PROCRIT - FDA-Approved Routes of Administration & Minimizing Pain at the Site of Subcutaneous Injection

summary

• Since most hospitals and clinics have internal policies and procedures regarding the administration of intravenous (IV) medications, it is recommended that you consult the policies that exist within your institution.
• Additional studies evaluating methods to reduce pain after SC administration of EPO have been published.²

CLINICAL DATA

Minimizing Pain at the Site of Subcutaneous Injection

• Some patients receiving epoetin alfa subcutaneously have complained of discomfort at the site of injection. The following information is offered to attempt to minimize discomfort during subcutaneous (SC) administration:
  • As noted in the PREPARATION AND ADMINISTRATION section of the PROCRIT Prescribing Information: Preservative-free PROCRIT from single-dose vials may be admixed in a syringe with bacteriostatic 0.9% sodium chloride injection, USP with benzyl alcohol 0.9% (bacteriostatic saline) in a 1:1 ratio using aseptic technique at the time of administration. Do not mix PROCRIT with bacteriostatic saline when administering to pregnant women, lactating women, neonates, and infants [see Use in Specific Populations].¹
  • Allow the PROCRIT vial to reach room temperature prior to injection. This may decrease some of the pain associated with injection.^3-6 Unopened PROCRIT formulations in single-dose and multidose vials showed no significant degradation or loss of activity when protected from light and exposed to elevated temperatures ≤86°F (30°C) for up to 72 hours.⁷
  • Use a 25-gauge, 5/8 inch size needle.^3,8,9
  • Ice may be applied to the site prior to injection.^3,9
  • Minimize the volume of the PROCRIT injection.¹⁰ The amount per each injection should not exceed 1 mL^8,9 or as recommended by your practitioner or institution guidelines. PROCRIT is available in 10,000 U/mL, 20,000 U/mL, and 40,000 U/mL vials that allow delivery of small volumes.
  • Rotate injection sites. Any sites used during the same week should be separated by at least 1 inch.⁸ As illustrated in the PROCRIT Prescribing Information under Instructions for Use, common SC injection sites include the abdomen (except for the 2 inch area around the navel), the front of the middle thighs, outer area of upper arms, and the upper outer area of the buttocks.¹ Sites with fewer sensory nerve endings, blood vessels and bones near the surface are preferred.⁸
  • Ensure that no liquid is on the needle or in the needle tip prior to injection. Pull all liquid fully into the syringe prior to injection.⁵
  • Administer slowly to minimize possible discomfort that may occur with rapid injection under high pressure.⁸
  • Alcohol swabs may be used prior to injection. However, alcohol should be allowed to dry prior to injection.⁸
  • Pinch a fold of skin and inject PROCRIT at an angle of 90° to the injection site.¹
  • EMLA^® cream (lidocaine 2.5% and prilocaine 2.5%) may be applied to the injection site 2 hours prior to administering PROCRIT. In a double-blind, placebo-controlled, paired-comparison study in 48 hemodialysis patients receiving epoetin alfa (EPO), use of EMLA cream significantly reduced pain at the site of injection (P=0.046).⁴
  • Although there is conflicting evidence to support its use, lidocaine 2% may be added to the syringe just prior to injection. One study admixed 0.2 mL of lidocaine for injection 2% with PROCRIT prior to injection in pediatric patients.¹¹ Results showed significantly decreased pain on injection compared with placebo. In contrast, another study admixed lidocaine 2% with EPO in 59 hemodialysis patients and showed that the combination may have reduced the therapeutic effect of EPO.¹²

Literature search

A literature search of MEDLINE^®, Embase^®, BIOSIS Previews^®, and Derwent Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 16 July 2025.