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Related to filgrastim: Sargramostim
Pharmacologic class: Granulocyte colony-stimulating factor
Therapeutic class: Hematopoietic stimulator, antineutropenic
Pregnancy risk category C
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.
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
• Aplastic anemia
• Hairy cell leukemia
• Hypersensitivity to drug, its components, or Escherichia coli-derived proteins
Use cautiously in:
• patients receiving lithium or other drugs that can potentiate neutrophil release
• breastfeeding patients.
• 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.
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
Hematologic: leukocytosis, sickle cell crisis, thrombocytopenia, splenic rupture
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
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
• 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.
• 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.