Darbepoetin alfa

How it works

It is a hyperglycosylated analogue of erythropoietin that stimulates erythropoietin receptors on erythroid progenitor cells to increase red cell production, with a longer half-life than epoetin allowing less frequent dosing.

Prescribing in practice

• Avoid rapid rises and excessive haemoglobin targets, as overcorrection is associated with increased thrombotic and cardiovascular events and hypertension.
• Assess and correct iron status, as response is impaired by functional or absolute iron deficiency.
• Investigate loss of response, considering pure red cell aplasia, bleeding, infection or other causes.

Monitoring

Monitor haemoglobin, blood pressure and iron indices, titrating to the lowest dose maintaining the target haemoglobin range.

Counselling the patient

• Regular blood tests are needed to keep your haemoglobin in the right range and avoid overcorrection.
• Report headaches or symptoms suggesting raised blood pressure.
• Tell your team if you take iron or have changes in diet or other medicines.

Evidence & guidelines

Use of erythropoiesis-stimulating agents in renal anaemia is guided by NICE, which recommends conservative haemoglobin targets to limit cardiovascular harm.