Adults

Initial dose for CKD patients not on dialysis: 0.45 mcg/kg IV or SC once every four weeks, or 0.75 mcg/kg SC every two weeks. For CKD patients on dialysis: 0.45 mcg/kg IV or SC once weekly. Doses are adjusted to maintain hemoglobin levels.

Elderly

No specific dose adjustment is generally required for elderly patients, but careful monitoring of hemoglobin levels and blood pressure is recommended.

Renal_impairment

Primary indication for CKD patients. Dosage adjusted based on hemoglobin response and target levels. No additional dose adjustment beyond what is specified for CKD.

Onset

Onset of action is gradual, with clinically significant increases in hemoglobin typically observed after 2-6 weeks.

Excretion

Mainly through renal excretion and cellular uptake/degradation.

Half life

Approximately 25.3 hours after intravenous administration and 48.8 hours after subcutaneous administration in CKD patients.

Absorption

Slow and sustained absorption after subcutaneous administration. Bioavailability is approximately 37% for subcutaneous and 100% for intravenous.

Metabolism

Primarily metabolized by non-renal pathways; peptide cleavage occurs.

Iron supplements

Iron supplementation is almost always required to support erythropoiesis, especially when initiating ESA therapy.

No specific drug interactions have been identified with Darbepoetin Alfa

Darbepoetin Alfa is not known to have significant drug-drug interactions. However, close monitoring is advised when used with other agents that might affect erythropoiesis or blood pressure.