NESP Dosage/Direction for Use

Renal Anemia: Hemodialysis patients: Initial dose: The usual dose of NESP in adult patients is 20 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single intravenous injection once weekly.
Initial dose at the switching from erythropoietin preparations (Epoetin Alfa (Genetical Recombination), Epoetin Beta (Genetical Recombination), etc): The usual dose of NESP in adult patients is 15-60 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single intravenous injection once weekly.
Maintenance dose: When correction of anemia is achieved, the usual dose of NESP in adult patients is 15-60 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single intravenous injection once weekly. If alleviation of anemia is maintained by once weekly injection, the frequency of administration can be changed to once every two weeks with an initial dose set to be two-fold of the dose in the once weekly injection. In this case, the usual dose in adult patients is 30-120 μg administered as a single intravenous injection once every two weeks.
In all cases, the dose should be adjusted in view of the degree of anemic symptoms and the patient's age, and should not exceed 180 μg as a single injection.
Peritoneal dialysis patients and patients with chronic kidney disease not on dialysis: Initial dose: The usual dose of NESP in adult patients is 30 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single injection once every two weeks subcutaneously or intravenously.
Initial dose at the switching from erythropoietin preparations (Epoetin Alfa (Genetical Recombination), Epoetin Beta (Genetical Recombination), etc): The usual dose of NESP in adult patients is 30-120 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single injection once every two weeks subcutaneously or intravenously.
Maintenance dose: When correction of anemia is achieved, the usual dose of NESP in adult patients is 30-120 μg as Darbepoetin Alfa (Genetical Recombination), to be administered as a single injection once every two weeks subcutaneously or intravenously. If alleviation of anemia is maintained by once every two weeks injection, the frequency of administration can be changed to once every four weeks with an initial dose set to be two-fold of the dose in the once every two weeks injection. In this case, the usual dose in adult patients is 60-180 μg administered as a single injection once every four weeks subcutaneously or intravenously.
In all cases, the dose should be adjusted in view of the degree of anemic symptoms and the patient's age, and should not exceed 180 μg as a single injection.
Anemia with myelodysplastic syndrome: The usual dose of NESP in adults is 240 μg as darbepoetin alfa (genetical recombination), to be administered as a single subcutaneous injection once weekly. The dose should be decreased in view of the degree of anemic symptoms and the patient's age.
Precautions related to Dosage and Administration: Renal Anemia: Regarding the target levels for the improvement of anemia, refer to the guidelines and other relevant updates.
Initial dose at the switching from an erythropoietin preparation: When NESP is started in substitution for an erythropoietin preparation, the dose and the frequency of administration should be determined on the basis of the dose of the erythropoietin preparation that has been used. See the table as follows.
Patients who have been treated with an erythropoietin preparation twice weekly or three times weekly: Calculate the total dose of the erythropoietin preparation administered during the week before the switching, and then determine the initial dose of NESP according to the table as follows. The treatment should be started on once weekly basis.
Patients who have been treated with an erythropoietin preparation once weekly or once every two weeks: Calculate the total dose of the erythropoietin preparation administered during the two weeks before the switching, and then determine the initial dose of NESP according to the table as follows. The treatment should be started on once every two weeks basis. (See Table 5.)

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Dose adjustment: If dose adjustment is required (for example, when the appropriate increase in the hemoglobin concentration or the hematocrit levels cannot be achieved in correction phase, or when the hemoglobin concentration or the hematocrit level deviates from the target range for successive two weeks in maintenance phase), the dose should be increased or decreased according to the table as follows. Any dose increase should be performed stage by stage in principle. (See Tables 6 and 7.)

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Change of the frequency of administration: When changing the frequency of administration, the hemoglobin concentration or the hematocrit level should be sufficiently monitored before expanding the interval of administration. Be sure that the hemoglobin concentration or the hematocrit level have been kept stable at a certain dose of NESP and then change the frequency of administration from once weekly to once every two weeks, or from once every two weeks to once every four weeks. The hemoglobin concentration or the hematocrit level should be monitored after the change as well, and adjustment should be made as needed.
If the hemoglobin concentration or the hematocrit level fails to reach the target range even with the dose of 180 μg the dose should be reduced by half and the frequency of administration should be changed from once every two weeks to once weekly, or from once every four weeks to once every two weeks.
Anemia with myelodysplastic syndrome: The efficacy and safety of NESP in combination with other antitumor agents have not been established.
If cases such as excessive hemopoiesis occur (the hemoglobin concentration exceeds approximately 11 g/dL) and dose reduction is required, the dose should be reduced by approximately 50%. If after dose reduction, the hemoglobin concentration falls (below approximately 9 g/dL) and dose increase is required, the dose should be increased approximately two-fold. The dose should not exceed 240 μg as a single injection.
If the desired improvement in anemia is not obtained or anemia is aggravated after administration of NESP, change to another treatment should be considered. The necessity of continued administration of NESP should be assessed at approximately 16 weeks after the initiation of administration (see Pharmacology: Clinical Studies under Actions).