pegfilgrastim

pegfilgrastim

[peg-fil-gras′tim]

a long-acting colony-stimulating factor produced by recombinant technology and used as an adjunct in patients with bone marrow suppression caused by antineoplastic therapy.

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pegfilgrastim [peg″-fil-gras´tim]

a long-acting colony-stimulating factor produced by recombinant technology and used as an adjunct in patients with bone marrow suppression caused by antineoplastic therapy.

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pegfilgrastim

Neulasta

Pharmacologic class: Granulocytic colony stimulating factor

Therapeutic class: Hematopoietic drug

Pregnancy risk category C

Action

Binds to specific cell-surface receptors on hematopoietic cells, stimulating their proliferation and differentiation in bone marrow

Availability

Injection: 6 mg/0.6 ml in prefilled syringes

⊘Indications and dosages

➣ To reduce risk of infection in nonmyeloid cancer patients who are receiving myelosuppressive drugs

Adults: 6 mg subcutaneously as a single dose once per chemotherapy cycle

Contraindications

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

Precautions

Use cautiously in:
• myeloid cancers, sickle cell disease
• patients undergoing chemotherapy or radiation
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Inspect solution for particles; discard if particles or discoloration appear.
• Don't give 14 days before to 24 hours after administration of cytotoxic chemotherapy.

Route	Onset	Peak	Duration
Subcut.	Variable	Variable	Variable

Adverse reactions

CNS: headache, weakness, fatigue, dizziness, insomnia

CV: peripheral edema

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, stomatitis, splenic rupture

Hematologic: leukocytosis, granulocytopenia

Musculoskeletal: bone pain, myalgia, joint pain

Respiratory: adult respiratory distress syndrome (ARDS) in septic patients

Skin: alopecia, mucositis

Other: taste perversion, allergic reaction, increased pain, fever, neutropenic fever, aggravation of sickle cell disease

Interactions

Drug-drug. Lithium: potentiation of neutrophil release

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

Patient monitoring

☞ Assess for signs and symptoms of impending splenic rupture, such as left upper abdominal quadrant or shoulder pain and splenic enlargement.
• Monitor vital signs and temperature.
☞ Watch for signs and symptoms of sepsis, ARDS, and neutropenic fever.
• Monitor CBC, uric acid level, and liver function tests.

Patient teaching

• Teach patient or caregiver how to administer injection and dispose of syringes at home, if appropriate.
☞ Teach patient to recognize and immediately report respiratory distress or signs and symptoms of splenic rupture.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct patient to have follow-up laboratory tests as needed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.