Metabolic adjuvants to erythropoietin therapy

It is possible to potentiate the response to epoietin by co-administering other agents. In some instances, this response is seen when there is a deficiency of a certain substance. In other cases, administration of an adjuvant such as intravenous iron, vitamin D, L-carnitine, or androgens can enhance the response to epoietin when given as a surfeit. With most of these agents, with perhaps the exception of intravenous iron, further research is required to determine the exact role they may play in clinical practice. As long as the cost of epoietin therapy remains fairly high, the challenge will continue as to the best way of optimizing its effect, and we can look forward to new developments in this expanding area of research.