BIOHACKPHARMStack Analyzer

Darbepoetin alfa

Aranesp, NESP, dEPO

EPO & blood boostersPrescription onlyWADA S2 · prohibitedEvidence: approved medicineExtreme risk

A long-acting form of erythropoietin with extra sugar chains, so it stays in the blood about three times longer than epoetin. Approved for anemia; misused for endurance blood doping.

Legal status: Prescription medicine for anemia; not a controlled substance in the US, rules vary by country. Banned in sport at all times (WADA S2.1.1).

What it gives

What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.

Purpose

Medically: anemia from chronic kidney disease and from cancer chemotherapy. In sport: endurance blood doping; three cross-country skiers tested positive for it at the 2002 Winter Olympics. There is no safe way to use it in a healthy person.

What people seek and what studies show

Used for endurance, like epoetin: more red cells and hemoglobin to carry oxygen. Performance trials of darbepoetin itself in athletes are lacking; the evidence comes from epoetin, where lab endurance rose but a race result in trained cyclists did not change. It keeps acting for days after an injection.

Effects

Endurance

Evidence: Approved medicine — studied in people for its medical use

Possible side effects

With an extreme-risk substance some of these can be life-threatening or permanent; no dose, test or early sign makes it safe. Below — what each risk looks like; the signs that need urgent help are in block 04.

7 possible side effects

level · how often it is reported
High
Thick blood (hematocrit) / clot risk
Thick blood raises clot risk: in a large trial in kidney disease with diabetes, aiming for higher hemoglobin nearly doubled strokes. No measure makes use in a healthy person safe.
How to notice: Often silent; sometimes headaches, flushed face, itch after a hot shower.
common
High
Heart strain / heart-muscle thickening
Higher hemoglobin targets increased deaths and heart attacks in patients, and the label warns that misuse by healthy people can cause life-threatening heart attacks and clots.
How to notice: Shortness of breath on effort, lower endurance, palpitations.
possible
Elevated
Higher blood pressure
About 40% of kidney patients needed new or stronger blood-pressure treatment early on; hypertensive encephalopathy and seizures have been reported.
How to notice: Often silent; sometimes headaches, flushing, nosebleeds — a home monitor shows it.
possible
Elevated
Black-market quality risk (fakes, contamination)
When it is obtained outside pharmacies, the identity, potency, storage and sterility of this protein drug cannot be checked.
How to notice: Unexpected effects, pain or infection, a stronger or weaker effect than expected.
possible
Moderate
Unknown long-term safety (little human data)
Not studied in healthy athletes. Rarely, antibodies against erythropoietin switch off the body's own red-cell production (pure red-cell aplasia).
How to notice: Nothing to notice — the risk is what is not yet known.
possible
Moderate
Abnormal tissue growth (theoretical cancer risk)
In head and neck cancer, darbepoetin worsened tumor control, and ESAs shortened survival in several cancers; relevance to healthy people is unknown.
How to notice: No direct signs — the point is not to fuel existing growths.
rare
Low
Injection pain, infection, oil cough
Local pain or irritation; shared or non-sterile equipment carries a risk of infection.
How to notice: Soreness, lumps; a short coughing fit right after an injection.
possible

How to lower the risks

Extreme risk

Extreme risk. No measure makes using this substance for sport safe: severe, including life-threatening, consequences are possible. The only reliable way to avoid these risks is not to use it.

If a doctor prescribed this medicine to treat you, do not stop taking it on your own — discuss it with your doctor.

Warning signs that need urgent help are listed in block 04.

Check-ups and blood tests

For an extreme-risk substance there is no testing schedule.

No testing schedule makes this substance safe, so there is no plan of tests here. If it has already been taken, watch for the urgent warning signs on this page and see a doctor — tell them exactly what was taken.

Get medical help at once if

  • Swelling, pain or redness in one leg; sudden shortness of breath or chest pain; sudden one-sided weakness or numbness, trouble speaking or seeing — seek urgent care.
  • Chest pain or pressure, breathlessness on light effort, swollen ankles, fainting — seek urgent care.
  • Sudden severe headache, vision changes, numbness or weakness on one side, trouble speaking — call emergency services.
  • A new lump (including in the neck), trouble swallowing or persistent hoarseness, unexplained weight loss, or blood in stool or urine — see a doctor promptly.

In an emergency, call your local emergency number.

For women

Pregnancy data are limited; in animal studies it increased early pregnancy loss at doses close to clinical ones.

Myth & fact

Myth

“Aspirin and plenty of water make EPO-type drugs safe.”

Fact

In patients, no trial has found a hemoglobin target or dose that avoids the extra risk of clots, stroke and death, and darbepoetin keeps acting for days after the last injection.

Combinations

No specific combination notes for this substance yet. The stack check still adds up side effects that several substances share.

Sources

FDA: Aranesp (darbepoetin alfa) prescribing information (opens in a new tab)Pfeffer et al., N Engl J Med 2009: darbepoetin in diabetic kidney disease nearly doubled strokes (TREAT) (opens in a new tab)Debeljak & Sytkowski, Drug Test Anal 2012: erythropoietin and erythropoiesis-stimulating agents, misuse in sport (opens in a new tab)