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Epoetin Alfa side effects: what 11,775 FDA adverse event reports show

Epoetin Alfa · Epogen · 1,094 reaction terms · 51,122 drug–reaction co-reports · data 2026-09-14
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Drug class

Erythropoiesis-stimulating agent (esa)

FDA label, Indications wording

Brand names

Epogen

openFDA label

Who reports

11,775 reports · 72% serious · 1,874 with death outcome · 49% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Epogen is an erythropoiesis-stimulating agent (ESA) indicated for: Treatment of anemia due to: - Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis ( 1.1 ). - Zidovudine in patients with Human Immunodeficiency Virus (HIV) infection ( 1.2 ).

FDA label, Indications and Usage

What it is

Epoetin alfa is a 165-amino acid erythropoiesis-stimulating glycoprotein manufactured by recombinant DNA technology. It has a molecular weight of approximately 30,400 daltons and is produced by mammalian cells into which the human erythropoietin gene has been introduced.

FDA label, Description section

Boxed warning

ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE Chronic Kidney Disease: In controlled trials, patients with ch.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled (related wording) 2Likely indication confounding 1Reporting / coding artifact 3Lab value / disease marker 5Not in label — unassessed 29
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,054 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Anti-erythropoietin antibody negative421,505.2
997.2–2,272.0ROR 1,510.6 · χ² 33,190 / p <1e-300
591.2 EB05 455.8 · IC025 +5.8
3/3 methods agree
Reporting / coding artifactserious n=42not reported in cached trials
Anti-erythropoietin antibody positive931,033.6
800.5–1,334.6ROR 1,041.8 · χ² 59,745 / p <1e-300
573.7 EB05 482.3 · IC025 +6.8
3/3 methods agree
Lab value / disease markerserious n=93 · 97% cliniciannot reported in cached trials
Non-neutralising antibodies positive151,013.1
536.7–1,912.2ROR 1,014.4 · χ² 8,986 / p <1e-300
353.0 EB05 227.0 · IC025 +4.0
3/3 methods agree
Lab value / disease markerserious n=15not reported in cached trials
Peau d'orange26691.8
439.6–1,088.7ROR 693.3 · χ² 12,375 / p <1e-300
363.5 EB05 260.7 · IC025 +4.9
3/3 methods agree
Not in label — unassessedserious n=25NCT02876835: 1/1,937 (0.1%) on Epoetin Alfa (serious AE)
Skin fibrosis102478.9
385.0–595.7ROR 483.1 · χ² 37,848 / p <1e-300
351.6 EB05 298.0 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious n=99not reported in cached trials
Nephrogenic systemic fibrosis530373.6
340.8–409.6ROR 391.2 · χ² 162,125 / p <1e-300
304.9 EB05 283.7 · IC025 +7.8
3/3 methods agree
Not in label — unassessedserious n=528not reported in cached trials
Device interaction39345.9
245.5–487.4ROR 347.0 · χ² 10,918 / p <1e-300
253.3 EB05 193.3 · IC025 +5.4
3/3 methods agree
Reporting / coding artifactserious n=39 · ♀ 0% (drug 49%)not reported in cached trials
Shunt stenosis31221.3
152.4–321.4ROR 221.9 · χ² 5,843 / p <1e-300
175.5 EB05 129.5 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=31 · 100% cliniciannot reported in cached trials
Congenital nail disorder13209.4
117.9–372.1ROR 209.7 · χ² 2,227 / p <1e-300
147.2 EB05 91.6 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=13not reported in cached trials
Skin induration204195.3
169.2–225.5ROR 198.8 · χ² 35,321 / p <1e-300
173.0 EB05 154.0 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious n=202not reported in cached trials
Extremity contracture61187.3
143.9–243.7ROR 188.2 · χ² 10,045 / p <1e-300
160.9 EB05 129.8 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=60not reported in cached trials
Joint contracture98178.9
145.4–220.0ROR 180.4 · χ² 15,573 / p <1e-300
157.5 EB05 133.0 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=98not reported in cached trials
Skin hypertrophy185125.9
108.6–146.0ROR 127.9 · χ² 21,279 / p <1e-300
116.2 EB05 102.8 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=183not reported in cached trials
Nephrogenic fibrosing dermopathy13122.1
69.6–214.1ROR 122.2 · χ² 1,349 / p 2e-295
98.2 EB05 61.0 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=11not reported in cached trials
Intensive care unit acquired weakness24119.4
79.0–180.5ROR 119.6 · χ² 2,529 / p <1e-300
102.9 EB05 72.8 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=24not reported in cached trials
Endometrial disorder24112.1
74.2–169.3ROR 112.3 · χ² 2,380 / p <1e-300
97.5 EB05 68.9 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=24NCT00093015: 1/2,004 (0.0%) on Epoetin Alfa (serious AE)
Microtia17100.2
61.5–163.3ROR 100.3 · χ² 1,487 / p <1e-300
86.0 EB05 56.8 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Reticulocyte count decreased2399.0
65.1–150.6ROR 99.2 · χ² 2,020 / p <1e-300
87.2 EB05 61.2 · IC025 +4.3
3/3 methods agree
Lab value / disease markerserious n=19 · 100% cliniciannot reported in cached trials
Arteriovenous fistula thrombosis1897.0
60.3–155.8ROR 97.1 · χ² 1,530 / p <1e-300
84.0 EB05 56.2 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=18NCT02876835: 9/1,933 (0.5%) on Epoetin Alfa (serious AE)
Arteriovenous fistula site complication3196.2
67.0–138.0ROR 96.4 · χ² 2,679 / p <1e-300
86.5 EB05 63.9 · IC025 +4.6
3/3 methods agree
Reporting / coding artifactserious n=31 · ♀ 77% (drug 49%) · 100% clinicianNCT00093015: 1/2,004 (0.0%) on Epoetin Alfa (serious AE)
Refractory cytopenia with unilineage dysplasia1093.4
49.5–176.4ROR 93.5 · χ² 782 / p 2e-172
76.3 EB05 44.3 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=10not reported in cached trials
Congestive hepatopathy2188.2
56.9–136.7ROR 88.4 · χ² 1,642 / p <1e-300
78.3 EB05 54.0 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=21not reported in cached trials
Fibrosis13682.4
69.4–97.7ROR 83.3 · χ² 10,364 / p <1e-300
77.9 EB05 67.5 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious n=135NCT00093015: 1/2,019 (0.0%) control (serious AE)
Congenital diaphragmatic hernia1675.3
45.7–124.2ROR 75.4 · χ² 1,055 / p 1e-231
66.8 EB05 43.6 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=16not reported in cached trials
Shunt occlusion2073.2
46.8–114.4ROR 73.3 · χ² 1,298 / p 1e-284
66.0 EB05 45.1 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=20 · 100% cliniciannot reported in cached trials
Enterococcus test positive2570.9
47.6–105.7ROR 71.1 · χ² 1,590 / p <1e-300
65.0 EB05 46.3 · IC025 +4.2
3/3 methods agree
Lab value / disease markerserious n=25not reported in cached trials
Hyperparathyroidism secondary9770.9
57.9–86.8ROR 71.5 · χ² 6,360 / p <1e-300
67.3 EB05 56.8 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=96NCT00093015: 1/2,004 (0.0%) on Epoetin Alfa (serious AE)
Chronic kidney disease-mineral and bone disorder3661.6
44.2–85.9ROR 61.8 · χ² 2,016 / p <1e-300
57.8 EB05 43.6 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=36not reported in cached trials
Pseudomonal bacteraemia2861.5
42.2–89.6ROR 61.6 · χ² 1,551 / p <1e-300
57.2 EB05 41.5 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=28not reported in cached trials
Skin tightness15460.4
51.5–70.9ROR 61.2 · χ² 8,648 / p <1e-300
58.1 EB05 50.8 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=152not reported in cached trials
Bone debridement1660.3
36.6–99.2ROR 60.4 · χ² 846 / p 3e-186
54.7 EB05 35.7 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=15not reported in cached trials
Serum ferritin abnormal1058.3
31.1–109.5ROR 58.4 · χ² 491 / p 4e-109
51.3 EB05 29.8 · IC025 +2.9
3/3 methods agree
Lab value / disease markerserious n=9not reported in cached trials
Nephrogenic anaemia14155.4
46.9–65.4ROR 56.0 · χ² 7,245 / p <1e-300
53.3 EB05 46.3 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=141NCT00093015: 2/2,004 (0.1%) on Epoetin Alfa; 1/2,019 (0.0%) control (serious AE)
Peritoneal dialysis2555.1
37.0–82.0ROR 55.2 · χ² 1,235 / p 7e-271
51.5 EB05 36.7 · IC025 +4.1
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=25NCT02876835: 2/1,933 (0.1%) on Epoetin Alfa (serious AE)
Marrow hyperplasia2053.3
34.2–83.1ROR 53.4 · χ² 946 / p 5e-208
49.5 EB05 33.8 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=20not reported in cached trials
Bone marrow depression2750.0
34.1–73.3ROR 50.1 · χ² 1,214 / p 3e-266
47.1 EB05 34.0 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=27 · 100% cliniciannot reported in cached trials
Wound debridement1147.7
26.2–86.8ROR 47.7 · χ² 445 / p 4e-99
43.2 EB05 25.8 · IC025 +2.9
3/3 methods agree
Not in label — unassessedserious n=11not reported in cached trials
Arteriovenous fistula1244.5
25.1–78.8ROR 44.5 · χ² 456 / p 2e-101
40.8 EB05 24.9 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=11NCT00093015: 2/2,004 (0.1%) on Epoetin Alfa; 1/2,019 (0.0%) control (serious AE)

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Epoetin Alfa as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (9 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Product storage error1,12423.4
22.1–24.8ROR 25.8 · χ² 23,886 / p <1e-300
23.1 EB05 22.0 · IC025 +4.4
3/3 methods agree
Reporting / coding artifactserious PRR 2.6not reported in cached trials
Anaemia (low red blood cells)7687.2
6.7–7.7ROR 7.6 · χ² 4,107 / p <1e-300
7.1 EB05 6.7 · IC025 +2.7
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 5.9NCT00093015: 65/2,004 (3.2%) on Epoetin Alfa; 155/2,019 (7.7%) control (serious AE)
Dyspnoea (shortness of breath)6322.0
1.8–2.1ROR 2.0 · χ² 319 / p 1e-71
2.0 EB05 1.9 · IC025 +0.9Not in label — unassessedserious PRR 2.0NCT00093015: 10/2,004 (0.5%) on Epoetin Alfa; 10/2,019 (0.5%) control (serious AE)
Haemoglobin decreased60410.5
9.7–11.4ROR 11.0 · χ² 5,181 / p <1e-300
10.4 EB05 9.7 · IC025 +3.2
3/3 methods agree
Labeled — boxed warning
synonym match
serious PRR 7.7NCT00093015: 1/2,004 (0.0%) on Epoetin Alfa (serious AE)
Nausea5991.4
1.3–1.5ROR 1.4 · χ² 57 / p 3e-14
1.4 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 1.7NCT00093015: 3/2,004 (0.1%) on Epoetin Alfa; 4/2,019 (0.2%) control (serious AE)
Pain5591.6
1.5–1.8ROR 1.6 · χ² 135 / p 1e-31
1.6 EB05 1.5 · IC025 +0.6Labeled adverse reaction
exact term
serious PRR 2.0NCT00093015: 14/2,004 (0.7%) on Epoetin Alfa; 16/2,019 (0.8%) control (serious AE)
Diarrhoea (diarrhea)5481.5
1.4–1.6ROR 1.5 · χ² 99 / p 1e-23
1.5 EB05 1.4 · IC025 +0.5Not in label — unassessedserious PRR 1.9NCT00093015: 11/2,004 (0.5%) on Epoetin Alfa; 7/2,019 (0.3%) control (serious AE)
Vomiting5342.0
1.9–2.2ROR 2.1 · χ² 284 / p 6e-64
2.0 EB05 1.9 · IC025 +0.9Labeled adverse reaction
exact term
serious PRR 2.1NCT00093015: 7/2,004 (0.3%) on Epoetin Alfa; 8/2,019 (0.4%) control (serious AE)
Nephrogenic systemic fibrosis530373.6
340.8–409.6ROR 391.2 · χ² 162,125 / p <1e-300
304.9 EB05 283.7 · IC025 +7.8
3/3 methods agree
Not in label — unassessedserious n=528not reported in cached trials
Death5241.1
1.0–1.2ROR 1.1 · χ² 3 / p 0.032
1.1 EB05 1.0 · IC025 -0.0
PRR-only: not supported by EBGM or IC
Outcome field, not a reaction
boxed warning mentions mortality
serious PRR 0.9NCT00093015: 1/2,019 (0.0%) control (serious AE)
Off label use (used outside approved label)5141.1
1.0–1.1ROR 1.1 · χ² 1 / p 0.114
1.1 EB05 1.0 · IC025 -0.1
PRR-only: not supported by EBGM or IC
Reporting / coding artifactserious PRR 1.0not reported in cached trials
Asthenia (weakness)4912.3
2.1–2.5ROR 2.4 · χ² 376 / p 4e-84
2.3 EB05 2.2 · IC025 +1.1
3/3 methods agree
Not in label — unassessedserious PRR 2.4NCT00093015: 9/2,004 (0.4%) on Epoetin Alfa; 9/2,019 (0.4%) control (serious AE)
Therapeutic response decreased45813.6
12.4–14.9ROR 14.1 · χ² 5,317 / p <1e-300
13.5 EB05 12.5 · IC025 +3.6
3/3 methods agree
Reporting / coding artifactserious PRR 18.1 · 90% cliniciannot reported in cached trials
Hypotension (low blood pressure)4574.1
3.7–4.5ROR 4.2 · χ² 1,063 / p 2e-233
4.0 EB05 3.7 · IC025 +1.9
3/3 methods agree
Not in label — unassessedserious PRR 3.6NCT00093015: 16/2,004 (0.8%) on Epoetin Alfa; 13/2,019 (0.6%) control (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Erythropoiesis-stimulating agents (darbepoetin alfa) ↔ Mortality / cardiovascular risk.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Epoetin Alfa?

In FDA FAERS, the most frequently co-reported reaction terms for Epoetin Alfa are anaemia, dyspnoea, haemoglobin decreased, nausea, pain, diarrhoea. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Epoetin Alfa have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE Chronic Kidney Disease: In controlled trials, patients with ch.

Do FAERS signals prove that Epoetin Alfa causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.