risks extend beyond cardiovascular events. Clinical studies have found that erythropoiesis-stimulating agents like Procrit shortened overall survival or increased tumor progression in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers. This is why oncologists use it selectively and only when the benefit of avoiding transfusions justifies the potential risk.
Blood clots are another concern across all patient groups. In CKD patients on hemodialysis, higher hemoglobin targets were associated with more clotting in the vascular access site used for dialysis. Clots in the legs and lungs (venous thromboembolism) have also been reported.
What Treatment Looks Like Day to Day
If you’re prescribed Procrit, expect regular blood tests to monitor your hemoglobin. Your dose will be adjusted up or down based on how your body responds, with the goal of staying within a safe hemoglobin range. For CKD patients on dialysis, injections often happen during dialysis sessions, so there’s no extra appointment. For other conditions, you may learn to give yourself subcutaneous injections at home, or receive them at a clinic.
Response isn’t immediate. It takes weeks for new red blood cells to mature and enter your bloodstream. Most people begin to notice improvements in energy and stamina after two to six weeks, though the timeline varies. If hemoglobin doesn’t rise adequately after an appropriate trial, your doctor may investigate other causes of anemia, such as iron deficiency, which is common and can blunt Procrit’s effectiveness. Many patients take iron supplements alongside Procrit to ensure the bone marrow has the raw materials it needs.