Indication |
- Treatment of anaemia associated with CKD
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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
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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
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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
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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
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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
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Dose in renal impairment |
- As in normal renal function, not dialysed
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Interactions |
- If given with ACEi, increased risk of hyperkalaemia
- May affect ciclosporin and tacrolimus levels
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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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