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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.



Pharmacologic class: Granulocytic colony stimulating factor


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


Injection: 6 mg/0.6 ml in prefilled syringes

Indications and dosages

To reduce risk of infection in non-myeloid cancer patients who are receiving myelosuppressive drugs

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


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


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


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

Adverse reactions

CNS: headache, weakness, fatigue, dizziness, insomnia

CV: peripheral edema

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

Hematologic: leukocytosis, granulo-cytopenia

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


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.


(peg-fil-gra-stim) ,


(trade name)


Therapeutic: colony stimulating factors
Pregnancy Category: C


To decrease the incidence of infection (febrile neutropenia) in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics associated with a high risk of febrile neutropenia.


Filgrastim is a glycoprotein that binds to and stimulates neutrophils to divide and differentiate. Also activates mature neutrophils. Binding to a polyethylene glycol molecule prolongs its effects.

Therapeutic effects

Decreased incidence of infection in patients who are neutropenic from chemotherapy.


Absorption: Well absorbed following subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 15–80 hr.

Time/action profile



Contraindicated in: Hypersensitivity to filgrastim or Escherichia coli-derived proteins.
Use Cautiously in: Patients with sickle cell disease (↑ risk of sickle cell crisis);Concurrent use of lithium;Malignancy with myeloid characteristics; Obstetric / Lactation: Pregnancy or lactation; Pediatric: 6 mg fixed dose should not be used in infants, children, and adolescents weighing <45 kg.

Adverse Reactions/Side Effects


  • adult respiratory distress syndrome (ards) (life-threatening)


  • splenic rupture (life-threatening)


  • sickle cell crisis (life-threatening)
  • leukocytosis


  • medullary bone pain (most frequent)


  • allergic reaction including anaphylaxis (life-threatening)


Drug-Drug interaction

Simultaneous use with antineoplastics may have adverse effects on rapidly proliferating neutrophils; avoid use for 24 hr before and 24 hr following chemotherapy.Lithium may potentiate the release of neutrophils; concurrent use should be undertaken cautiously.


Subcutaneous (Adults and Children >45 kg) 6 mg per chemotherapy cycle.


Solution for injection: 6 mg/0.6 mL in prefilled syringes

Nursing implications

Nursing assessment

  • Assess patient for bone pain throughout therapy. Pain is usually mild to moderate and controllable with nonopioid analgesics, but may require opioid analgesics.
  • Assess patient periodically for signs of ARDS (fever, lung infiltration, respiratory distress). If ARDS occurs, treat condition and discontinue pegfilgrastim and/or withold until symptoms resolve.
  • Lab Test Considerations: Obtain CBC and platelet count before chemotherapy. Monitor hematocrit and platelet count regularly.
    • May cause elevated LDH, alkaline phosphatase, and uric acid.

Potential Nursing Diagnoses

Risk for infection (Indications)
Acute pain (Side Effects)


  • Do not confuse Neulasta (pegfilgrastim) with Lunesta (eszopiclone) or Neumega (oprelvekin).
  • Pegfilgrastim should not be administered between 14 and 24 days after administration of cytotoxic chemotherapy.
    • Keep patients with sickle cell disease receiving pegfilgrastim well hydrated and monitor for sickle cell crisis.
  • Subcutaneous: Administer subcut once per chemotherapy cycle. Do not administer solutions that are discolored or contain particulate matter. Do not shake. Store refrigerated; may be allowed to reach room temperature for a maximum of 48 hr, but protect from light.
    • Supplied in prefilled syringes. Following administration, activate UltraSafe Needle Guard to prevent needle sticks by placing hands behind needle, grasping guard with one hand, and sliding guard forward until needle is completely covered and guard clicks into place. If audible click is not heard, guard may not be completely activated. Dispose of by placing entire prefilled syringe with guard activated into puncture-proof container.

Patient/Family Teaching

  • Advise patient to notify health care professional immediately if signs of allergic reaction (shortness of breath, hives, rash, pruritus, laryngeal edema) or signs of splenic rupture (left upper abdominal or shoulder tip pain) occur.
  • Emphasize the importance of compliance with therapy and regular monitoring of blood counts.
  • Home Care Issues: Instruct patient on correct disposal technique for home administration. Caution patient not to reuse needle, syringe, or drug product. Provide patient with a puncture-proof container for disposal of prefilled syringe.

Evaluation/Desired Outcomes

  • Decreased incidence of infection in patients who receive bone marrow–depressing antineoplastics.


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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References in periodicals archive ?
Additional data from the study showed that there were no clinically meaningful differences between the proposed biosimilar pegfilgrastim and the reference product.
In addition, Sandoz, a Novartis company and the global leader in biosimilars, will present data from PROTECT 2, one of their pivotal Phase III trials investigating use of their proposed pegfilgrastim biosimilar in patients with chemotherapy-induced neutropenia.
Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin's lymphoma: cost-effectiveness analyses.
Myeloid growth factors currently used for the prophylaxis of febrile neutropenia and maintenance of scheduled dose delivery include filgrastim, pegfilgrastim (category 1), and sargramostim (category 2B).
Methods: Thirteen consecutive patients undergoing peripheral blood progenitor cell transplantation for hematologic malignancy received a single 6-mg injection of pegfilgrastim after chemotherapy.
Pegfilgrastim, which goes by the trade name Neulasta, reduces infectious complications of neutropenia, enabling cancer patients to receive greater dose intensity chemotherapy, thus increasing their chance of prolonged survival or even cure, as discussed by other researchers at the meeting, also sponsored by the American Gastroenterological Association, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.
The Swiss company said it sold part of its European filgrastim and pegfilgrastim business amid the planned merger of its Japanese subsidiary with Chugai, another Japanese company.
Severe and sometimes fatal sickle cell crises can occur in patients with sickle cell disorders receiving filgrastim, the parent compound of pegfilgrastim.
2) Of the top 15 hospital drug expenditures, one was an antineoplastic agent (rituximab) and five were oncology-related supportive care agents (epoetin alfa, darbeopoetin, pegfilgrastim, ondansetron, and filgrastim).
The United States is the first country where Neulasta, known generically as pegfilgrastim, is approved.
In both phase III breast cancer studies the primary endpoint was achieved, demonstrating reduction in the duration of severe neutropenia (DSN) in cycle 1, comparable to pegfilgrastim results in both efficacy and safety measures.
as a result of acquiring the licenses to filgrastim and pegfilgrastim effective January 1, 2014.