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(C) Vancouver
General Hospital.
This monograph may not be reproduced without permission.
For further information, please contact a Pharmacist. |
NAME OF DRUG
darbepoetin
NON-FORMULARY DRUG
CLASSIFICATION
Erythropoiesis regulating hormone
ALTERNATE NAME
ARANESP, NESP
INDICATIONS
- treatment of anemia associated with chronic renal
dysfunction in both dialysis and non-dialysis patients (use patient's own
supplies)
RECONSTITUTION AND STABILITY
- refrigerate; do not freeze
- DO NOT SHAKE
- protect from excessive exposure to light
- syringes stable out of fridge for up to 7 days
COMPATIBILITY
- incompatible with other drugs
ROUTES OF ADMINISTRATION
- SC - into upper arms, abdomen,
thighs, or upper outer areas of buttocks
- IV direct - slow IV bolus into the
venous cannula
VH & HSC ADMINISTRATION POLICY
B - Direct IV route restricted to nurses in Special and
Critical Care areas. On general nursing units the direct IV route must be
administered by a physician.
DOSAGE
Initial Dosage: (IV, SC)
- 0.45 mcg/kg weekly
- weekly dosage is adjusted upward or downward in 25%
increments every 4-6 weeks to target hemoglobin of 110-120 g/L
Maintenance Dosage: (IV, SC)
- once the hemoglobin is within the target range, the
maintenance dose must be individualized for each patient
- equivalent total doses of darbepoetin have produced similar
hematopoietic responses whether divided into weekly doses or given every 2
weeks
Conversion of Erythropoietin (EprexÒ) to Darbepoetin:
|
Previous Weekly
EPO Dose (Units/week) |
Darbepoetin
Weekly Dose (mcg/week) |
Dose Ratio
Range |
|
Less than 8000 |
Divide weekly EPO
dose by 200 and round to closest 10mcg |
200:1 |
|
8000 or greater |
Divided weekly EPO dose by 300 and
round to closest 10mcg |
300:1 |
POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION
- skin rash and urticaria with SC use
- hypotension
IMPORTANT IMPLICATIONS
- use with caution in patients with uncontrolled
hypertension
- an increased risk of hypertension, hypertensive
encephalopathy or seizures may be associated with a rapid rise in hemoglobin
(>10g/L in any 2 week period)
- increased doses of heparin may be required during
hemodialysis to prevent clotting of the artificial kidney
- response to darbepoetin is first noted by an increase in
the reticulocyte count within 10 days, followed by increases in hemoglobin
usually within 2-6 weeks
- the hemoglobin should be monitored biweekly upon initiation
of therapy and after any dose adjustment until stabilization of response
(4-6 weeks)
- iron stores should be monitored prior to and during
therapy; transferrin saturation should be at least 20% and serum ferritin at
least 100 mcg/L
Rev. Oct 2007