Retacrit is a medication that stimulates your body to produce more red blood cells. It’s used to treat anemia in three main situations: chronic kidney disease, cancer treatment with chemotherapy, and HIV treatment with certain antiviral medications. It can also be given before scheduled surgery to reduce the chance you’ll need a blood transfusion. Approved by the FDA in May 2018, Retacrit was the first biosimilar version of older brand-name medications (Epogen and Procrit) to reach the U.S. market, offering the same active ingredient at a lower cost.
How Retacrit Works
Your kidneys naturally produce a hormone called erythropoietin, which tells your bone marrow to make red blood cells. When disease or treatment disrupts that process, your red blood cell count drops and you develop anemia, leaving you fatigued, short of breath, and sometimes dizzy. Retacrit is a lab-made version of erythropoietin. It mimics the natural hormone, signaling your bone marrow to ramp up red blood cell production.
For Retacrit to work properly, your body needs adequate iron stores. Before starting treatment, your iron levels are checked to confirm that a measure called transferrin saturation is at least 20%. If your iron is too low, you may need iron supplements or iron therapy alongside Retacrit, because without enough raw material, the medication can’t effectively boost red blood cell production.
Anemia From Chronic Kidney Disease
This is the most common reason Retacrit is prescribed. Damaged kidneys produce less erythropoietin, so red blood cell counts gradually fall. The resulting anemia can cause persistent fatigue, weakness, and difficulty concentrating. Retacrit replaces what the kidneys can no longer make on their own, and it’s used in people on dialysis as well as those who aren’t yet on dialysis but have significant kidney impairment.
During treatment, your blood counts are typically checked monthly so your care team can adjust the dose. The goal is to raise your hemoglobin enough to relieve symptoms and reduce the need for transfusions, but not too high. Pushing hemoglobin above 11 g/dL with this type of medication has been linked to a higher risk of heart attack, stroke, and other serious cardiovascular events in people with kidney disease.
Anemia From Chemotherapy
Certain chemotherapy drugs suppress the bone marrow, which can cause anemia alongside other blood count drops. Retacrit is used in this setting specifically to reduce the need for blood transfusions. It’s only appropriate when chemotherapy is the direct cause of the anemia and when the treatment plan is not intended to cure the cancer (the risks outweigh the benefits in curative-intent regimens).
This is an important distinction because studies have found that erythropoietin-stimulating agents can shorten survival or increase the risk of tumor progression in several cancer types, including breast, lung, head and neck, and cervical cancers. For that reason, Retacrit is used cautiously and for the shortest duration necessary in cancer patients.
Anemia in HIV Patients on Zidovudine
Zidovudine, an antiviral medication used to treat HIV, can suppress red blood cell production as a side effect. Retacrit is approved for people on zidovudine whose bodies aren’t compensating well on their own. Specifically, it’s used when the natural erythropoietin level in the blood is 500 mUnits/mL or lower. In clinical trials, patients meeting this threshold who received the medication needed significantly fewer blood transfusions and saw meaningful increases in their hemoglobin levels compared to those on placebo.
Reducing Transfusions Before Surgery
If you’re scheduled for a non-cardiac, non-vascular elective surgery and expect significant blood loss, Retacrit can be given in the weeks before the procedure. The idea is to build up your red blood cell reserve so you’re less likely to need donated blood during or after the operation. This use is particularly relevant for people who want to avoid transfusions for personal or medical reasons.
Retacrit is not used for heart bypass surgery. Clinical trials found that erythropoietin-stimulating agents increased the risk of death in patients undergoing coronary artery bypass grafting. In orthopedic procedures, there was also an elevated risk of deep vein thrombosis, so careful assessment of clot risk is part of the decision to use it before any surgery.
Important Safety Risks
Retacrit carries a boxed warning, the FDA’s most serious safety label. The core concern is cardiovascular: the medication can increase the risk of heart attack, stroke, blood clots, and death, particularly when hemoglobin is raised too quickly or too high. In people with kidney disease, targeting hemoglobin above 11 g/dL significantly increased these risks. In cancer patients, both cardiovascular events and tumor progression were more common.
Blood clots are a risk across all uses. These can occur in deep veins (deep vein thrombosis), in the lungs (pulmonary embolism), or in dialysis access sites. Your blood pressure may also rise during treatment, since more red blood cells thicken the blood slightly. Regular blood pressure monitoring is a standard part of therapy.
Common side effects are generally milder and include joint pain, nausea, fever, headache, and injection site reactions. In rare cases, the body develops antibodies against the medication, which can paradoxically worsen anemia by attacking the natural hormone as well.
Biosimilar Status and Cost
Retacrit is classified as a biosimilar to Epogen and Procrit, meaning it’s highly similar in structure, function, and clinical effect. It is not, however, designated as “interchangeable,” which is a separate FDA classification that would allow pharmacists to substitute it automatically without a new prescription. In practice, this distinction matters mainly at the pharmacy level. Your prescriber specifically writes for Retacrit rather than having a pharmacist swap it in for another brand.
As a biosimilar, Retacrit typically costs less than the original brand-name products. It remains the only FDA-approved biosimilar in this drug class in the U.S.
How Retacrit Is Stored and Given
Retacrit is given as an injection, either under the skin or into a vein. Many people on dialysis receive it intravenously during their dialysis sessions. Others, including those with cancer or HIV-related anemia, typically inject it under the skin at home.
If you’re handling it at home, the medication needs to be refrigerated and protected from light. It should never be frozen, and if it freezes accidentally, it must be discarded. The same goes for shaking: if the vial or syringe has been shaken, don’t use it. Single-use vials should be discarded after one injection. Multi-dose vials last up to three weeks after first use. Prefilled syringes can be kept at room temperature for up to seven days if refrigeration isn’t available, but any unused portion is thrown away after a single use.