• Aranesp® (darbepoetin alfa) and EPOGEN® (epoetin alfa) are contraindicated in patients with:
  • Uncontrolled hypertension
  • Pure red cell aplasia (PRCA) that begins after treatment with Aranesp®, EPOGEN®, or other erythropoietin protein drugs
  • Serious allergic reactions to Aranesp® or EPOGEN®
• EPOGEN® from multidose vials contains benzyl alcohol and is contraindicated in neonates, infants, pregnant women, and lactating women.
• Use caution in patients with coexistent cardiovascular disease and stroke.
• Patients with CKD and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular reactions and mortality than other patients. A rate of hemoglobin rise of > 1 g/dL over 2 weeks may contribute to these risks.
• In controlled clinical trials, ESAs increased the risk of death in patients undergoing coronary artery bypass graft surgery (CABG) and the risk of deep venous thrombosis (DVT) in patients undergoing orthopedic procedures.
• Control hypertension prior to initiating and during treatment with Aranesp® or EPOGEN®.
• Aranesp® and EPOGEN® increase the risk of seizures in patients with CKD. Monitor patients closely for new-onset seizures, premonitory symptoms, or change in seizure frequency.
• For lack or loss of hemoglobin response to Aranesp® or EPOGEN®, initiate a search for causative factors. If typical causes of lack or loss of hemoglobin response are excluded, evaluate for PRCA.
• Cases of PRCA and of severe anemia, with or without other cytopenias that arise following the development of neutralizing antibodies to erythropoietin have been reported in patients treated with Aranesp® or EPOGEN®.

• • This has been reported predominantly in patients with CKD receiving ESAs by subcutaneous administration.
  • PRCA has also been reported in patients receiving ESAs for anemia related to hepatitis C treatment (an indication for which Aranesp® and EPOGEN® are not approved).
  • If severe anemia and low reticulocyte count develop during treatment with Aranesp® or EPOGEN®, withhold Aranesp® or EPOGEN® and evaluate patients for neutralizing antibodies to erythropoietin.
  • Permanently discontinue Aranesp^® or EPOGEN^® in patients who develop PRCA following treatment with Aranesp^®, EPOGEN^®, or other erythropoietin protein drugs. Do not switch patients to other ESAs.
• Serious allergic reactions, including anaphylactic reactions, angioedema, bronchospasm, skin rash, and urticaria may occur with Aranesp® or EPOGEN®. Immediately and permanently discontinue Aranesp® or EPOGEN® if a serious allergic reaction occurs.
• Blistering and skin exfoliation reactions including Erythema multiforme and Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN), have been reported in patients treated with ESAs (including Aranesp^® and EPOGEN^®) in the postmarketing setting. Discontinue Aranesp^® or EPOGEN^® therapy immediately if a severe cutaneous reaction, such as SJS/TEN, is suspected.
• Serious and fatal reactions including “gasping syndrome” can occur in neonates and infants treated with benzyl alcohol-preserved drugs, including EPOGEN^® multiple-dose vials. There is a potential for similar risks to fetuses and infants exposed to benzyl alcohol in utero or in breast-fed milk, respectively.
• Adverse reactions (≥ 10%) in Aranesp® clinical studies in patients with CKD were hypertension, dyspnea, peripheral edema, cough, and procedural hypotension.
• Adverse reactions (≥ 5%) in EPOGEN® clinical studies in patients with CKD were hypertension, arthralgia, muscle spasm, pyrexia, dizziness, medical device malfunction, vascular occlusion, and upper respiratory tract infection.

Indications and Limitations of Use

Aranesp^® (darbepoetin alfa) is indicated for the treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and patients not on dialysis.
EPOGEN^® (epoetin alfa) is indicated for the treatment of anemia due to chronic kidney disease (CKD) in patients on dialysis to decrease the need for red blood cell (RBC) transfusion. Limitations of Use:

• Aranesp^® and EPOGEN^® have not been shown to improve quality of life, fatigue, or patient well-being.
• Aranesp^® and EPOGEN^® are not indicated for use as a substitute for RBC transfusions in patients who require immediate correction of anemia.

Please click to see accompanying Aranesp^® full prescribing information and EPOGEN^® full prescribing information, including Boxed WARNINGS and Medication Guide.