Derise 25

Indications

• Anemia due to chronic kidney disease
• Anemia in patients with cancer undergoing chemotherapy
• Reduction of allogeneic blood transfusions in patients undergoing elective surgery

Dosage

Children: Refer to the BNF for Children for specific dosing information tailored to paediatric patients.

Adults: Refer to the BNF for specific dosing guidelines based on the condition being treated.

Mechanism of action

Darbepoetin binds to the erythropoietin receptor on erythroid progenitor cells in the bone marrow, promoting their proliferation and differentiation into red blood cells. This action stimulates erythropoiesis, increasing hemoglobin levels in the blood.

Pharmacodynamics

The pharmacodynamic effects of darbepoetin include increased red blood cell count and hemoglobin levels, leading to improved oxygen delivery to tissues. The onset of action may take several weeks as erythropoiesis is a gradual process, and the peak effects are usually observed after 2 to 6 weeks of treatment.

Pharmacokinetics

Darbepoetin has a longer half-life than recombinant erythropoietin, allowing for less frequent administration. It is primarily eliminated by the kidneys, and its pharmacokinetics are influenced by renal function. The peak plasma concentration occurs approximately 24 to 48 hours after subcutaneous administration.

Contra-indications

• Hypersensitivity to darbepoetin or any of its components
• Uncontrolled hypertension
• Pure red cell aplasia that begins after treatment with erythropoiesis-stimulating agents

Adverse effects

• Hypertension
• Headache
• Fatigue
• Nausea
• Diarrhea
• Edema
• Thrombotic events such as myocardial infarction or stroke

Interactions

• Antihypertensive medications may require adjustment due to potential increases in blood pressure
• Iron supplementation may be necessary for optimal response to therapy

Precautions

• Monitor hemoglobin levels regularly to avoid excessive increases
• Evaluate iron status before and during treatment
• Use with caution in patients with a history of cardiovascular disease

Pregnancy

Darbepoetin is categorized as pregnancy category C. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether darbepoetin is excreted in human milk. Caution should be exercised when administering to a nursing mother.

Storage

Store in the refrigerator at 2 to 8 degrees Celsius. Do not freeze. Protect from light.

Formulations

• Injectable solution for subcutaneous or intravenous use