Renvista is a first-in-class, orally administered HIF-PH inhibitor that promotes erythropoiesis through increasing endogenous production of erythropoietin, as well as improving iron regulation and overcoming the EPO-suppressive effects of inflammation on hemoglobin synthesis and red blood cell production by downregulating hepcidin.
Children: Renvista is not indicated in children.
Liver dysfunction patients: Renvista is not recommended for use in patients with severe hepatic impairment.
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Roxadustat is an orally active hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) used for its anti-anemic effects. It works by inhibiting HIF-prolyl hydroxylase (HIF-PH), an enzyme that normally promotes the breakdown of hypoxia-inducible factor (HIF) proteins when oxygen levels are normal. By preventing HIF degradation, roxadustat increases HIF activity and activates genes involved in erythropoietin (EPO) production, red blood cell formation, and iron metabolism.
Increased HIF activity stimulates the body's natural production of erythropoietin, which promotes erythropoiesis and supports the formation of red blood cells. Roxadustat also decreases the production of hepcidin, a hormone that restricts iron availability. Reduced hepcidin levels improve the mobilization and utilization of stored iron, enhance intestinal iron absorption, and facilitate iron transport for hemoglobin synthesis.
By activating the HIF pathway, roxadustat increases the expression of genes involved in erythropoiesis, including those responsible for EPO, the EPO receptor, iron absorption, iron transport, and haem synthesis. In patients with CKD-associated anemia, roxadustat has been shown to increase hemoglobin levels while producing a temporary rise in endogenous EPO that generally remains within or close to the normal physiological range.
Roxadustat can help correct the abnormal iron metabolism commonly associated with chronic kidney disease. It may increase serum transferrin, intestinal iron absorption, and the release of iron from body stores, thereby improving iron availability for red blood cell production. Its effects on erythropoiesis have been observed in different groups of CKD patients, including those with inflammation, and may occur without requiring additional intravenous iron in some patients.
Roxadustat has also been associated with a reduction in cholesterol levels from baseline. This effect has been observed regardless of whether patients were taking statins or other lipid-lowering medicines.
The appropriate dose of roxadustat must be taken orally three times per week and not on consecutive days. The dose should be individualized to achieve and maintain target Hb levels of 10 to 12 g/dL as described below:
Patients not on erythropoiesis-stimulating agent treatment: For adults, the usual starting dose is 50 mg three times weekly. The recommended starting dose of roxadustat is 70 mg three times per week in patients weighing less than 100 kg and 100 mg three times per week in patients weighing 100 kg and over.
Patients switching from erythropoiesis-stimulating agents: For adults, the usual starting dose is 70 or 100mg three times weekly. The dosage thereafter should be adjusted according to the patient's condition.
Dose adjustment: When dose adjustments are required, increase or decrease the dose according to the "Dose increase/decrease table" and "stepwise Dose adjustment sequence" below. Once adjusted, maintain the dose level for ≥4 weeks. If the hemoglobin concentration increases rapidly (>2.0 g/dL) within 4 weeks of a dose increase, decrease the dose or suspend the treatment immediately.
The stepwise dose adjustments up or down should follow the sequence of the available doses: 20 mg-40 mg-50 mg-70 mg-100 mg-150 mg-200 mg-250 mg-300 mg-400 mg (only for CKD patients on dialysis).
Missed dose: When there is ≥ 24-hour interval until the next scheduled dosing time, take the missed dose immediately and follow the prescribed schedule for subsequent doses. If there is <24 hours until the next scheduled dosing time, skip the missed dose, and take the next dose as scheduled. Do not take 2 doses on the same day.
Method of administration: Roxadustat tablets are to be taken orally with or without food.
Renvista, in combination with other medications, may have drug-drug interactions.
Renvista with Phosphate binders and other products containing multivalent cations (EXCEPT) lanthanum carbonate:
Renvista with gemfbrozil (CYP2C8 and OATP1B1inhibitor) or probenecid (UGT and OAT1/OAT3 inhibitor)
Renvista with OATP1B1 or BCRP Substrates (simvastatin, rosuvastatin & atorvastatin)
Do not administer to women who may be pregnant or are pregnant. Roxadustat is contraindicated during breastfeeding.
Renvista tablets should be used with caution. It may initiate a few thrombotic vascular events (TVEs), particularly in patients with pre-existing risk factors for TVEs, including obesity and prior history of TVEs. Renvista should be used with caution in patients with a history of seizures. Renvista should not be administered if the patient has serious signs and symptoms of an infection. Renvista should not be administered if the patient has a liver disorder. Renvista should not be initiated in pregnant women.
Store in a cool (below 30°C), dry place, away from light and moisture. Keep out of the reach of children.
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