Erythropoietin (EPO) is a natural glycoprotein hormone, which regulates the quantity of red blood cells. In medical practice erythropoietin is used to treat chronic renal failure and anemia of different origin. EPO greatly increases production of red blood cells in bone marrow (erythropoiesis). The more red blood cells, the more oxygen is transferred from lungs to other tissues of the body, which leads to increase of stamina.
Nowadays manufacturers produce EPO by recombinant DNA technology (rHuEPO). There are different types of erythropoiesis-stimulating agents available on the market. Among them: epoetin-alfa, epoetin-beta, epoetin-omega, epoetin-delta and darbepoetin-alpha. Recombinant EPO does not differ from natural EPO in its function.
EPO in the Sport
Due to its unique properties to increase stamina, EPO is widely used in performance sports. Despite the rumors it is not a dangerous substance if you use it properly and monitor your blood values regularly. Before EPO there was a very popular practice of “blood doping” among endurance athletes.
The procedure was the following: a definite quantity of blood was removed and stored apart from the body. Before competition athletes injected the blood, thus boosting the amount of erythrocytes and increasing endurance. However blood is difficult to store and administer. Besides, it can cause the problem of extra cell volume. Administration of EPO is much easier, however the problem of cell volume still remains.
In general it increases the VO2 max by 9% and power by 7%, meanwhile decreases heart rate by 5%. Though the benefit of EPO is evident, there may be considerable side-effects. Higher concentration of erythrocytes causes thicker viscosity of blood, which can lead to thromboembolism and death. If a sportsman exceeds the dosage, thrombi may block the blood circulation in vessels.
Due to deaths of top cyclists during 80s – 90s, many athletic federations have banned “blood doping” and introduced the hemoglobin limit of 18.5 g/dL. Nevertheless EPO still remains one of the most popular nonsteroid doping among endurance athletes (runners, cyclists, triathletes, fighters, football players etc.)
Dosage and usage
The usual weekly dosage is 50-300 IU per kg of body weight. Thus a maximum dosage for an athlete weighing 176 lb (80 kg) is 4000 U per injection. You should make injection in several days/weeks before competition. Usually the results become evident after a couple of weeks (the increase of hematocrit by 3-4%). We do not recommend using EPO for more than 6 weeks.
For optimal results use the following scheme: initial phase 4500-12000 IU for week 1-3 (6000 IU in average); then supportive phase 3000-4000 IU for weeks 4-6. Divide the weekly dose into 3 equal injections.
There is also another scheme: 20-30 IU per kg for every injection (3 injections / week). The conservative scheme is 4500 IU / week (3 injections x 1500 IU) with supportive dosage 3000 IU (3 injection x 1000 IU). Do not exceed the recommended dosage. But if you want to exceed, you should make blood tests regularly.
It’s also useful to take aspirin in order to decrease blood viscosity (1 tab 2 times a day after a meal). If you take milk along with aspirin it can protect your stomach from damage.
Dilute the powder with sterile water. Injection should be done subcutaneously or intravenously. Insulin syringes are preferable. The two ways of administration provide different effects on blood level of the substance. In case of intravenous injection the drug reaches peak level very quickly, and its half life is about 4-5 hours. During subcutaneous injection it takes 12 – 18 h to reach the peak level, and its half life is about 24 hours. However the intravenous method results in higher concentration in the blood than subcutaneous one.
You should make subcutaneous injection in the outer upper arms, front of thighs, or abdomen. Don’t make it close to umbilicus. If you inject anticoagulant, chose the other site for EPO administration. In order to avoid burn of EPO injection, you should warm the syringe between your hands for 2 minutes to let it get the room temperature. In this case it will be painless.
You should be very careful while stacking it with anabolic steroids. It can be extremely dangerous especially with erythropoiesis – stimulating compounds (e.g. Anadrol). Some athletes take EPO along with Winstrol during pre-contest cycle. However, we don’t have information on synergetic effect of this combination, as well as on side-effects. In case of high dosages concomitant intake of anticoagulants (e.g. Lovenox) can reduce the risks of deep vein thrombosis. At regular dosages aspirin can do the job.
Usually supplementation of iron accompanies EPO injections. However iron overdose can lead to symptoms similar to hemochromatosis. Folic acid and vitamins are also helpful during the course.
Here is an example of weekly dosage for EPO combination:
- 100 IU/kg of rhEPO
- 25 mg of iron
- 25 mg of folic acid
- 2500 mcg of vitamin B12
Duration of the course should be 10-20 days, 2-3 injections a week.
Until recently it was difficult to detect recombinant EPO as it is almost identical to natural erythropoietin. The only way to ban an athlete was to check hematocrit level (above 50%). Unfortunately nowadays there are a lot of accurate blood and urine tests that can distinguish between synthetic and natural EPO. Therefore athletes should make a gap between EPO usage and doping test, which decreases chances to detect it.
Pay attention that there are short-acting and long-acting versions of EPO. As to the doping test, it’s better to take smaller doses of short-acting EPO regularly than one big injection. In case of smaller doses you can be “positive” during 12 hours from last injection. Besides, smaller doses are more natural from the point of view of physiology, than super high doses. Thus it’s better to take 2000 IU three times a week than 6000 IU once a week.
Usually detection time may last from 12 to 48 hours. But in case of high dosages it may be longer. rhEPO can make positive reaction in blood tests during 2 days from last injection, while in urine test – 1 day from last injection. The sensitivity of urine/blood tests falls by 50% after 3 days from EPO administration. But don’t forget that they can catch you in a test for high erythropoiesis during 2-6 weeks before competitions.
The major risk and side-effect of EPO is in high viscosity of blood. It can be dangerous and even fatal. The increased amount of red blood cells can clog capillaries and cause stroke (if it happens in brain) or heart attack (if it happens in heart). During prolonged exercises you may lose a lot of liquids and automatically increase blood viscosity. So, drink enough water and don’t forget to take aspirin.
Besides, your organism may also develop antibodies against EPO, which can lead to anemia. So, don’t use it for more than 6 weeks and don’t use it often. Take it only 1-2 times prior to the most important contest.
The other side-effects include: headaches, high blood pressure, flu-like symptoms, aching bones, chills. In case of evident side-effects discontinue the usage of EPO.