BIOHACKPHARMStack Analyzer

Epoetin (recombinant erythropoietin, EPO)

Epoetin alfa, Epoetin beta, Epoetin zeta, Epoetin theta, rHuEPO, Epogen, Procrit, Eprex

Forms: The same hormone from different makers: epoetin alfa (Epogen, Procrit, Eprex/Erypo), beta (NeoRecormon, Recormon), theta (Eporatio), zeta and biosimilars such as Binocrit, Retacrit and Silapo. Long-acting forms have their own cards.

EPO & blood boostersPrescription onlyWADA S2 · prohibitedEvidence: approved medicineExtreme risk

A lab-made copy of the kidney hormone that drives red-cell production. A medicine for anemia in kidney disease and during chemotherapy, and the classic endurance doping drug.

Legal status: Prescription medicine for anemia; not a controlled substance in the US, rules vary by country. Banned in sport at all times (WADA S2.1.1).

What it gives

What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.

Purpose

Medically: anemia from chronic kidney disease, cancer chemotherapy or HIV treatment, and fewer transfusions around some operations. In sport: more red cells and hemoglobin to carry more oxygen in cycling, running and skiing. There is no safe way to use it in a healthy person.

What people seek and what studies show

Used for endurance. In a small study of untrained men, VO2max rose about 12% and time to exhaustion about 54%. In a placebo-controlled trial in trained cyclists, hemoglobin and lab VO2max ended higher than with placebo (VO2max by about 5%), but a 45-minute effort test and a race up Mont Ventoux showed no difference.

Effects

Endurance

Evidence: Approved medicine — studied in people for its medical use

Possible side effects

With an extreme-risk substance some of these can be life-threatening or permanent; no dose, test or early sign makes it safe. Below — what each risk looks like; the signs that need urgent help are in block 04.

7 possible side effects

level · how often it is reported
High
Thick blood (hematocrit) / clot risk
Thicker blood raises the risk of clots, stroke and heart attack; a cyclist on EPO developed a clot in the brain's veins. No measure makes use in a healthy person safe.
How to notice: Often silent; sometimes headaches, flushed face, itch after a hot shower.
common
High
Heart strain / heart-muscle thickening
In kidney patients, aiming for higher hemoglobin led to more deaths, heart attacks, heart failure and strokes; no target or dose free of this risk has been found.
How to notice: Shortness of breath on effort, lower endurance, palpitations.
possible
Elevated
Higher blood pressure
About a quarter of dialysis patients needed new or more blood-pressure drugs; hypertensive encephalopathy and seizures have been reported, and severe hypertension after overdose.
How to notice: Often silent; sometimes headaches, flushing, nosebleeds — a home monitor shows it.
possible
Elevated
Black-market quality risk (fakes, contamination)
When it is obtained outside pharmacies, the identity, potency, storage and sterility of this protein drug cannot be checked.
How to notice: Unexpected effects, pain or infection, a stronger or weaker effect than expected.
possible
Moderate
Unknown long-term safety (little human data)
Harms in healthy athletes are poorly studied. Rarely, antibodies against EPO switch off the body's own red-cell production (pure red-cell aplasia).
How to notice: Nothing to notice — the risk is what is not yet known.
possible
Moderate
Abnormal tissue growth (theoretical cancer risk)
In patients with several cancers, ESAs shortened survival or sped tumor growth; whether this matters for healthy people is unknown.
How to notice: No direct signs — the point is not to fuel existing growths.
rare
Low
Injection pain, infection, oil cough
Pain, redness and irritation where it is injected; shared or non-sterile equipment carries a risk of infection.
How to notice: Soreness, lumps; a short coughing fit right after an injection.
possible

How to lower the risks

Extreme risk

Extreme risk. No measure makes using this substance for sport safe: severe, including life-threatening, consequences are possible. The only reliable way to avoid these risks is not to use it.

If a doctor prescribed this medicine to treat you, do not stop taking it on your own — discuss it with your doctor.

Warning signs that need urgent help are listed in block 04.

Check-ups and blood tests

For an extreme-risk substance there is no testing schedule.

No testing schedule makes this substance safe, so there is no plan of tests here. If it has already been taken, watch for the urgent warning signs on this page and see a doctor — tell them exactly what was taken.

Get medical help at once if

  • Swelling, pain or redness in one leg; sudden shortness of breath or chest pain; sudden one-sided weakness or numbness, trouble speaking or seeing — seek urgent care.
  • Chest pain or pressure, breathlessness on light effort, swollen ankles, fainting — seek urgent care.
  • Sudden severe headache, vision changes, numbness or weakness on one side, trouble speaking — call emergency services.
  • A new lump (including in the neck), trouble swallowing or persistent hoarseness, unexplained weight loss, or blood in stool or urine — see a doctor promptly.

In an emergency, call your local emergency number.

For women

Pregnancy data are limited; in rats, fetal harm occurred at doses close to clinical ones. Multi-dose vials contain benzyl alcohol and are contraindicated in pregnancy and breastfeeding.

Myth & fact

Myth

“EPO guarantees a big advantage in endurance races.”

Fact

In a placebo-controlled trial in trained cyclists, lab VO2max ended higher than with placebo, but race time up Mont Ventoux did not differ, while the risk of clots and stroke is real.

Combinations

No specific combination notes for this substance yet. The stack check still adds up side effects that several substances share.

Sources

FDA: Epogen/Procrit (epoetin alfa) prescribing information (opens in a new tab)Heuberger et al., Lancet Haematol 2017: EPO raised lab VO2max but not race performance in trained cyclists (opens in a new tab)Singh et al., N Engl J Med 2006: higher hemoglobin target with epoetin alfa increased death and cardiovascular events (CHOIR) (opens in a new tab)