Names and pronunciation
(dar′bee-poh′eh-tin) Aranesp
PDF page 352
Loading InternPractice…
Drug reference
(dar′bee-poh′eh-tin) Aranesp
PDF page 352
Func. class.: Colony-stimulating factor
PDF page 352
Chem. class.: Recombinant human erythropoietin
PDF page 352
ACTION: Stimulates erythropoiesis by the same mechanism as endogenous erythropoietin; in response to hypoxia, erythropoietin is produced in the kidney and released into the bloodstream, where it interacts with progenitor stem cells to increase red cell production
PDF page 352
USES: Anemia associated with chronic renal failure in patients on and not on dialysis and anemia in nonmyeloid malig- nancies for patients receiving coadminis- tered chemotherapy
PDF page 352
CONTRAINDICATIONS: Hyper- sensitivity to hamster protein products, human albumin, polysorbate 80; uncon- trolled hypertension; red cell aplasia Precautions: Pregnancy, breastfeeding, children, seizure disorder, porphyria, hyper- tension, sickle cell disease; vitamin B12, folate deficiency; chronic renal failure, dialysis; latex hypersensitivity, CABG, angina, anemia
PDF page 353
Black Box Warning: HB >11 g/dL, neo- plastic disease, MI, stroke, thromboem- bolic disease Black Box Warning: Increased risk of death if hemoglobin >11 g/dL: monitor Hb prior to and weekly × 4 wk or after change in dose and then often after target range has been reached; a rise >1g/dL over 2 wk may increase risks; reduce dose, keep Hb <10 g/dL in chronic kidney disease Black Box Warning: Renal studies: urinalysis, protein, blood, BUN, cre- atinine, electrolytes; monitor dialysis shunts; during dialysis, heparin may need to be increased; those with renal dysfunction may be at greater risk of death. Keep Hb <10 g/dL in chronic kidney disease Black Box Warning: Blood studies: ferritin, transferrin monthly; transferrin saturation ≥20%, ferritin ≥100 ng/mL; Hb 2×/wk until stabilized in target range (30%-33%), then at regular intervals; those with endogenous erythropoietin levels of <500 units/L respond to this agent; iron stores should be corrected prior to begin- ning therapy; if there is lack of response, obtain folic acid, iron, vitamin B12 levels Black Box Warning: Neoplastic dis- ease: breast, non–small-cell lung, head and neck, lymphoid, or cervical cancers, increased tumor progression; use lowest dose to avoid RBC transfusion • B/P: check for rising B/P as Hb rises; antihypertensives may be needed Black Box Warning: CV status: hyper- tension may occur rapidly, leading to hy- pertensive encephalopathy; Hb >11 g/ dL may lead to stroke, MI, death; do not administer • I&O; report drop in output to <50 mL/hr • Seizures: if Hb is increased by 1 g/dL within 2 wk, institute seizure precautions, decrease dose • CNS symptoms: sweating, pain in long bones • Dialysis patients: thrill, bruit of shunts; monitor for circulation impairment • Pregnancy/breastfeeding: Those who become pregnant should register with Am- gen’s Pregnancy Surveillance Program (800-772-6436), may cause fetal harm Black Box Warning: To report to pre- scriber any chest pain, SOB, swelling/ pain in legs, confusion, inability to speak; to comply with treatment regimen • That menses and fertility may return; to use contraception • About home administration proce- dures, if appropriate • Seizures: discuss injury prevention in those who are prone to seizures, may oc- cur if Hb is increased too rapidly, to report immediately if seizures occur • Chronic renal failure: that product does not cure condition, that other treat- ment regimens should be followed
PDF pages 353, 354
SIDE EFFECTS CNS: Seizures, headache, dizziness, stroke CV: Hypo/hypertension, cardiac arrest, angina pectoris, HF, acute MI, dysrhythmias, chest pain, edema GI: Diarrhea, vomiting, nausea, abdominal pain, constipation HEMA: Red cell aplasia MISC: Infection, fatigue, fever MS: Bone pain, myalgia, limb pain, back pain, arthralgia RESP: Dyspnea, cough, bronchitis SYST: Allergic reactions, anaphylaxis
PDF page 353
INTERACTIONS Increase: darbepoetin alfa effect— androgens Drug/Lab Test Increase: WBC, platelets, Hb Decrease: bleeding time
PDF page 353
DOSAGE AND ROUTES Correction of anemia in chronic renal failure • Adult: SUBCUT/IV For those on di- alysis 0.45 mcg/kg as a single injection; every week, or 0.75 mcg/kg q2wk; for those not on dialysis 0.45 mcg/kg q4wk titrate, max target Hb of 11 g/dL Anemia due to chemotherapy • Adult: SUBCUT 2.25 mcg/kg/wk or 500 mcg q3wk, start only if Hb <10 g/dL and 2 more months of chemotherapy Epoetin alfa to darbepoetin conversion • Adult: SUBCUT/IV (epoetin alfa <2500 units/wk) 6.25 mcg/wk; (epo- etin alfa 2500-4999 units/wk) 12.5 mcg/wk; (epoetin alfa 5000-10,999 units/wk) 25 mcg/wk; (epoetin alfa 11,000-17,999 units/wk) 40 mcg/wk; (epoetin alfa 18,000-33,999 units/wk) 60 mcg/wk; (epoetin alfa 34,000- 89,999 units/wk) 100 mcg/wk; (epoe- tin alfa >90,000 units/wk) 200 mcg/ wk
PDF page 353
Available forms: Sol for injection 25, 40, 60, 100, 150, 200, 300, 500 mcg/mL
PDF page 353
Administer: • Transfusions may still be required for anemia, use iron supplements with this product SUBCUT route • Do not give intradermally • Identify latex allergy • Don’t shake, protect from light IV route • Without shaking; check for discoloration, particulate matter, do not use if present; do not dilute, do not mix with other products or solutions, discard unused portion • IV given direct undiluted or bolus into IV tubing or venous line after completion D of dialysis; watch for clotting of line • Adjust dosage every month or more • Store refrigerated, do not freeze; pro- tect from light
PDF page 353
Assess: • Symptoms of anemia: fatigue, dys- pnea, pallor • Serious allergic reactions: rash, urticaria; if anaphylaxis occurs, stop product, administer emergency treat- ment (rare)
PDF page 353
Evaluate: • Therapeutic response: increase in re- ticulocyte count, Hb/Hct; increased ap- petite, enhanced sense of well-being
PDF page 354
CLINICAL CONSIDERATIONS
PDF page 353
Patient and caregiver information: • To avoid driving or hazardous activity during beginning of treatment • To monitor B/P, Hb, max Hb 11 g/dL • To take iron supplements, vitamin B12, folic acid as directed
PDF page 354
PHARMACOKINETICS IV: Onset of increased reticulocyte count 2-6 wk; distributed to vascular space; absorption slow and rate limiting; termi- nal half-life 49 hr (SUBCUT), 21 hr (IV); peak 34 hr; increased Hb levels not observed until 2-6 wk
PDF page 353
• Adult: SUBCUT/IV For those on di- alysis 0.45 mcg/kg as a single injection; every week, or 0.75 mcg/kg q2wk; for those not on dialysis 0.45 mcg/kg q4wk titrate, max target Hb of 11 g/dL Anemia due to chemotherapy
PDF page 353
• Adult: SUBCUT 2.25 mcg/kg/wk or 500 mcg q3wk, start only if Hb <10 g/dL and 2 more months of chemotherapy Epoetin alfa to darbepoetin conversion
PDF page 353
• Adult: SUBCUT/IV (epoetin alfa <2500 units/wk) 6.25 mcg/wk; (epo- etin alfa 2500-4999 units/wk) 12.5 mcg/wk; (epoetin alfa 5000-10,999 units/wk) 25 mcg/wk; (epoetin alfa 11,000-17,999 units/wk) 40 mcg/wk; (epoetin alfa 18,000-33,999 units/wk) 60 mcg/wk; (epoetin alfa 34,000- 89,999 units/wk) 100 mcg/wk; (epoe- tin alfa >90,000 units/wk) 200 mcg/ wk
PDF page 353