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Erythropoietin erythropoetin or erithropoyetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production. It is a cytokine for erythrocyte (red blood cell) precursors in the bone marrow. It is sold as a drug under the tradname Eprex 

EPO is used as a 'performance-enhancing drug', and it is used to treat anaemia, principally in patients with chronic renal failure and who are on dialysis and those who have undergone chemotherapy. ESAs have a history of use as blood doping agents in endurance sports such as horseracing, cycling, rowing, distance running, race walking, cross country skiing, biathlon, and triathlons. In 2010, Floyd Landis admitted to using performance-enhancing drugs, including EPO, throughout the majority of his career as a professional cyclist.

Erythropoietin has its primary effect on red blood cells by promoting red blood cell survival through protecting these cells from apoptosis. It also interacts with various growth factors involved in the development of precursor red cells. Thus dosage is key, as overdose could severely compromise the immune system for example with red cells competing with white cells. Furthermore an increase in red cells may have an effect on plaque build up with thrombosis being a risk, and increased coagulation. EPO is known to have a range of actions including “vasoconstriction-dependent hypertension, stimulating angiogenesis, and inducing proliferation of smooth muscle fibers”.

Any overdose would thus contribute to hallucinations via a whole string of effects not least of which would be hypoxia 

“ Any benefit of erythropoetin must be weighed against the 50% increase in thrombosis, which has been demonstrated in numerous trials. Early treatment with erythropoietin correlated with an increase in the risk of Retinopathy of prematurity in premature infants who had anemia of prematurity, raising concern that the angiogenic actions of erythropoietin may exacerbate retinopathy”.

The results of the DAHANCA 10 clinical trial found that 3-year loco-regional cancer control in subjects treated with this drug was significantly worse than for those not receiving it. The FDA then issued an advisory recommending “caution in using these agents in cancer patients receiving chemotherapy or off chemotherapy”, and indicated “a lack of clinical evidence to support improvements in quality of life or transfusion requirements in these settings”.

In March 9, 2007, drug manufacturers agreed to new black box warnings about the safety of these drugs.

Drug interactions with Erythropoietin include: Major interaction:Lenalidomide--risk of thrombosis Moderate interaction:Cyclosporine--risk of high blood pressure may be greater in combination with EPO. EPO may lead to variability in blood levels of cyclosporine. Minor interactions: ACE inhibitors may interfere with hematopoiesis by decreasing the synthesis of endogenous erythropoietin or decreasing bone marrow production of red blood cells.

 On Jan, 30, 2017 4,432 people reported to have side effects when taking Eprex.
Among them, 1 person (0.02%) has Hallucination, Auditory