Mircera (Methoxy Polyethylene Glycol-Epoetin Beta): Uses, Side Effects

What Is Mircera?

Mircera (methoxy polyethylene glycol-epoetin beta) is a prescription injectable medication that creates more red blood cells when your blood counts are low. It’s approved for use in people in the late stages of kidney disease who may or may not also be on dialysis, which is a procedure that removes waste products from the blood when the kidneys are unable to.

Mircera helps to increase red blood cell levels by communicating with your body’s bone marrow. Your bone marrow contains special human cells called stem cells that can develop into many types of cells, including red blood cells. Mircera can decrease the need for other blood-replenishing techniques, such as blood transfusions, in situations that are not medical emergencies.

Mircera can be given as a subcutaneous (under the skin) or intravenous (into the vein) injection.

Drug Facts

Generic Name: Methoxy polyethylene glycol-epoetin beta

Brand Name(s): Mircera

Drug Availability: Prescription

Administration Route: Intravenously or subcutaneously 

Therapeutic Classification: Hematopoietic growth factors

Available Generically: No 

Controlled Substance: N/A

Active Ingredient: Methoxy polyethylene glycol-epoetin beta

Dosage Form(s): Solution for injection

What Is Mircera Used For?

The Food and Drug Administration (FDA) approved Mircera to treat anemia (low red blood cell counts) associated with chronic kidney disease in adults that may or may not be on dialysis. It is also indicated for children and adolescents 5 to 17 years old on hemodialysis to ensure healthy red blood cell levels.

Red blood cells are extremely important for your body’s health. They contain a protein called hemoglobin, which carries oxygen from the lungs to the rest of the body and then transports carbon dioxide back to the lungs to be breathed out. Without a healthy amount of blood cells, you may experience weakness, shortness of breath, and dizziness. There are even more severe complications that could occur if these levels continue to stay low. 

How to Use Mircera

As with all medications, Mircera must be used as directed by your healthcare provider. Mircera is an injectable medication that is injected either into the veins (intravenously) or fatty part of the skin (subcutaneous).

If you are injecting yourself subcutaneously, inject the medicine into the thigh, belly, or upper arm once every two to four weeks. Follow your healthcare provider’s instructions for how to give yourself the injection. It is important not to shake the solution, mix it with other liquids, use if the solution changes color, or use if it has been frozen. Wash your hands before and after use, and never use the same syringe more than once.


Store Mircera at room temperature (between 68 and 77 degrees F) or in the refrigerator (between 36 and 46 degrees F). Room temperature storage is only good for up to 30 days. After day 30, it will need to be thrown away.

Always keep your Mircera in the original container to protect it from light. In addition, it is extremely important to keep it in a safe place that is out of reach of children or pets.

Off-Label Uses

There are situations in which medications are used for reasons other than what is approved by the FDA. This is known as off-label use. Mircera does not have any reported off-label uses.

How Long Does Mircera Take to Work?

Mircera does not immediately increase your red blood cell count. It may take around four weeks to see any improvement. Your healthcare provider will monitor your counts and adjust your dose if needed.

What Are the Side Effects of Mircera?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Mircera include:

  • Diarrhea 
  • Common cold symptoms 
  • Increase in blood pressure (hypertension)

Other side effects may occur that are not mentioned here. Contact your healthcare provider for any further advice or concerns about side effects.

Severe Side Effects

A boxed warning added to Mircera’s labeling warns about the potentially life-threatening safety risks of the medication. The boxed warning states that Mircera can increase the risk of:

  • Myocardial infarction (heart attack)
  • Stroke (blood supply to the brain is blocked or a blood vessel in the brain bursts)
  • Venous thromboembolism (blood clot in a vein)
  • Thrombosis (blood clots blocking blood vessels)
  • Tumor growth and tumor recurrence in certain patients with cancer

Still, life-threatening side effects from Mircera are rare when the medication is used appropriately. However, some symptoms are severe and should not be taken lightly. Seek medical help right away if you experience:

  • Signs of severe skin hypersensitivity (Stevens-Johnson syndrome), characterized by rash, swelling, and shedding of the skin 
  • Symptoms of extremely high blood pressure, including major headache, extreme dizziness, and changes in eyesight
  • Symptoms of high potassium levels, such as a heartbeat that feels abnormal, confusion, weakness, light-headedness, dizziness, or shortness of breath 
  • Signs of urinary tract infection, such as blood in the urine, burning pain when passing urine, feeling the need to urinate often or urgently, and lower-stomach pain
  • Weakness on one side of the body  
  • Seizures
  • Difficulty walking
  • Change in balance
  • Signs of hemorrhaging, particularly in the gastrointestinal tract, which can cause black or tarry stool, abdominal cramps, bloody vomit or stool, dizziness, paleness, and shortness of breath

Call your healthcare provider immediately if you experience any of these serious side effects. Call 911 if your symptoms feel life-threatening or think you are having a medical emergency.

Long-Term Side Effects

Long-term or inappropriate use of this medication can cause or worsen high blood pressure or increase the risk of blood clots. Proper use and follow-up with your healthcare or dialysis provider are important to monitor any unwanted side effects and to ensure the medication is working correctly.

Report Side Effects

Mircera may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Mircera Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:

    • For patients with chronic kidney disease not on dialysis:

      • Adults—Dose is based on body weight and must be determined by your doctor. The starting dose is 0.6 microgram (mcg) per kilogram (kg) of body weight injected into a vein or under the skin once every 2 weeks. Your doctor may adjust the dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For patients with chronic kidney disease on dialysis:

      • Adults—Dose is based on body weight and must be determined by your doctor. The starting dose is 0.6 microgram (mcg) per kilogram (kg) of body weight injected into a vein or under the skin once every 2 weeks. Your doctor may adjust the dose as needed.
      • Children 5 to 17 years of age—Dose is based on your child’s hemoglobin level or whether he or she is receiving epoetin alfa or darbepoetin alfa and must be determined by your doctor. The dose may be 48 mcg (from epoetin) or 145.5 mcg (from darbepoetin) given through a needle placed into your child’s vein once every 4 weeks.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.


Due to the possible effects of this medication, there may be changes to how it is used in certain groups of people:

  • Adults 65 and older: As you age, your body may respond to medications differently. To ensure the safe use of Mircera, your healthcare provider may recommend lower doses initially. 
  • Children: It is recommended that injections for those 5 to 17 years old are placed into the vein only. 
  • People with high blood pressure: Since Mircera can cause high blood pressure, lower doses or withholding of this medication completely may be recommended.

Missed Dose

It is important to take this medication as directed by your healthcare provider. If you miss a dose of Mircera, contact your healthcare provider for appropriate guidance on what to do.

Overdose: What Happens If I Take Too Much Mircera?

An overdose of Mircera can increase hemoglobin levels above what the body needs. There have been reports of cases of severe high blood pressure following an overdose of similar medications.

What Happens If I Overdose on Mircera?

If you think you or someone else may have overdosed on Mircera, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn’t breathing after taking Mircera, call 911 immediately.


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It is very important that your doctor check your or your child’s progress regularly while you or your child are using this medicine. Blood tests are needed to check for unwanted effects. You may also need to monitor your blood pressure at home. If you notice any changes to your normal blood pressure, call your doctor right away.

This medicine may increase your risk of having heart attack, stroke, congestive heart failure, and blood clotting problems. Check with your doctor right away if you start having dizziness, fainting spells, severe tiredness, chest pain, trouble breathing, sudden or severe headache, or problems with vision, speech, or walking.

This medicine may increase the risk of a tumor worsening in patients with cancer. Talk with your doctor if you have concerns.

This medicine may cause convulsions (seizures), especially during the first few months of treatment. Talk with your doctor if you have concerns about this.

This medicine may cause serious allergic reactions, including anaphylaxis, can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, swelling of the face, tongue, or throat, trouble breathing, or chest pain after you receive the medicine.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery. Your doctor may want you to take a blood thinner (eg, warfarin) to prevent blood clots during or after surgery.

What Are Reasons I Shouldn’t Use Mircera?

Mircera may not be the right medication for you. Do not use Mircera if:

  • You have uncontrolled high blood pressure.
  • You have hypersensitivity to any of its ingredients (allergic reaction). Symptoms of an allergic reaction include hives, fever, and swelling. 
  • You have pure red cell aplasia (PRCA). PRCA is a medical condition in which some red blood cells do not form correctly, which also can result in low red blood cell counts. Mircera should be discontinued permanently when this condition has been diagnosed.

What Other Medications Interact With Mircera?

Before starting treatment, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

There have been no clinical studies on drug interactions with Mircera. Talk with your pharmacist or healthcare provider for more detailed information about potential interactions to ensure you take your medication safely.

What Medications Are Similar?

Other medications that can increase red blood cell levels, called erythropoiesis-stimulating agents (ESAs), are similar to Mircera. Some examples include:

  • Epogen, Procrit (epoetin alfa)
  • NeoRecormon (epoetin beta)
  • Aranesp (darbepoetin alfa)

Frequently Asked Questions

  • Do I need to take iron supplements while taking Mircera?

    It is common for your healthcare provider to have you take iron supplements while taking Mircera. Your body needs appropriate iron levels to make red blood cells and respond to Mircera.

  • When do I take Mircera if I am on dialysis?

    Your dialysis provider will determine when to take Mircera based on your dialysis schedule. Mircera is likely to be given during your dialysis session. 

  • What is the difference between Mircera and other ESAs?

    Both medications will have the same result but work differently. Mircera activates the same receptor as hormones within the bone marrow, while other ESAs (e.g., epoetin alfa) work and act as a replacement for the hormone.

How Can I Stay Healthy While Taking Mircera?

To stay healthy while taking Mircera, it is important to let all healthcare team members know what medications you are taking. Always take your medications as prescribed, even if you feel better.

Additionally, follow up with your healthcare providers regularly to check your blood count level and iron status before and during treatment. Many patients tend to receive iron supplementation, too. Maintaining a healthy lifestyle can help improve your overall health, so try to get ample sleep, stay hydrated, and eat healthy foods.

Medical Disclaimer

Verywell Health’s drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

The author would like to recognize and thank Faith Awoniyi for contributing to this article.