Darbepoetin Alfa

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.