Erythropoiesis-stimulating agents (ESAs) increase the risk for death, myocardial infarction, stroke, and other serious cardiovascular events. Patients with chronic kidney disease (CKD) were at a greater risk for death, serious adverse cardiovascular reactions, and stroke when administered ESAs to target Hb levels of greater than 11 g/dL in clinical studies. No trial has identified a Hb target level, ESA dose, or dosing strategy that does not increase these risks. In CKD patients, use the lowest sufficient dose to reduce the need for RBC transfusions. In cancer patients with certain tumor types (ie, breast, non-small cell lung, head and neck, lymphoid, cervical), ESAs shortened overall survival and increased the risk of tumor progression or recurrence in clinical studies. In cancer patients, use the lowest dose needed to avoid RBC transfusions to reduce these risks and the risk of serious cardiovascular and thromboembolic reactions. Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy, and discontinue following the completion of a chemotherapy course. Patients receiving myelosuppressive therapy when the anticipated outcome is cure should not be treated with ESAs .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Hematopoietic
Pharmacologic Class: Erythropoietic
Uses For darbepoetin alfa
Darbepoetin alfa injection causes the bone marrow to produce red blood cells. If the body does not produce enough red blood cells, severe anemia can occur. This often occurs in people with chronic kidney failure whose kidneys are not working properly. Darbepoetin may be used for patients on kidney dialysis or for those not on dialysis. Anemia can also occur in people who are receiving chemotherapy to treat cancer. Darbepoetin alfa is used to treat severe anemia in these patients.
darbepoetin alfa is available only with your doctor's prescription.
Before Using darbepoetin alfa
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For darbepoetin alfa, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to darbepoetin alfa or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of darbepoetin alfa injection in children with chronic kidney failure.
Appropriate studies have not been performed on the relationship of age to the effects of darbepoetin alfa injection in children with cancer. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of darbepoetin alfa injection in the elderly.
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of darbepoetin alfa. Make sure you tell your doctor if you have any other medical problems, especially:
- Aluminum poisoning, severe or
- Bleeding, severe or
- Bone marrow fibrosis (osteofibrosis cystica) or
- Folic acid deficiency or
- Infections, inflammation, or cancer or
- Iron deficiency or
- Vitamin B12 deficiency—May cause a delay in response to treatment.
- Blood clots (history of) or other problems with the blood or
- Congestive heart failure or
- Heart attack, history of or
- Heart bypass surgery or
- Heart or blood vessel disease or
- Stroke, history of or
- Thrombosis, at risk for—The chance of side effects may be increased.
- Bone marrow problems (eg, hemolytic anemia, sickle cell anemia, porphyria, thalassemia)—Use of darbepoetin alfa injection has not been established in patients with these conditions.
- Hypertension (high blood pressure), uncontrolled or
- Pure red cell aplasia (rare bone marrow disease)—Should not be used in patients with these conditions.
- Seizures, history of—Use with caution. May make this condition worse.
Proper Use of darbepoetin alfa
darbepoetin alfa comes with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
Darbepoetin alfa is usually given by a doctor. However, medicines given by injection are sometimes used at home. If you will be using darbepoetin alfa at home, your doctor will teach you how the injections are to be given. Be sure you understand exactly how the medicine is to be injected.
darbepoetin alfa is available in 2 forms. You may use a vial or a prefilled syringe with an UltraSafe® Needle Guard.
darbepoetin alfa may be given as a shot under your skin or into a vein. If your doctor tells you to inject it a certain way, follow your doctor's instructions.
If you are giving darbepoetin alfa at home:
- Use a new needle and syringe each time you inject your medicine.
- Do not use more medicine or use it more often than your doctor tells you to.
- You will be shown the body areas where this shot can be given.
- Throw away used needles and syringes in a hard, closed container that the needles cannot poke through (puncture-resistant). Keep this container away from children and pets.
Do not shake the container of medicine before you use it, and do not use darbepoetin alfa if it has been frozen.
You might not use all of the medicine in each vial (glass container) or prefilled syringe. Use each vial or syringe only one time. Do not save an open vial or syringe. If the medicine in the vial or syringe has changed color, or if you see particles in it, do not use it.
Carefully follow your doctor's instructions about any special diet. You may need to eat foods that contain iron, folic acid, or vitamin B12 such as eggs, certain cereals, meats, and vegetables, or you may take an iron, folic acid, or vitamin B12 supplement while you are using darbepoetin alfa.
The dose of darbepoetin alfa will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of darbepoetin alfa. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For injection dosage form:
- For anemia from chronic kidney failure:
- Adults and children—Dose is based on body weight and must be determined by your doctor. The starting dose is 0.45 to 0.75 microgram (mcg) per kilogram (kg) of body weight injected into a vein or under the skin once a week or once every 2 weeks. Your doctor may adjust the dose as needed.
- For anemia from cancer chemotherapy:
- Adults—Dose is based on body weight and must be determined by your doctor. The starting dose is 2.25 micrograms (mcg) per kilogram (kg) of body weight once a week or 500 mcg once every 3 weeks injected under the skin. Your doctor may adjust the dose as needed.
- Children—Use and dose must be determined by your doctor.
- For anemia from chronic kidney failure:
Call your doctor or pharmacist for instructions.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store in the refrigerator. Do not freeze.
Protect the medicine from bright light. Keep your medicine in the original package until you are ready to use it.
Precautions While Using darbepoetin alfa
People with severe anemia usually feel very tired and sick. When darbepoetin alfa begins to work, usually in about 6 weeks, most people start to feel better. Some people are able to be more active. But darbepoetin alfa only corrects anemia. It has no effect on kidney disease, cancer, or any other medical problem that needs regular medical attention. Even if you are feeling much better, it is very important that you do not miss any appointments with your doctor or any dialysis treatments.
It is very important that your doctor check your blood regularly while you are using darbepoetin alfa. You may also need to monitor your blood pressure at home. If you notice any changes to your normal blood pressure, call your doctor right away.
Darbepoetin alfa may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Check with your doctor right away if you have a rash, itching, swelling of the face, tongue, and throat, trouble with breathing, or chest pain after you receive the medicine.
darbepoetin alfa may increase your risk of having blood clots. This is more likely in patients who use high doses of darbepoetin alfa, or who use darbepoetin alfa before major surgery. If you have chest pain, trouble breathing, or pain, redness, or swelling in your arms or legs while using darbepoetin alfa, call your doctor right away. If you are getting kidney dialysis treatments, tell your doctor right away if you notice blood clots at your injection site. Your doctor may give you a blood thinner before surgery to help prevent blood clots.
darbepoetin alfa may also increase your risk of having serious heart and blood vessel problems such as a heart attack, congestive heart failure, or stroke. Check with your doctor right away if you start having dizziness, fainting spells, severe tiredness, chest pain, trouble with breathing, sudden or severe headache, or problems with vision, speech, or walking.
When used in patients with certain types of cancer (eg, breast, cervix, lymphoid, lung, head, or neck cancer), darbepoetin alfa has shortened survival time and worsened the tumor or cancer in some patients. If you are concerned about this, talk with your doctor.
Darbepoetin alfa sometimes causes convulsions (seizures), especially during the first few months of treatment. During this time, it is best to avoid driving, operating heavy machinery, or other activities that could cause a serious injury if a seizure occurs while you are performing them.
One form of darbepoetin alfa injection has an ingredient that comes from donated human blood. Some human blood products have transmitted certain viruses to people who have received them. The risk of getting a virus from medicines made from human blood has been greatly reduced in recent years. This is the result of required testing of human donors for certain viruses, and testing during the making of these medicines. Although the risk is low, talk with your doctor if you have concerns.
The needle cover of the prefilled syringe contains dry natural rubber (a derivative of latex), which may cause allergic reactions in people who are sensitive to latex. Tell your doctor if you have a latex allergy before you start using darbepoetin alfa.
Many people with kidney problems need to be on a special diet. Also, people with high blood pressure (which may be caused by kidney disease or by darbepoetin alfa treatment) may need to be on a special diet or to take medicine to keep their blood pressure under control. After their anemia has been corrected, some people feel so much better that they want to eat more than before. To keep your kidney disease or your high blood pressure from getting worse, it is very important that you follow your special diet and take your medicines regularly, even if you are feeling better.
In addition to darbepoetin alfa, your body needs iron and vitamins to make red blood cells. Your doctor may direct you to take iron or vitamin supplements. Be sure to follow your doctor's orders carefully. Darbepoetin alfa will not work well if you do not have enough iron or vitamins in your body.
darbepoetin alfa Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- Abdominal or stomach pain
- accumulation of pus
- arm, back, or jaw pain
- blurred vision
- breathing problems (irregular, noisy, or trouble when resting)
- chest pain, discomfort, tightness, or heaviness
- cough producing mucus
- decrease in the amount of urine
- dilated neck veins
- dizziness, fainting, or lightheadedness
- dry mouth
- fast, slow, or irregular heartbeat
- fatigue or tiredness (extreme or unusual)
- pain, tenderness, swelling, or warmth over injection site
- pounding in the ears
- rapid breathing
- rapid or pounding pulse
- shortness of breath
- skin discoloration at the injection site
- sunken eyes
- swelling of the ankles, face, fingers, feet, hands, or lower legs
- trouble with breathing
- weight gain
- wrinkled skin
- difficulty with speaking (slow speech or unable to speak)
- double vision
- trouble with thinking
- trouble with walking
- unable to move the arms, legs, or face muscles (including numbness and tingling)
- Fever and sore throat
- pale skin
- skin rash
- unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- general feeling of discomfort or illness
- lack or loss of strength
- loss of appetite
- muscle aches, pains, or stiffness
- pain in the joints
- runny nose
- trouble with sleeping
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
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- Drug class: recombinant human erythropoietins
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