Darbepoetin alfa
CLINICAL USE
Treatment of anaemia associated with chronic renal failure, and with non-haematological malignancies in adult cancer patients receiving chemotherapy
DOSE IN NORMAL RENAL FUNCTION
Renal failure: 0.45 micrograms/kg once a week; dose is adjusted by 25% every 4 weeks according to response; maintenance every 1–2 weeksPatients not on dialysis: 0.75 mcg every 2 weeks; maintenance may be every 1–4 weeksCancer: 2.25 mcg/kg once a week, or 6.75 mcg/kg every 3 weeks; adjust doses by 50% every 4 weeks according to response
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsCiclosporin and tacrolimus: monitor ciclosporin and tacrolimus levels; since these drugs are bound to red blood cells there is a potential risk of a drug interaction as haemoglobin concentration increasesACE inhibitors and angiotensin- II antagonists: increased risk of hyperkalaemia
ADMINISTRATION
Reconstition
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Route
SC, IV
Rate of Administration
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Comments
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OTHER INFORMATION
To convert to darbepoetin from epoetin, divide total weekly epoetin dose by 200 although that may slightly overestimate the darbepoetin doseSame dose may be given either SC or IV – monitor responseUse with caution in patients with a history of epilepsy as convulsions have been reported in patients with CKDOnce a pre-filled pen has been removed from the fridge and brought to room temperature it must be used within 7 daysPre-treatment checks and appropriate correction/ treatment needed for iron, folate and B12 deficiency, infection, inflammation or aluminium toxicity to produce optimum response to therapyConcomitant iron therapy (200–300 mg elemental oral iron) needed daily. IV iron may be needed for patients with very low serum ferritin (<100 nanograms/mL)May increase heparin requirement during