Darbepoetin – Uses, Dosage, Side Effects, Interaction Darbepoetin alfa is a recombinant form of human erythropoietin used to increase the differentiation of progenitor cells to red blood cells in the treatment of anemia. Human erythropoietin with 2 aa substitutions to enhance glycosylation (5 N-linked chains), 165 residues (MW=37 kD). Produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology. Darbepoetin alfa injection is used to treat anemia (a lower-than-normal number of red blood cells) in people with chronic kidney failure (a condition in which the kidneys slowly and permanently stop working over a period of time). Darbepoetin alfa injection is also used to treat anemia caused by chemotherapy in people with certain types of cancer. Darbepoetin alfa cannot be used in place of a red blood cell transfusion to treat severe anemia and has not been shown to improve tiredness or poor well-being that may be caused by anemia. Darbepoetin alfa is in a class of medications called erythropoiesis-stimulating agents (ESAs). It works by causing the bone marrow (soft tissue inside the bones where blood is made) to make more red blood cells Darbepoetin alfa is a re-engineered form of erythropoietin containing 5 amino acid changes (N30, T32, V87, N88, T90) resulting in the creation of 2 new sites for N-linked carbohydrate addition. It has a 3-fold longer serum half-life compared to epoetin alpha and epoetin beta. It stimulates erythropoiesis (increases red blood cell levels) by the same mechanism as rHuEpo (binding and activating the Epo receptor) and is used to treat anemia, commonly associated with chronic kidney failure and cancer chemotherapy. Darbepoetin is marketed by Amgen under the trade name Aranesp. Mechanism of action Darbepoetin alfa stimulates erythropoiesis by the same mechanism as endogenous erythropoietin. Erythropoietin interacts with progenitor stem cells to increase red cell production. The binding of erythropoietin to the erythropoietin receptor leads to receptor dimerization, which facilitates the activation of JAK-STAT signaling pathways within the cytosol. Activated STAT (signal transducers and activators of transcription) proteins are then translocated to the nucleus where they serve as transcription factors that regulate the activation of specific genes involved in cell division or differentiation. Darbepoetin alfa is used in the treatment of anemia. It is involved in the regulation of erythrocyte differentiation and the maintenance of a physiological level of circulating erythrocyte mass. Indications For the treatment of anemia (from renal transplants or certain HIV treatments) Anemia Treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy. Use in Cancer Darbepoetin alfa is approved to treat: Anemia is caused by myelosuppressive chemotherapy used for certain types of cancer. Contraindications inadequate folic acid inadequate vitamin B12 porphyria anemia from inadequate iron high blood pressure significant uncontrolled high blood pressure a heart attack a clot in the lung sudden and serious symptoms of heart failure called acute decompensated heart failure a stroke obstruction of a blood vessel by a blood clot a blood clot blood clot in a deep vein of the extremities seizures visible water retention a blood clot in a vascular access device pure red cell aplasia Aluminum poisoning, severe Bleeding, severe or Bone marrow fibrosis (osteoporosis cystic) Folic acid deficiency, Infections, inflammation, cancer Iron deficiency, or Vitamin B12 deficiency—This may cause a delay in response to treatment. Blood clots (history of) or other problems with the blood or Congestive heart failure or Heart attack, history of or Heart bypass surgery or Heart or blood vessel disease or Stroke, history of or Thrombosis, at risk for—The chance of side effects may be increased. Bone marrow problems (eg, hemolytic anemia, sickle cell anemia, porphyria, thalassemia)—The use of darbepoetin alfa injection has not been established in patients with these conditions. Hypertension (high blood pressure), uncontrolled or Pure red cell aplasia (rare bone marrow disease)—Should not be used in patients with these conditions. Seizures, history of—Use with caution. May make this condition worse. Dosage Strengths: 25 mcg/mL; 40 mcg/mL; 60 mcg/mL; 100 mcg/mL; 200 mcg/mL; 300 mcg/mL; 40 mcg/0.4 mL; 60 mcg/0.3 mL; 100 mcg/0.5 mL; 150 mcg/0.3 mL; 200 mcg/0.4 mL; 500 mcg/mL; 300 mcg/0.6 mL; 150 mcg/0.75 mL; 25 mcg/0.42 mL; 10 mcg/0.4 mL Anemia Associated with Chronic Renal Failure Chronic Kidney Disease (CKD) Patients Not on Dialysis: Initial dose: 0.45 mcg/kg IV or subcutaneously once every 4 weeks as appropriate Initiate treatment only when hemoglobin is less than 10 g/dL, the rate of hemoglobin decline indicates the likelihood of requiring RBC transfusion, and reducing the risk of alloimmunization and/or other RBC transfusion-related risks is a goal. CKD Patients on Dialysis: Initial dose: 0.45 mcg/kg IV or subcutaneously once a week or 0.75 mcg/kg once every 2 weeks as appropriate Initiate treatment when hemoglobin is less than 10 g/dL. IV route is recommended for patients on hemodialysis. Anemia Associated with Chemotherapy Initial dose: 2.25 mcg/kg subcutaneously once a week or 500 mcg subcutaneously once every 3 weeks Duration of therapy: Until completion of the chemotherapy course Initiate treatment if hemoglobin is less than 10 g/dL and a minimum of 2 additional months of chemotherapy is planned. Use the lowest dose necessary to avoid RBC transfusions. Pediatric Dose for Anemia Associated with Chronic Renal Failure Less than 18 Years: Initial dose: Chronic Kidney Disease (CKD) Patients Not on Dialysis: 0.45 mcg/kg IV or subcutaneously once a week or 0.75 mcg/kg once every 2 weeks CKD Patients on Dialysis: 0.45 mcg/kg IV or subcutaneously once a week Initiate treatment when hemoglobin is less than 10 g/dL. Dose Adjustments All chronic kidney disease (CKD) patients: May increase dose no more than every 4 weeks; may decrease dose more frequently. Avoid frequent dose adjustments. If hemoglobin increases by more than 1 g/dL in 2 weeks, reduce the dose by 25% or more as needed to reduce rapid responses. If hemoglobin has not increased by more than 1 g/dL after 4 weeks of therapy, increase the dose by 25%. For patients who do not respond adequately over a 12-week escalation period, further dose increases are unlikely to improve response and may increase risks. Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions. Evaluate other causes of anemia. Discontinue if responsiveness does not improve. CKD patients on dialysis: If hemoglobin approaches or exceeds 11 g/dL, reduce or interrupt the dose of this drug. CKD patients not on dialysis: If hemoglobin exceeds 10 g/dL, reduce or interrupt the dose and use the lowest dose sufficient to reduce the need for RBC transfusions. Pediatric CKD patients: If hemoglobin approaches or exceeds 12 g/dL, reduce or interrupt the dose of this drug. Conversion from epoetin alfa to this drug in CKD patients on dialysis: Maintain the route of administration when converting. Administer this drug once weekly in patients who were receiving epoetin alfa 2 to 3 times weekly; administer once every 2 weeks in patients who were receiving epoetin alfa once weekly. Previous weekly epoetin alfa dose (units/week): Darbepoetin alfa dose (mcg/week) Less than 1500: Adults: 6.25; Pediatric: Unknown 1500 to 2499: Adults: 6.25; Pediatric: 6.25 2500 to 4999: Adults: 12.5; Pediatric: 10 5000 to 10999: Adults: 25; Pediatric: 20 11000 to 17999: Adults: 40; Pediatric: 40 18000 to 33999: Adults: 60; Pediatric: 60 34000 to 89999: Adults: 100; Pediatric: 100 90000 or greater: Adults: 200; Pediatric: 200 Conversion from epoetin alfa to this drug in CKD patients not on dialysis: Refer to doses for CKD patients on dialysis. Dose conversion does not accurately estimate the once-monthly dose of this drug. All chemotherapy patients: If hemoglobin increases greater than 1 g/dL in 2 weeks or reaches a level needed to avoid RBC transfusion, reduce the dose by 40%. If hemoglobin exceeds a level needed to avoid RBC transfusion, withhold the dose until hemoglobin approaches a level where RBC transfusions may be required and reinitiate at a dose 40% below the previous dose. If hemoglobin increases by less than 1 g/dL and remains below 10 g/dL after 6 weeks of therapy, increase the dose to 4.5 mcg/kg/week, if on the weekly dosing schedule. If on the every 3-week dosing schedule, no dose adjustment is recommended. If there is no response as measured by hemoglobin levels or if RBC transfusions are still required after 8 weeks of therapy, or if the chemotherapy course is complete, discontinue this drug. Side Effects The Most Common cough stomach pain redness, swelling, bruising, itching, or a lump at the spot where you injected darbepoetin alfa rash itching difficulty breathing or swallowing wheezing hoarseness swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs fast pulse excessive tiredness lack of energy dizziness fainting pale skin More common Accumulation of pus arm, back, or jaw pain blurred vision breathing problems (irregular, noisy, or trouble when resting) chest pain, discomfort, tightness, or heaviness chills confusion cough producing mucus decrease in the amount of urine diarrhea dilated neck veins dizziness, fainting, or lightheadedness dry mouth fast, slow, or irregular heartbeat fatigue or tiredness (extreme or unusual) fever headache nausea pain, tenderness, swelling, or warmth over the injection site pounding in the ears rapid breathing rapid or pounding pulse skin discoloration at the injection site stomach pain sunken eyes sweating swelling of the ankles, face, fingers, feet, hands, or lower legs thirst trouble with breathing unconsciousness vomiting weight gain wrinkled skin Rare Anxiety difficulty with speaking (slow speech or unable to speak) double vision seizures trouble with thinking trouble with walking unable to move the arms, legs, or face muscles (including numbness and tingling) Fever hives, itching, skin rash pale skin sore throat Blistering, peeling, or loosening of the skin cough joint or muscle pain red, irritated eyes red skin lesions, often with a purple center sores, ulcers, or white spots in the mouth or on the lips Drug Interactions DRUG INTERACTION Abemaciclib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Abemaciclib. Abiraterone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Abiraterone. Afatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Afatinib. Aldesleukin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Aldesleukin. Alectinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Alectinib. Alemtuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Alemtuzumab. Alitretinoin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Alitretinoin. Alpelisib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Alpelisib. Altretamine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Altretamine. Aminoglutethimide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Aminoglutethimide. Aminolevulinic acid The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Aminolevulinic acid. Amsacrine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Amsacrine. Anagrelide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Anagrelide. Anastrozole The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Anastrozole. Apalutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Apalutamide. Arsenic trioxide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Arsenic trioxide. Artesunate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Artesunate. Asciminib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Asciminib. Asparaginase Erwinia The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Asparaginase Erwinia chrysanthemi. Asparaginase Escherichia The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Asparaginase Escherichia coli. Atezolizumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Atezolizumab. Avelumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Avelumab. Axicabtagene ciloleucel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Axicabtagene ciloleucel. Axitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Axitinib. Azacitidine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Azacitidine. Belinostat The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Belinostat. Belzutifan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Belzutifan. Bendamustine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bendamustine. Bevacizumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bevacizumab. Bexarotene The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bexarotene. Bicalutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bicalutamide. Binimetinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Binimetinib. Bleomycin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bleomycin. Blinatumomab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Blinatumomab. Bortezomib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bortezomib. Bortezomib D-mannitol The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bortezomib D-mannitol. Bosutinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bosutinib. Brentuximab vedotin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Brentuximab vedotin. Brexucabtagene The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Brexucabtagene autoleucel. Brigatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Brigatinib. Buserelin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Buserelin. Busulfan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Busulfan. Cabazitaxel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cabazitaxel. Cabergoline The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cabergoline. Cabozantinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cabozantinib. Capecitabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Capecitabine. Capmatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Capmatinib. Carboplatin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Carboplatin. Carfilzomib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Carfilzomib. Carmustine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Carmustine. Catumaxomab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Catumaxomab. Cemiplimab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cemiplimab. Ceritinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ceritinib. Cetuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cetuximab. Chlorambucil The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Chlorambucil. Cisplatin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cisplatin. Cladribine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cladribine. Clofarabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Clofarabine. Cobimetinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cobimetinib. Copanlisib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Copanlisib. Crizotinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Crizotinib. Curcumin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Curcumin. Cyclophosphamide The risk or severity of pulmonary toxicity can be increased when Darbepoetin alfa is combined with Cyclophosphamide. Cyproterone acetate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cyproterone acetate. Cytarabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cytarabine. Dabrafenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dabrafenib. Dacarbazine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dacarbazine. Dacomitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dacomitinib. Dactinomycin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dactinomycin. Daratumumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Daratumumab. Darolutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Darolutamide. Dasatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dasatinib. Daunorubicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Daunorubicin. Decitabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Decitabine. Degarelix The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Degarelix. Denileukin diftitox The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Denileukin diftitox. Dexamethasone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dexamethasone. Dienogest The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dienogest. Dinutuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dinutuximab. Docetaxel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Docetaxel. Dostarlimab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Dostarlimab. Doxorubicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Doxorubicin. Durvalumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Durvalumab. Duvelisib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Duvelisib. Elotuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Elotuzumab. Enasidenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Enasidenib. Encorafenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Encorafenib. Enfortumab vedotin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Enfortumab vedotin. Entrectinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Entrectinib. Enzalutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Enzalutamide. Epirubicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Epirubicin. Erdafitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Erdafitinib. Eribulin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Eribulin. Erlotinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Erlotinib. Estramustine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Estramustine. Etoposide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Etoposide. Everolimus The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Everolimus. Exemestane The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Exemestane. Fedratinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Fedratinib. Floxuridine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Floxuridine. You Might Also Read What Is Evabotulinumtoxina? Indications, Contraindications Fludarabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Fludarabine. Fluorouracil The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Fluorouracil. Flutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Flutamide. Formestane The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Formestane. Fulvestrant The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Fulvestrant. Futibatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Futibatinib. Gallium nitrate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Gallium nitrate. Gefitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Gefitinib. Gemcitabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Gemcitabine. Gemtuzumab ozogamicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Gemtuzumab ozogamicin. Gilteritinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Gilteritinib. Glasdegib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Glasdegib. Goserelin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Goserelin. Hydroxyprogesterone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Hydroxyprogesterone caproate. Hydroxyurea The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Hydroxyurea. Ibrutinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ibrutinib. Idarubicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Idarubicin. Idecabtagene vicleucel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Idecabtagene vicleucel. Idelalisib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Idelalisib. Ifosfamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ifosfamide. Imatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Imatinib. Infigratinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Infigratinib. Inotuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Inotuzumab ozogamicin. Interferon alfa-2a The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Interferon alfa-2a. Interferon alfa-2b The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Interferon alfa-2b. Ipilimumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ipilimumab. Irinotecan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Irinotecan. Isatuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Isatuximab. Ivosidenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ivosidenib. Ixabepilone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ixabepilone. Ixazomib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ixazomib. Lanreotide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lanreotide. Lapatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lapatinib. Larotrectinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Larotrectinib. Lenalidomide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lenalidomide. Lenvatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lenvatinib. Letrozole The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Letrozole. Leuprolide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Leuprolide. Lisocabtagene The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lisocabtagene maraleucel. Lomustine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lomustine. Loncastuximab tesirine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Loncastuximab tesirine. Lorlatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lorlatinib. Lurbinectedin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lurbinectedin. Margetuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Margetuximab. Masoprocol The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Masoprocol. Mechlorethamine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mechlorethamine. Medroxyprogesterone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Medroxyprogesterone acetate. Megestrol acetate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Megestrol acetate. Melphalan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Melphalan. Mercaptopurine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mercaptopurine. Methotrexate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Methotrexate. Methylprednisolone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Methylprednisolone. Methylprednisolone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Methylprednisolone hemisuccinate. Methyltestosterone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Methyltestosterone. Midostaurin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Midostaurin. Miltefosine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Miltefosine. Mirvetuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mirvetuximab Soravtansine. Mitomycin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mitomycin. Mitotane The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mitotane. Mitoxantrone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mitoxantrone. Mogamulizumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mogamulizumab. Mosunetuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Mosunetuzumab. Moxetumomab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Moxetumomab pasudotox. Nandrolone decanoate The therapeutic efficacy of Darbepoetin alfa can be increased when used in combination with Nandrolone decanoate. Nandrolone The therapeutic efficacy of Darbepoetin alfa can be increased when used in combination with Nandrolone phenpropionate. Necitumumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Necitumumab. Nedaplatin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nedaplatin. Nelarabine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nelarabine. Neratinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Neratinib. Nilotinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nilotinib. Nilutamide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nilutamide. Nintedanib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nintedanib. Niraparib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Niraparib. Nivolumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nivolumab. Obinutuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Obinutuzumab. Octreotide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Octreotide. Ofatumumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ofatumumab. Olaparib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Olaparib. Olaratumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Olaratumab. Omacetaxine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Omacetaxine mepesuccinate. Osimertinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Osimertinib. Oxaliplatin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Oxaliplatin. Paclitaxel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Paclitaxel. Palbociclib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Palbociclib. Pamidronic acid The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pamidronic acid. Panitumumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Panitumumab. Panobinostat The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Panobinostat. Pazopanib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pazopanib. Pegaspargase The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pegaspargase. Peginterferon alfa-2a The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Peginterferon alfa-2a. Pembrolizumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pembrolizumab. Pemetrexed The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pemetrexed. Pemigatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pemigatinib. Pentostatin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pentostatin. Pertuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pertuzumab. Pexidartinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pexidartinib. Pipobroman The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pipobroman. Pirfenidone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pirfenidone. Pixantrone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pixantrone. Plicamycin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Plicamycin. You Might Also Read Bevacizumab; Uses, Dosage, Side Effects, Drug Interactions Pomalidomide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pomalidomide. Ponatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ponatinib. Porfimer sodium The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Porfimer sodium. Pralatrexate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pralatrexate. Pralsetinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Pralsetinib. Prednisolone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Prednisolone. Prednisone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Prednisone. Prednisone acetate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Prednisone acetate. Procarbazine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Procarbazine. Radium Ra 223 dichloride The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Radium Ra 223 dichloride. Raltitrexed The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Raltitrexed. Ramucirumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ramucirumab. Regorafenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Regorafenib. Ribociclib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ribociclib. Ripretinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ripretinib. Rituximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Rituximab. Romidepsin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Romidepsin. Roxadustat The risk or severity of adverse effects can be decreased when Roxadustat is combined with Darbepoetin alfa. Rucaparib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Rucaparib. Ruxolitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Ruxolitinib. Sacituzumab govitecan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Sacituzumab govitecan. Selinexor The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Selinexor. Selpercatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Selpercatinib. Selumetinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Selumetinib. Siltuximab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Siltuximab. Sonidegib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Sonidegib. Sorafenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Sorafenib. Sotorasib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Sotorasib. Streptozocin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Streptozocin. Sunitinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Sunitinib. Tafasitamab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tafasitamab. Tagraxofusp The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tagraxofusp. Talazoparib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Talazoparib. Talimogene The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Talimogene laherparepvec. Tamoxifen The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tamoxifen. Taurolidine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Taurolidine. Tebentafusp The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tebentafusp. Tegafur The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tegafur. Temoporfin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Temoporfin. Temozolomide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Temozolomide. Temsirolimus The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Temsirolimus. Teniposide The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Teniposide. Tepotinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tepotinib. Testolactone The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Testolactone. Thalidomide The risk or severity of thromboembolism can be increased when Thalidomide is combined with Darbepoetin alfa. Thiotepa The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Thiotepa. Tioguanine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tioguanine. Tisagenlecleucel The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tisagenlecleucel. Tisotumab vedotin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tisotumab vedotin. Tivozanib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tivozanib. Topotecan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Topotecan. Toremifene The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Toremifene. Tositumomab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tositumomab. Trabectedin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trabectedin. Trametinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trametinib. Trastuzumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trastuzumab. Trastuzumab deruxtecan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trastuzumab deruxtecan. Trastuzumab emtansine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trastuzumab emtansine. Tremelimumab The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tremelimumab. Treosulfan The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Treosulfan. Tretinoin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tretinoin. Trifluridine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trifluridine. Trilostane The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trilostane. Trimetrexate The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Trimetrexate. Triptorelin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Triptorelin. Tucatinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tucatinib. Umbralisib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Umbralisib. Uracil mustard The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Uracil mustard. Urethane The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Urethane. Valproic acid The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Valproic acid. Valrubicin The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Valrubicin. Vandetanib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vandetanib. Vemurafenib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vemurafenib. Venetoclax The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Venetoclax. Vinblastine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vinblastine. Vincristine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vincristine. Vindesine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vindesine. Vinflunine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vinflunine. Vinorelbine The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vinorelbine. Vismodegib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vismodegib. Vorinostat The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Vorinostat. Zanubrutinib The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Zanubrutinib. You Might Also Read Isavuconazole; Uses, Dosage, Side Effects, Interactions, PragnancyPregnancy and Lactation AU TGA pregnancy category: B3 US FDA pregnancy category: Not assigned Pregnancy Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans. The limited data available on use in pregnant women is insufficient to know this drug’s risks, including the risk of fetal harm or reproductive effects. Animal reproduction studies showed increased early post-implantation loss at doses about equal to the usual human starting dose. Lactation Darbepoetin alfa is biologically and immunologically indistinguishable from erythropoietin, a normal component of human milk. IV darbepoetin has been given safely to newborn infants in doses much larger than those expected to appear in breast milk. There is no information regarding this drug on the presence of human milk, its effects on a breastfed infant, or its effects on milk production. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for this medication as well as any potential adverse effects from this drug or the underlying maternal condition. How should this medicine be used? Darbepoetin alfa injection comes as a solution (liquid) to inject subcutaneously (just under the skin) or intravenously (into a vein). It is usually injected once every 1 to 4 weeks. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use darbepoetin alfa injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Your doctor will start you on a low dose of darbepoetin alfa injection and adjust your dose depending on your lab results and on how you are feeling. Your doctor may also tell you to stop using darbepoetin alfa injection for a time. Follow these instructions carefully. Darbepoetin alfa injection will help to control your anemia only as long as you continue to use it. It may take 2-6 weeks or longer before you feel the full benefit of darbepoetin alfa injection. Continue to use darbepoetin alfa injection even if you feel well. Do not stop using darbepoetin alfa injection without talking to your doctor. Darbepoetin alfa injections may be given by a doctor or nurse, or your doctor may decide that you can inject darbepoetin alfa yourself, or that you may have a friend or relative give the injections. You and the person who will be giving the injections should read the manufacturer’s information for the patient that comes with the darbepoetin alfa injection before you use it for the first time at home. Ask your doctor to show you or the person who will be injecting the medication how to inject it. Darbepoetin alfa injection comes in prefilled syringes and in vials to be used with disposable syringes. If you are using vials of darbepoetin alfa injection, your doctor or pharmacist will tell you what type of syringe you should use. Do not use any other type of syringe because you may not get the right amount of medication. Do not shake the darbepoetin alfa injection. If you shake the darbepoetin alfa injection it may look foamy and should not be used. Always inject darbepoetin alfa injection in its own syringe. Do not dilute it with any liquid and do not mix it with any other medications. You can inject darbepoetin alfa injection anywhere on the outer area of your upper arms, and your stomach except for the 2-inch (5-centimeter) area around your navel (belly button), the front of your middle thighs, and the upper outer areas of your buttocks. Choose a new spot each time you inject darbepoetin alfa. Do not inject darbepoetin alfa into a spot that is tender, red, bruised, or hard, or that has scars or stretch marks. If you are being treated with dialysis (treatment to remove waste from the blood when the kidneys are not working), your doctor may tell you to inject the medication into your venous access port (the place where dialysis tubing is connected to your body). Ask your doctor if you have any questions about how to inject your medication. Always look at the darbepoetin alfa injection solution before injecting it. Be sure that the prefilled syringe or vial is labeled with the correct name and strength of medication and an expiration date that has not passed. If you are using a vial, check to be sure that it has a colored cap, and if you are using a prefilled syringe, check that the needle is covered with the grey cover and that the yellow plastic sleeve has not been pulled over the needle. Also check that the solution is clear and colorless and does not contain lumps, flakes, or particles. If there are any problems with your medication, call your pharmacist and do not inject it. Do not use prefilled syringes, disposable syringes, or vials of darbepoetin alfa injection more than once. Dispose of used syringes in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture-resistant container. What special precautions should I follow? Before using darbepoetin alfa injection, tell your doctor and pharmacist if you are allergic to darbepoetin alfa, epoetin alfa (Epogen, Procrit), any other medications, or any of the ingredients in darbepoetin alfa injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients. If you will be using the prefilled syringes, tell your doctor if you or the person who will be injecting the medication is allergic to latex. tell your doctor if you have or have had high blood pressure, and if you have ever had pure red cell aplasia (PRCA; a type of severe anemia that may develop after treatment with an ESA such as darbepoetin alfa injection or epoetin alfa injection). Your doctor may tell you not to use darbepoetin alfa injection. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had seizures. If you are using darbepoetin alfa injection to treat anemia caused by chronic kidney disease, tell your doctor if you have or have ever had cancer. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using darbepoetin alfa injection, call your doctor. before having surgery, including dental surgery, tell your doctor or dentist that you are being treated with darbepoetin alfa injection. It is especially important to tell your doctor that you are using darbepoetin alfa injection if you are having coronary artery bypass graft (CABG) surgery or surgery to treat a bone problem. Your doctor may prescribe an anticoagulant (‘blood thinner’) to prevent clots from forming during surgery. References https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103951orig1s5173_103951orig1s5258lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/darbamg071902lb.pdf https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-aranesp-darbepoetin-alfa https://www.cancer.gov/about-cancer/treatment/drugs/darbepoetinalfa https://www.webmd.com/drugs/2/drug-21884/aranesp-in-albumin-injection/details/list-contraindications https://www.drugs.com/mtm/darbepoetin-alfa.html https://go.drugbank.com/drugs/DB00012 https://pubchem.ncbi.nlm.nih.gov/substance/17397749 https://medlineplus.gov/druginfo/meds/a604022.html https://en.wikipedia.org/wiki/Darbepoetin_alfa https://www.mayoclinic.org/drugs-supplements/darbepoetin-alfa-injection-route/side-effects/drg-20068072?p=1 Show More