An automatic substitution of epoetin using a conversion of 100 units/kg/week of epoetin for 0.45 mcg/kg/week of darbepoetin is recommend. Patients receiving darbepoetin every other week will be given weekly epoetin. Patients receiving darbepoetin every week will receive epoetin two to three times a week.

·        The dosage equivalence chart in the package insert of darbepoetin (AranespÔ) underestimates the potency of epoetin. Equivalent doses in studies were 1 mcg/kg/week darbepoetin = 200 units/kg/week of epoetin or 0.45 mcg/kg/week of darbepoetin = 100 units/kg/week of epoetin. The ratio in the package insert is 1 mcg/kg/week = 300 to 515 units/kg/week. Leading to an overestimate of the cost of epoetin when compared to darbepoetin.

Dialysis patients, use subcutaneous route and round to the closes vial size or combination of vials that results in an injection volume of < 2 ml ( 2,000, 4,000, 6,000, 8,000, 10,000, 12,000, and 14,0000).

Hgb monitoring and dosage adjustments

·        Pegfilgrastim (Neulasta^TM)  is not suggested for addition to the formulary.  It lacks adequate additional benefit for the hospitalized individual as compared to filgrastim (Neupogenâ) and is much more expensive.

·        An automatic substitution with filgrastim (Neupogenâ) 5mcg/kg/day, rounded to the closest vial size (300 mcg or 480 mcg) is recommended when pegfilgrastim (Neulasta^TM) is ordered.