Hematopoietic agentUS FDA Database Verified

darbepoetin (Rx)

Generic: Darbepoetin

Brand: Aranesp

(dar'bee-poh'eh-tin)

Pregnancy Category: C

Pharmacological Action

Stimulates erythropoiesis by the same mechanism as endogenous erythropoietin; in response to hypoxia, erythropoietin is produced in the kidney and released into the bloodstream, where it interacts with progenitor stem cells to increase red cell production

Therapeutic outcome: Decreased anemia with increased RBCs

Uses

Anemia associated with chronic renal failure in patients on and not on dialysis and anemic in nonmyeloid malignancies receiving coadministered chemotherapy

Contraindications

Hypersensitivity to mammalian cell–derived products, human albumin, polysorbate 80; uncontrolled hypertension, red cell aplasia

Precautions: Pregnancy C, breastfeeding, children, seizure disorder, porphyria, hypertension, sickle cell disease, vit B12, folate deficiency, chronic renal failure, dialysis, latex hypersensitivity, CABG, angina, anemia

BLACK BOX WARNING: Hgb >12 g/dl, neoplastic disease

Dosage & Routes

Correction of anemia in chronic renal failure

Adult: SUBCUT/IV 0.45 mcg/kg as a single inj, titrate max target Hgb of 12 g/dl Chemotherapy treatment

Adult: SUBCUT 2.5 mcg/kg/wk or 500 mcg q3 wk Epoetin alfa to darbepoetin conversion

Adult: SUBCUT/IV (epoetin alfa <2500 units/wk) 6.25 mcg/wk; (epoetin alfa 2500-4999 units/wk) 12.5 mcg/wk; (epoetin alfa 5000-10,999 units/wk) 25 mcg/wk; (epoetin alfa 11,000-17,999 units/wk) 40 mcg/wk; (epoetin alfa 18,000-33,999 units/wk) 60 mcg/wk; (epoetin alfa 34,000-89,999 units/wk) 100 mcg/wk; (epoetin alfa >90,000 units/wk) 200 mcg/wk

Available forms: Sol for inj 25, 40, 60, 100, 150, 200, 300, 500 mcg/ml

Implementation IV/SUBCUT route • Do not shake, do not dilute, do not mix with other products or solutions • Check for discoloration, particulate matter; do not use if present; discard unused portion; do not pool unused portion • Store refrigerated, do not freeze, protect from light

Adverse Effects

CNS: Seizures, sweating, headache, dizziness, stroke

CV: Hypo/hypertension, cardiac arrest, angina pectoris, thrombosis, CHF, acute MI, dysrhythmias, chest pain, transient ischemic attacks, edema

GI: Diarrhea, vomiting, nausea, abdominal pain, constipation

HEMA: Red cell aplasia

MISC: Infection, fatigue, fever, death, fluid overload, vascular access hemorrhage, dehydration, sepsis

MS: Bone pain, myalgia, limb pain, back pain

RESP: Upper respiratory infection, dyspnea, cough, bronchitis, pulmonary embolism

SYST: Allergic reactions, anaphylaxis

Pharmacokinetics

Absorption: Slow, rate-limiting (SUBCUT)

Distribution: Vascular space

Metabolism: Metabolized in body (IV), extent unknown

Excretion: Unknown

Half-life: 49 hr

Pharmacodynamics

Onset: Onset of increased reticulocyte count 1-6 wk

Peak: 34 hr

Duration: Unknown

Interactions

Individual drugs Do not use epoetin alfa with this product

Drug classifications

Androgens: increased darbepoetin alfa effect

Drug/lab test

Increased: WBC, platelets

Decreased: bleeding time

Nursing Considerations

Assessment • Assess for serious allergic reactions: rash, urticaria; if anaphylaxis occurs, stop product, administer emergency treatment (rare)

BLACK BOX WARNING: Assess blood studies: ferritin, transferrin monthly; transferrin sat ≥20%, ferritin ≥100 ng/ml; Hgb 2 3/wk until stabilized in target range (30%-33%), then at regular intervals; those with endogenous erythropoietin levels of <500 units/L respond to this agent, if there is lack of response, obtain folic acid, iron, B12 levels • Assess renal studies: urinalysis, protein, blood, BUN, creatinine • Assess B/P, Hct; check for rising B/P as Hct rises; antihypertensives may be needed • Assess CV status: hypertension may occur rapidly, leading to hypertensive encephalopathy; Hgb >12 g/dl may lead to death • Assess • I&O ratio; report drop in output to <50 ml/hr • Assess for seizures if Hgb is increased within 2 wk by 4 points • Assess CNS symptoms: cold sensation, sweating, pain in long bones • Assess dialysis patients for thrill, bruit of shunts; monitor for circulation impairment

BLACK BOX WARNING: Neoplastic disease: breast, non-small cell lung, head and neck, lymphoid or cervical cancers, increased tumor progression, use lowest dose to avoid RBC transfusion

Patient/family education • Caution patient to avoid driving or hazardous activity during beginning of treatment • Advise patient to monitor B/P, Hgb • Advise patient to take iron supplements, vit B12, folic acid as directed • Advise patient to report side effects to prescriber, to comply with treatment regimen • Teach patient that menses may return, use contraception • Teach home administration and review information for patients and caregivers if home administration is deemed appropriate

Evaluation

Positive therapeutic outcome: Increased reticulocyte count, Hgb/Hct; Increased appetite; Enhanced sense of well-being TREATMENT OF

OVERDOSE: If polycythemia occurs, discontinue product temporarily; perform phlebotomy if clinically indicated

Reference

Mosby's Drug Guide; Davis Drug Guide

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