1. Definition & Mechanism
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Generic Name: Darbepoetin Alfa (25 mcg/dose)
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Class: Long-acting Erythropoiesis-Stimulating Agent (ESA)
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Function: Stimulates red blood cell (RBC) production by binding to erythropoietin receptors in bone marrow.
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Half-life: ~3× longer than recombinant erythropoietin (EPO), allowing less frequent dosing.
2. Importance & Clinical Use
Primary Indications:
✅ Chronic Kidney Disease (CKD) Anemia (Dialysis & non-dialysis)
✅ Chemotherapy-Induced Anemia (in non-myeloid cancers)
✅ HIV-associated anemia (for patients on AZT therapy)
Key Benefits:
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Reduces need for blood transfusions
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Improves fatigue, dyspnea, and quality of life
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Dosed less frequently than EPO (weekly/biweekly vs. 2–3× weekly)
3. Dosage & Administration
Patient Group | Route | Initial Dose | Maintenance |
---|---|---|---|
CKD (Dialysis) | IV/SC | 0.45 mcg/kg weekly | Adjust to maintain Hb 10–12 g/dL |
CKD (Non-Dialysis) | SC | 0.45 mcg/kg every 2–4 weeks | Monitor Hb monthly |
Chemotherapy Anemia | SC | 2.25 mcg/kg weekly or 500 mcg every 3 weeks | Hold if Hb >12 g/dL |
⚠️ Critical Notes:
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Never exceed Hb >12 g/dL (↑ risk of thrombosis).
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Iron status must be checked (co-administer iron if deficient).
4. Side Effects
Common (≥10%):
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Hypertension (↑ BP)
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Headache, dizziness
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Injection-site pain
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Nausea, diarrhea
Serious (Monitor Closely):
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Thrombosis (DVT, stroke, MI) – *Highest risk if Hb >12 g/dL*
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Pure Red Cell Aplasia (PRCA) – Rare antibody-mediated RBC failure
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Seizures (in CKD patients)
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Severe allergic reactions (rash, angioedema)
5. Storage & Handling
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Temperature: Refrigerate at 2–8°C (do not freeze).
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Light Sensitivity: Keep in original carton.
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Shaking: Avoid – causes protein degradation.
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Expiry: Discard unused portions (single-use vial).
6. Contraindications & Warnings
❌ Do NOT use in:
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Uncontrolled hypertension
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Pure Red Cell Aplasia (PRCA) post-ESA therapy
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Hemoglobinopathy (e.g., sickle cell anemia) without concomitant transfusions
⚠️ Black Box Warning (FDA):
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↑ Risk of death, MI, stroke, thrombosis if Hb >12 g/dL.
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Cancer patients: ESA use may ↓ survival in some malignancies.
7. Conclusion
CRESP 25 (Darbepoetin Alfa) is a potent ESA for anemia in CKD and chemotherapy patients, offering convenient dosing but requiring strict Hb monitoring to avoid life-threatening complications. Must be prescribed by specialists with regular follow-up.
Need details on:
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Cost comparison (vs. EPO or biosimilars)?
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Guidelines for dose adjustments?
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Management of ESA resistance?
Reviews
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