Mircera
Mircera is a medication that's used to treat anemia (low red blood cells) in people who have kidney problems. It's approved for people age 5 years and older who are on dialysis, though it can also be used for adults who aren't on dialysis. Mircera is an injection that can be given by your healthcare provider, but you can give the injection to yourself at home in some cases after you get trained on how to use it. The dose is given once every two weeks or once a month. This medication can cause high blood pressure as a side effect, so your provider will check that your blood pressure is under control before you start treatment with Mircera.
What is Mircera?
What is Mircera used for?
Anemia due to chronic kidney disease (CKD)
How Mircera works
Mircera is a type of erythropoiesis-stimulating agent (ESA) called an erythropoietin receptor activator. It attaches to the same receptor (signaling protein) that a hormone in the body called erythropoietin does. This tells the body to make more red blood cells.
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What are the side effects of Mircera?
Common Side Effects
- High blood pressure (13%)
- Diarrhea (11%)
- Cold and flu symptoms (11%)
- Upper respiratory infection (9%)
- Headache (9%)
- Muscle spasms (8%)
Other Side Effects
- Vomiting
- Constipation
- Cough
- Pain in arms or legs
- Back pain
- Urinary tract infection
Serious Side Effects
- Blood clot: redness, swelling, or pain in one leg; chest pain; vision problems; shortness of breath; sudden confusion; trouble speaking; trouble walking; fainting
- Serious allergic or skin reaction: trouble breathing, fast heartbeat, skin rash, blistering skin, swelling in the face or throat, fever
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Increase in blood pressure
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Seizures
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Diarrhea
- Runny or stuffy nose
- Sore throat
Pros and cons of Mircera
Pros
Long-lasting, so it only needs to be given once or twice a month
Can be given at home in certain situations
Comes in prefilled syringes for easier use
Can use for children age 5 and older
Cons
Not recommended for use in anemia caused by chemotherapy nor as a substitute for blood transfusions
Can't use if you have uncontrolled high blood pressure
Only works if you have enough iron in your blood
Hasn't been shown to improve quality of life, fatigue, or well-being
Pharmacist tips for Mircera
Make sure your provider's office and pharmacy have an updated list of your allergies. Mircera contains mannitol, which can cause an allergic reaction.
Mircera must be given into the vein if you or your child is under the age of 18. For adults, the medication can be given intravenously (IV, into the vein) or subcutaneously (under the skin of the stomach, arm, or thigh).
Make sure that you get your blood work done on time while you're taking Mircera. These blood tests check your hemoglobin and iron levels. This helps your provider track how well the medication is working for you and whether you need any changes to your treatment plan (i.e., supplemental iron therapy).
Check your blood pressure as directed and take any blood pressure medications as prescribed while you're taking Mircera. Mircera can raise your blood pressure, so it's important to make sure your blood pressure stays under control. Let your provider know if your blood pressure reading is unusually high.
Tips on how to use Mircera at home (if instructed and trained by your provider)
Make sure you understand how to properly use Mircera at home. Your provider or pharmacist should've carefully gone over the instructions with you. Review the instructions for the subcutaneous injection (under the skin) or intravenous injection (into the vein through a special access port). Ask your provider or pharmacist if you have any questions about how to inject Mircera.
Store Mircera in the refrigerator (not in the freezer). Keep Mircera in its original carton to protect it from light. If you don't have access to a refrigerator, you can keep medication at room temperature for up to 30 days; throw away the medication after this time.
Always inspect the medication before you prepare for your Mircera injection. Make sure the liquid inside the syringe isn't looking cloudy, leaking out, or containing any particles (solid chunks). If it has particles, is discolored, or is foamy, don't use it. Instead, contact your provider or pharmacy about getting a replacement syringe. Don't shake the syringes.
After injecting the medication, throw away the Mircera syringe in a sharps container or something made of heavy-duty plastic (like an empty milk carton or laundry detergent bottle). This helps lower the risk of needle-stick injuries. Don't throw away needles or syringes in your trash can. Visit the FDA's website to learn about throwing away your sharps container safely in your state.
Frequently asked questions about Mircera
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What are the risks and warnings for Mircera?
Mircera can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death, heart attack, stroke, and blood clots
Risk factors: History of heart problems or stroke | Uncontrolled high blood pressure | Cancer | Getting surgery | High target hemoglobin level | Inadequate hemoglobin response to Mircera
Studies found that ESAs like Mircera can raise the risk of death, blood clots, and serious conditions, such as heart attack, stroke and heart failure. The risk might be higher in people with a history of heart-related conditions and in those with a target hemoglobin level of greater than 11 g/dL. Keep in mind that we don't know what target hemoglobin level or ESA dose would put you at less of a risk. In general, your provider will make sure that you take the lowest dose of Mircera to help with your anemia. Make sure you have your blood drawn regularly so your provider can monitor your body's response to Mircera.
Not for use in people with anemia due to chemotherapy
Unlike other medications in the same drug class, Mircera isn't approved to treat anemia caused by cancer chemotherapy. Researchers had to stop clinical trials early when they found that more deaths occurred in people who took Mircera than in those who took another ESA.
High blood pressure
Mircera can raise your blood pressure. For this reason, the medication can't be used if you have high blood pressure that isn't under control. If needed, your provider will prescribe blood pressure medications to help manage your blood pressure before you start Mircera. And during treatment, it's important that you continue any blood pressure medications and dietary plans that are helping to keep your blood pressure under control. Your provider might pause your treatment with Mircera or lower your Mircera dose if your blood pressure becomes too high while you're taking the medication. They might also add more blood pressure-lowering medications if possible.
Seizures
In clinical studies, some people taking Mircera had seizures during treatment. To be safe, your provider will closely monitor you for any pre-seizure symptoms during the first few months of treatment. Contact your provider if you have any pre-seizure symptoms, such as a migraine, sensitivity to light or sound, or changes in mood or behavior. Get medical help if you do have a seizure.
Possible to have no response or to lose response to the medication
Risk factors: Low iron levels | Bleeding | Infection | Inflammation
Sometimes, Mircera doesn't work or stops working after a while. If your anemia doesn't seem to get better during treatment, your provider will look for potential factors that might be causing the anemia. One possible reason is low iron levels, so it's important to take iron supplements if prescribed or directed.
Severe allergic and skin reactions
In some rare cases, Mircera can cause a serious allergic reaction or a severe skin reaction. Stop using this medication and get medical help right away if you develop trouble breathing, swelling in the face or throat, blistering or peeling skin, or rash at any point during treatment.
Mircera dosage forms
Typical dosing for Mircera
For people who haven't had treatment with an ESA before
Adults who are on dialysis: The typical starting dose is 0.6 mcg/kg of body weight given as an injection under the skin or into the vein once every 2 weeks.
Adults who aren't on dialysis: The typical starting dose is 1.2 mcg/kg of body weight given as an injection under the skin once a month.
Children ages 5 to 17 years old who are on dialysis: The dose will depend on your child's previous ESA medication dose. Mircera is typically given as an injection into the vein once every 4 weeks.
For people who've had treatment with an ESA before
Adults only: Your Mircera dose will be based on the dose of your previous ESA therapy. Mircera is given as an injection either into a vein or under the skin, once every 2 weeks or once a month.
Your provider will adjust your Mircera dose based on your hemoglobin levels.
How much does Mircera cost?
Mircera contraindications
Uncontrolled high blood pressure
A rare form of anemia called pure red cell aplasia that develops after starting Mircera or other ESA
What are alternatives to Mircera?
Treatment of anemia due to chemotherapy, chronic kidney disease, and zidovudine use in HIV-infected patients
Reduction of allogeneic red blood cell transfusions in patients having elective, noncardiac, nonvascular surgery
Anemia due to chemotherapy
Anemia due to chronic kidney disease (dialysis and non-dialysis)
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References
Best studies we foundAlving, J., et al. (2013). Epileptic prodromes: Are they nonconvulsive status epilepticus? Seizure.
Billett, H. H. (1990). Chapter 151: Hemoglobin and hematocrit. Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd edition.
Mangla, A., et al. (2022). Pure red cell aplasia. StatPearls.
MedlinePlus. (2021). Iron tests.
MedlinePlus. (2022). Hemoglobin.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Anemia in chronic kidney disease.
National Kidney Foundation. (n.d.). Dialysis.
Nguyen, M., et al. (2023). Iron supplementation. StatPearls.
Sanchis-Gomar, F., et al. (2013). Erythropoietin receptor (EpoR) agonism is used to treat a wide range of disease. Molecular Medicine.
Tenny, S., et al. (2022). Mannitol. StatPearls.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
Vifor (International) Inc. (2023). Mircera- methoxy polyethylene glycol-epoetin beta injection, solution [package insert]. DailyMed.
Vifor (International) Inc. (2023). Using Mircera® at home: Instructions for subcutaneous injection.
You and Your Hormones. (2020). Erythropoietin.
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