Erythropoiesis-stimulating agent (ESA) Pregnancy: No adequate and well-controlled studies in pregnant women; animal studies do not indicate direct harmful effects. Caution should be exercised when prescribing in pregnancy. It is unknown whether it is excreted in human milk.

Darbepoetin alfa

Brand names: Aranesp

Darbepoetin alfa is a long-acting erythropoiesis-stimulating agent used for anaemia of chronic kidney disease and chemotherapy-induced anaemia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.45 mcg/kg body weight

Route: Subcutaneous (intravenous also used; subcutaneous preferred in non-haemodialysis patients)

Frequency: Once weekly (correction phase)

Symptomatic anaemia in adult chronic renal failure. Correction phase: initial dose 0.45 mcg/kg subcutaneously once weekly. Alternatively, in patients not on dialysis, 0.75 mcg/kg once every two weeks or 1.5 mcg/kg once monthly. If haemoglobin increase is inadequate (less than 1 g/dL in four weeks) increase dose by approximately 25% (dose increases no more often than every four weeks); if rise is greater than 2 g/dL in four weeks, or Hb exceeds 12 g/dL, reduce dose by approximately 25%. Aim for the lowest effective dose keeping haemoglobin below or at 12 g/dL (target range 10-12 g/dL); avoid a rise greater than 2 g/dL over four weeks. Maintenance: may be given once weekly, once every two weeks or (non-dialysis) once monthly, titrated by approximately 25%. Conversion from r-HuEPO: initial weekly Aranesp dose (mcg/week) = total weekly r-HuEPO dose (IU/week) divided by 200; keep the same route. Treatment should be initiated by physicians experienced in the indication.

Paediatric dose

Dose: 0.45 mcg/kg

Route: Subcutaneous (intravenous also used)

Frequency: Once weekly

Paediatric chronic renal failure, patients aged 1 year and older, correction phase: initial dose 0.45 mcg/kg subcutaneously once weekly. Alternatively, in patients not on dialysis, 0.75 mcg/kg subcutaneously once every two weeks. Treatment of patients younger than 1 year has not been studied in randomised clinical trials. Titrate as for adults (dose adjustments by approximately 25%).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Poorly controlled hypertension

Side effects

Hypertension (very common)
Hypersensitivity (very common)
Stroke (common); convulsions (uncommon)
Thromboembolic events; dialysis vascular access thrombosis
Injection site pain; rash/erythema; pure red cell aplasia (PRCA); SJS/TEN reported

Clinical monograph

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.

Reference: SmPC Aranesp; KDIGO Anaemia in CKD 2012; NICE NG8 (Anaemia in CKD 2015); CHOIR NEJM 2006; 355:2085; TREAT NEJM 2009; 361:2019; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways