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Pharmacology Anemia drugs

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"anemia"[MeSH Terms] AND "drug therapy"[Subheading]

Anemia drugs span several distinct pharmacological classes depending on the underlying cause. Here's the map of what this topic covers:

Topic Breakdown

  1. Iron preparations - oral (ferrous sulfate, ferrous gluconate, ferrous fumarate) and IV (iron sucrose, ferric carboxymaltose, ferumoxytol) for iron-deficiency anemia
  2. Vitamin B12 (cobalamin) - for pernicious anemia and B12-deficiency megaloblastic anemia
  3. Folic acid - for folate-deficiency megaloblastic anemia
  4. Erythropoiesis-stimulating agents (ESAs) - erythropoietin, darbepoetin alfa, epoetin alfa - mainly for anemia of chronic kidney disease and chemotherapy-induced anemia
  5. Anemia of chronic disease / inflammation agents - hepcidin-related therapy, hypoxia-inducible factor (HIF) stabilizers like roxadustat
  6. Drugs for hemolytic anemias - corticosteroids, rituximab (autoimmune hemolytic anemia), eculizumab (PNH)
  7. Drugs for aplastic anemia - immunosuppressants (cyclosporine, ATG), thrombopoietin receptor agonists (eltrombopag)
  8. Drugs for sickle cell anemia - hydroxyurea, L-glutamine, voxelotor, crizanlizumab

Brief Overview

Anemia treatment is guided entirely by mechanism. Nutritional deficiencies (iron, B12, folate) are corrected by replacing the missing substrate. Anemia driven by inadequate erythropoietin production (renal failure, chemotherapy) responds to ESAs, though these carry cardiovascular and thrombotic risk warnings and are titrated to avoid overcorrecting hemoglobin. Newer oral HIF-stabilizers (roxadustat, daprodustat) are an emerging alternative to injectable ESAs for renal anemia, with recent network meta-analyses comparing their efficacy and safety against darbepoetin. Hemolytic and aplastic anemias are managed with immune-modulating therapy rather than hematinics, and sickle cell disease has a growing set of disease-modifying agents beyond hydroxyurea.
A recent 2025 systematic review/network meta-analysis (PMID: 41249974) compared darbepoetin against other agents for CKD-related anemia - worth flagging if you want current comparative efficacy data on ESAs.
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