filgrastim

filgrastim /fil·gras·tim/ (fil-gras´tim) a human granulocyte colony-stimulating factor produced by recombinant technology; used to enhance neutrophil function, stimulating hematopoiesis and decreasing neutropenia.

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filgrastim

Neupogen

Pharmacologic class: Granulocyte colony-stimulating factor

Therapeutic class: Hematopoietic stimulator, antineutropenic

Pregnancy risk category C

Action

Induces formation of neutrophil progenitor cells by binding directly to receptor on surface granulocyte, stimulating cell proliferation and differentiation. Also potentiates effects of mature neutrophils and reduces fever and risk of infection associated with severe neutropenia.

Availability

SingleJect prefilled syringes: 300 mcg, 480 mcg

Vial for injection: 300 mcg/ml, 480 mcg/1.6 ml

⊘Indications and dosages

➣ To prevent infection after myelosuppressive chemotherapy

Adults: 5 mcg/kg/day by subcutaneous injection or I.V. infusion over 15 to 30 minutes, or continuous subcutaneous or continuous I.V. infusion, increased by 5 mcg/kg with each chemotherapy cycle if needed

➣ Neutropenia after bone marrow transplantation

Adults: 10 mcg/kg/day I.V. over 4 or 24 hours or as a continuous subcutaneous infusion over 24 hours

➣ To enhance peripheral blood progenitor cell collection in autologous hematopoietic stem cell transplantation

Adults: 10 mcg/kg/day by subcutaneous injection or as continuous subcutaneous infusion, starting 4 days before first leukapheresis procedure and continuing until last day of leukapheresis

➣ Neutropenia in congenital neutropenia

Adults: 6 mcg/kg subcutaneously b.i.d.

➣ Neutropenia in idiopathic or cyclic neutropenia

Adults: 5 mcg/kg/day subcutaneously

Off-label uses

• AIDS
• Aplastic anemia
• Hairy cell leukemia
• Myelodysplasia

Contraindications

• Hypersensitivity to drug, its components, or Escherichia coli-derived proteins

Precautions

Use cautiously in:
• patients receiving lithium or other drugs that can potentiate neutrophil release
• breastfeeding patients.

Administration

• Know that drug may be injected into venous return line of dialysis tubing after dialysis is completed.
☞ To dilute for I.V. administration, use dextrose 5% in water. Never use saline solution, because it may cause drug to precipitate.
• Administer single dose intermittently over 15 to 30 minutes or by continuous infusion over 4 to 24 hours.
• Don't mix with other drugs, and don't shake.
• Don't give within 24 hours of chemotherapy, bone marrow transplantation, or radiation therapy.

Route	Onset	Peak	Duration
I.V.	5-60 min	24 hr	1-7 days
Subcut.	5-60 min	2-8 hr	1-7 days

Adverse reactions

CNS: headache, weakness

CV: chest pain, hypotension, transient supraventricular tachycardia, myocardial infarction, arrhythmias

EENT: sore throat

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, splenomegaly, stomatitis

GU: bleeding

Hematologic: leukocytosis, sickle cell crisis, thrombocytopenia, splenic rupture

Metabolic: hyperuricemia

Musculoskeletal: bone, joint, muscle, arm, or leg pain

Respiratory: dyspnea, cough

Skin: pruritus, rash, erythema, alopecia, cutaneous necrotic vasculitis

Other: fever, mucositis, pain at injection site, edema, hypersensitivity reactions

Interactions

Drug-drug. Lithium: increased neutrophil production

Topotecan: prolonged neutropenia

Vincristine: increased risk of severe atypical peripheral neuropathy

Drug-diagnostic tests. Alkaline phosphatase, creatinine, lactate dehydrogenase, uric acid: increased levels

Platelets: decreased count

Patient monitoring

• Obtain CBC with platelet count before starting therapy; monitor these counts often thereafter.
• Monitor cardiovascular status carefully.
• Assess for signs and symptoms of sickle cell crisis and splenic rupture.

Patient teaching

• Teach patient how to recognize and promptly report signs and symptoms of allergic response.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to discuss possible need for iron supplements, vitamin B₁₂, and folic acid with prescriber.
• Teach patient how to monitor blood pressure at home.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking adequate fluids.
• Tell female patient to inform prescriber if she is breastfeeding.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.