Darbepoetin alfa

From Drugs Prescribing Information
(Redirected from Aranesp)
Jump to: navigation, search
Click on "►" to expand:

Contents

[edit] BRAND NAMES

[edit] MECHANISM OF ACTION

Human erythropoietin is an endogenous hormone that is the primary regulator of erythropoiesis (production of red blood cells) through specific interaction with the erythropoietin receptor on the erythroid progenitor cells in the bone marrow.

Erythropoietin is produced by the kidneys. In patients with chronic renal failure, anemia can be caused by a lack of erythropoietin. In patients with cancer receiving chemotherapy the etiology of anaemia is multifactorial. In these patients, erythropoietin deficiency and a reduced response of erythroid progenitor cells to endogenous erythropoietin both contribute significantly towards their anaemia.

Darbepoetin alfa acts exactly like the natural erythropoietin made by the body, but it is very slightly different in its structure. It has a longer duration of action (longer terminal half-life), and can be given less often than natural erythropoietin. The darbepoetin alfa is produced by a method known as ‘recombinant DNA technology’: it is made by a cell that has received a gene (DNA), which makes the cell able to produce darbepoetin alfa.

Increased hemoglobin levels are not generally observed until 2 to 6 weeks after initiating treatment

[edit] INDICATIONS

Treatment of anemia due to:
  • Chronic renal failure
  • Myelosuppressive chemotherapy

[edit] DOSAGE

  • Recommended starting dose for chronic renal failure patients on dialysis:
    • 0.45 mcg/kg intravenously or subcutaneously weekly, or
    • 0.75 mcg/kg intravenously or subcutaneously every 2 weeks

Intravenous route is recommended for patients on hemodialysis, and Darbepoetin alfa treatment should be initiated when the hemoglobin level is less than 10 g/dL. If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the drug


  • Recommended starting dose for patients with chronic renal failure not on dialysis:
    • 0.45 mcg/kg intravenously or subcutaneously at 4 week intervals. Darbepoetin alfa treatment should be initiated when the hemoglobin level is less than 10 g/dL and the following considerations apply:
      • The rate of hemoglobin decline indicates the likelihood of requiring a RBC transfusion and,
      • Reducing the risk of alloimmunization and/or other RBC transfusion-related risks is a goal.

   If the hemoglobin level approaches or exceeds 10 g/dL, reduce or interrupt the drug


  • Recommended starting dose for cancer patients on chemotherapy:
    • 2.25 mcg/kg subcutaneously weekly, or
    • 500 mcg subcutaneously every 3 weeks

Darbepoetin alfa treatment should be initiated when the hemoglobin level is less than 10 g/dL, and if there is a minimum of two additional months of planned chemotherapy.

[edit] CONTRAINDICATIONS

  • Hypersensitivity to darbepoetin alfa
  • Poorly controlled hypertension

[edit] WARNINGS AND PRECAUTIONS

  • Increased Mortality, Myocardial Infarction, Stroke, and Thromboembolism: Using Darbepoetin alfa to target a hemoglobin level of greater than 11 g/dL increases the risk of serious adverse cardiovascular reactions and has not been shown to provide additional benefit . Use caution in patients with coexistent cardiovascular disease and stroke
  • Increased Mortality and/or Increased Risk of Tumor Progression or Recurrence in Patients With Cancer
  • Hypertension: Control hypertension prior to initiating and during treatment with Darbepoetin alfa (Cases of severe hypertension, have been observed in CRF patients treated with Darbepoetin alfa).
  • Deficiencies of iron, folic acid or vitamin B12 reduce the effectiveness of Darbepoetin alfa and should therefore be corrected
  • Seizures: Darbepoetin alfa increases the risk for seizures in patients with CKD. Increase monitoring of these patients for changes in seizure frequency or premonitory symptoms
  • PRCA: If severe anemia and low reticulocyte count develop during Darbepoetin alfa treatment, withhold Darbepoetin alfa and evaluate for PRCA

[edit] INTERACTIONS

[edit] PREGNANCY AND LACTATION

[edit] SIDE EFFECTS

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES

[[Category:]] [[Category:]] [[Category:]]