Erythropoiesis-Stimulating Agent (Long-Acting 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 to treat symptomatic anaemia of chronic kidney disease, allowing less frequent dosing than epoetin.

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% (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

As a hyperglycosylated analogue of erythropoietin with a longer half-life, it stimulates erythropoietin receptors on marrow progenitor cells to increase red cell production.

Prescribing in practice

Do not over-correct haemoglobin or target normal/high levels, as higher haemoglobin targets increase the risk of thrombosis, stroke and hypertension; correct iron deficiency before and during treatment.
Aim for the lowest dose maintaining haemoglobin within the recommended sub-normal target range and avoiding the need for transfusion; uncontrolled hypertension is a contraindication.
An inadequate response should prompt a search for iron deficiency, infection, inflammation or, rarely, antibody-mediated pure red cell aplasia.

Monitoring

Monitor haemoglobin regularly to stay within target and avoid rapid rises, together with iron status and blood pressure.

Counselling the patient

Attend for regular blood tests so the dose can be adjusted to keep your blood count in the right range, not too high.
Report severe headache or worsening blood pressure.
Adequate iron is needed for this medicine to work, so take iron as prescribed.

Evidence & guidelines

MHRA and NICE advice on erythropoiesis-stimulating agents recommends conservative haemoglobin targets in renal anaemia after trials linked higher targets to increased cardiovascular risk.

Reference: KDIGO Anaemia in CKD Guidelines 2012; TREAT Trial (NEJM 2009); NICE NG203; 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.

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