plerixafor

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plerixafor

(ple-rix-a-fore) ,

Mozobil

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: hematopoietic stem cell mobilizers
Pregnancy Category: D

Indications

Mobilizes hematopoietic stem cells to peripheral blood for collection and use in autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma; used in combination with granulocyte-colony stimulation factor (G-CSF).

Action

Inhibits the CXCR-4 chemokine receptor, blocking it's binding ability. Inhibition decreases adherence of stem cells to bone marrow, freeing them up to mobilize to peripheral blood.

Therapeutic effects

Mobilization of stem cells to peripheral blood allowing collection.

Pharmacokinetics

Absorption: Well absorbed following subcut administration.
Distribution: Largely confined to extravascular fluid space.
Metabolism and Excretion: Not metabolized by the liver; 70% unchanged in urine.
Half-life: 5.3 hr.

Time/action profile (mobilization of cells)

ROUTEONSETPEAKDURATION
Subcutrapid10–14 hr*unknown
*With G-CSF pretreatment.

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Leukemia; Obstetric / Lactation: Pregnancy or lactation.
Use Cautiously in: Renal impairment (dose ↓ required if CCr ≤50 mL/min); Geriatric: Consider age-related ↓ in renal function and greater sensitivity to drug effects; Obstetric: Women with child-bearing potential; Pediatric: Safety and effectiveness not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • fatigue (most frequent)
  • headache (most frequent)
  • insomnia

Gastrointestinal

  • splenic rupture (life-threatening)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal distention/pain
  • constipation
  • dry mouth
  • dyspepsia
  • flatulence

Dermatologic

  • erythema
  • sweating

Hematologic

  • leukemia/tumor cell mobilization
  • thrombocytopenia

Local

  • injection site reactions (most frequent)

Musculoskeletal

  • musculoskeletal pain

Neurologic

  • oral hypoesthesia

Miscellaneous

  • anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Subcutaneous (Adults) Following pretreatment with G-CSF for 4 days—0.24 mg/kg once daily for up to 4 days (not to exceed 40 mg/day); use actual body weight to calculate dose.

Renal Impairment

Subcutaneous (Adults) Following pretreatment with G-CSF for 4 days—0.16 mg/kg once daily for up to 4 days (not to exceed 27 mg/day).

Availability

Solution for subcutaneous injection: 20 mg/mL

Nursing implications

Nursing assessment

  • Assess for splenic enlargement and potential rupture (left upper abdominal pain and/or scapular or shoulder pain) periodically during therapy.
  • Monitor for signs and symptoms of anaphylaxis (urticaria, periorbital swelling, dyspnea, hypoxia) during and for at least 30 min following administration. Discontinue therapy and treat symptomatically if symptoms occur.
  • Lab Test Considerations: Monitor WBC and platelets during therapy. May cause leukocytosis and thrombocytopenia.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Begin therapy after patient has received 4 days of G-CSF daily and approximately 11 hrs prior to initiation of apheresis.
  • Subcutaneous: Administer subcut daily for 4 days. Do not use solutions that are discolored or contain a precipitate. Vials are single use; discard any unused medication.

Patient/Family Teaching

  • Explain purpose of medication to patient.
  • Advise patient to report signs and symptoms of potential systemic reactions (urticaria, periorbital swelling, dyspnea, hypoxia) to health care professional.
  • Instruct patient to notify health care professional immediately if vasovagal reactions (orthostatic hypotension, syncope) occur during or shortly after injection.
  • Advise patient to notify health care professional if itching, rash, or reactions at injection site occur; may be treated with OTC medications.
  • May cause GI disorders including diarrhea, nausea, vomiting, flatulence, and abdominal pain. Advise patient to notify health care professional if GI disorders are severe.
  • Plerixafor is teratogenic. Caution female patients to use effective contraception during therapy and to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Increase in CD34+ cells/kg in peripheral blood prior to aphresis.