Darbepoetin Alfa

What is this medication for?

Darbepoetin alfa is used to treat anaemia (a condition where there are not enough red blood cells in your body to carry oxygen to your organs and tissues) in the following conditions:

• Chronic kidney disease (a long-term condition where the kidneys do not work as well as they should)
• Cancer patients who develop anaemia as a result of chemotherapy
• Myelodysplastic syndrome (a group of conditions where the bone marrow does not produce enough healthy blood cells)

This medication works by stimulating the bone marrow to produce more red blood cells.

How should I take or use this medication?

• Do not stop using your medication without checking with your healthcare professional.
• Darbepoetin alfa is given as an injection under the skin (subcutaneous). It may also be given into a vein (intravenous) when administered by a healthcare professional
• Do not shake the pre-filled syringe, as this may damage the medication.
• The injection should be inspected before use. Do not use if you notice any particles or discolouration in the solution.

Preparing your injection
	Step 1: Wash your hands thoroughly.
	Step 2: Remove one prefilled syringe from the refrigerator. Allow the syringe to reach room temperature naturally. Do not warm it using hot water or a microwave. Do not leave it in direct sunlight.
	Step 3: Check the medicine and the prefilled syringe. Make sure the medicine is clear and colourless. Do not use the syringe if the medicine is cloudy, discoloured, or contains flakes or particles or if the expiry date has passed
	Step 4: Attach the needle securely to the syringe after removing protective cap.
	Step 5: Choose and disinfect the injection site (stomach, thigh, upper arm, or buttocks) with alcohol swab.  For injections to the stomach area, inject at least 2 fingers away from the belly button. Avoid irritated, bruised, or scarred skin.
Using your injection
	Step 6: Sit or lie down in a comfortable position so that you are relaxed
	Step 7: Hold the syringe barrel and carefully pull the grey needle cap straight off and away from your body.
	Step 8: Expel (remove) air bubbles by tapping the syringe and slowly pushing the plunger upwards.
	Step 9: Create a skin fold using your thumb and index finger at the injection site.
	Step 9: Inject the needle at a right angle into the skin fold. Maintain the skin fold and slowly push the plunger until the medication is fully injected.
	Step 10: Remove the needle and gently press the alcohol swab on the injection site without rubbing or massaging.
	Step 11: Replace the needle cap and dispose of the syringe in a puncture-proof container (e.g. a plastic bottle with a cap).
	Step 12: For subsequent injections, rotate injection sites to reduce dents or lumps appearing under the skin (lipodystrophy).

What should I do if I forget to take or use this medication?

If you forget to inject a dose, do it as soon as you remember. Then inject your next dose at the usual time. Do not inject two doses to make up for the missed dose.

What precautions should I take when taking or using this medication?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You are pregnant, planning to become pregnant, or breastfeeding.
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have uncontrolled high blood pressure.
• You have a history of fits (seizures).
• You have any other medical conditions, especially heart disease, stroke, or blood clotting problems.
• You are going to receive any vaccination or surgery, including dental surgery.

If you have any question about this medication, please discuss with your healthcare professional.

What are some common side effects of this medication? ​

• High blood pressure
  • You may experience an increase in blood pressure during treatment. Your doctor will monitor your blood pressure regularly.
  • If your blood pressure is very high, you may have headache, dizziness or blurry eyesight. Inform your doctor if you have such symptoms frequently. (please check this phrasing)
  • If you have been prescribed blood pressure medications, continue to take them regularly as instructed.
  • If you have a blood pressure monitoring machine at home, measure your blood pressure at the same time(s) every day and record it. Bring it for your future appointments.
• Headache
  • Mild pain can be relieved by taking Paracetamol.
  • Inform your doctor if your headaches do not get better or if you are also vomiting, experiencing confusion or visual disturbances.
• Injection site pain
  • You may experience pain, redness, or swelling at the injection site.
  • Apply a cool compress over the affected area for relief.
• Feeling tired or lack of energy
  • Do not drive or operate machinery if you are feeling tired.
  • Eat well and get enough sleep.
  • Prioritise tasks to ensure you make the best use of your energy.
  • Simple exercise such as walking can help to boost your energy.
  • Avoid alcohol as this may cause you to feel more tired and drowsy.
• Swelling of the ankles and legs
  • You may notice some painless swelling at the lower legs or unusual weight gain. (please check this phrasing)
  • For mild leg swelling, elevating your legs on a foot stool, cushion or pillow may help to improve blood flow and reduce the swelling.
• Muscle aches and/or joint pain
  • Mild pain can be relieved by taking Paracetamol.
    Inform your doctor if the pain is not better.

These side effects may be temporary and reversible. If they are persistent and become bothersome, please discuss with your healthcare professional.

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

You can also find out about drug allergies by watching these videos:

For videos in 中文, Melayu and தமிழ், click here.

Other rare but serious side effects include:

• Abnormal blood clot
  • This may occur in one of the legs or arms (deep vein thrombosis) or lungs (pulmonary embolism). Symptoms may include warmth, pain or redness with swelling on the arm or leg, or sudden onset of cough, chest pain or shortness of breath.
• Symptoms of a stroke
  • Such as sudden onset of severe headache, eyesight changes, trouble talking or moving properly, or drooping of the face, weakness or numbness in an arm or leg.
• Symptoms of a heart attack
  • Discomfort in the middle of your chest that lasts for a few minutes or goes away and comes back, shortness of breath with or without chest discomfort, or chest pain that feels like an uncomfortable heavy pressure.
• Pure red cell aplasia (a condition where the bone marrow stops producing red blood cells).
  • This is a rare but serious condition. Symptoms may include worsening tiredness, shortness of breath, pale skin, lips, nails or a fast heartbeat while resting. Inform your doctor immediately if you experience these symptoms.
• Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN).
  • These are rare but severe skin side effects. Symptoms include mouth ulcers, face swelling, blisters on skin, skin rashes that spread throughout the body within hours to days after starting the medication. This usually occurs within the first few months of treatment. 

If you experience any of these symptoms, you should stop your medication and proceed to the emergency department immediately.

How should I store this medication?

Store in the refrigerator between 2–8°C. Do not freeze. Protect from light. Do not shake. Keep this medication away from children.

How do I throw away this medication safely? ​

Replace the needle cap and discard the entire syringe with the used needle in a puncture proof container, such as a metal tin or thick plastic bottle with cap or cover (for example, detergent bottles). You can also buy a container specially designed to throw sharp items, known as a sharps box, at pharmacies. This is to prevent any injuries due to needles.

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.