Darbepoetin Alfa (Aranesp®)



Indication
  • Treatment of anaemia associated with CKD
Preparations
  • An Erythropoiesis-Stimulating Agent (ESA). Hyperglycosylated derivative of Epoetin
  • Darbepoetin (Aranesp®) prefilled syringe or sureclick pen: 10,15,20, 30, 40, 50, 60, 80, 100, 130, 150, 300, 500 micrograms
Contraindications
  • Hypersensitivity to the active substance or to any of the excipients
  • Uncontrolled hypertension
  • Patients who develop pure red cell aplasia (PRCA) following treatment with erythropoietin
Cautions
  • Monitor FBC (aim Haemoglobin 10-12 g/dl), avoid a sustained haemoglobin level of greater than 12 g/dl
  • Monitor BP
  • Ensure patients have sufficient iron stores. Keep ferritin >100 ng/ml and TSAT >20%
  • Antibody-mediated pure red cell aplasia (PRCA) has been reported after months to years of subcutaneous epoetin treatment mainly in CKD patients
  • Darbopoetin is less effective when the patient is deficient in vitamin B12, during periods of infection or raised PTH
  • Use with caution in patients with a history of epilepsy as convulsions have been reported in patients with CKD
Side-effects
  • Hypertension, Pure Red Cell Aplasia (PRCA; McCoy, 2008), headache, venous and arterial thrombosis, vascular access (fistula or graft) thrombosis
  •  Hb > 12 g/dl increased risk of cardiovascular events and death, CVA
Dose
  • Aranesp ®:  0.45 mcg/kg weekly, dose is adjusted by 25% every 4 weeks according to response; maintenance every 1-2 weeks
  • Many units give injections IV if patient is on haemodialysis, SC for patients not on HD
  • Equivalent dose IV vs SC
  • Increase dose according to response every 4 weeks until target Hb is obtained. Then adjust dose to maintain required target Hb
  • Reduce dose if Hb rises too quickly or above target
  • Rise in Hb should not exceed 2 g/dl per month
Dose in renal impairment
  • As in normal renal function, not dialysed
Interactions
  • If given with ACEi, increased risk of hyperkalaemia
  • May affect ciclosporin and tacrolimus levels
How to Prescribe View Details
Patient comment
  • Target haemoglobin (Hb) = 10-12 g/dl
  • Rotate the injection sites and inject slowly to avoid discomfort at the site of injection
  • Store in the fridge

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