Filgrastim

Drugs used in Neutropenia · Recombinant G-CSF (Recombinant human granulocyte-colony stimulating factor)

Indications

Reduction in the duration of neutropenia in bone marrow transplant patients or those who have received cytotoxic therapy. Mobilisation of peripheral blood progenitor cells (PBPCs) in patients undergoing myelosuppressive therapy followed by autologous PBPC transplantation. Treatment of severe congenital, cyclic or idiopathic neutropenia. Persistent neutropenia in patients with advanced HIV infection.

Dosage

Cytotoxic chemotherapy for malignancy (except chronic myeloid leukaemia and myelodysplastic syndromes): Adults: SC or IV inf: 5 mcg/kg daily until neutrophil count in normal range, for up to 14 days (up to 38 days in AML), to be initiated at least 24 hrs after cytotoxic chemotherapy. If given by IV inf, administer over 30 mins. Children: 1 mth-18 yr: Same as adults. Myeloablative therapy followed by BMT: Adults: SC or IV inf: 10 mcg/kg daily, to be initiated at least 24 hrs following cytotoxic chemotherapy and within 24 hrs of bone-marrow inf, then altered acc to neutrophil count (consult product literature). By IV, adm over 30 min or 24 hrs. By SC, adm over 24 hrs. Children: 1 mth-18 yr: Same as adults. Mobilisation of peripheral blood progenitor cells for autologous inf, used alone: Adults: SC inf/inj: 10 mcg/kg daily for 5-7 days. By SC inf, adm over 24 hrs. Children: 1 mth-18 yr:…

Administration

May be administered undiluted by SC or IVP administration. May also be administered by IV infusion over 15-60 min in D5W. For SC dose larger than 1 mL, divide and give in more than one site. Reconstitution: Filgrastim may be diluted in dextrose 5% in water to a concentration >15 mcg/mL for IV Infusion administration. Minimum concentration is 15 mcg/mL. Concentrations <15 mcg/mL require addition of albumin (1 mL of 5%)to the bag to prevent absorption to plastics/PVC. Compatibility: Standard diluent: >375 mcg/25 mL D5W. Stable in D5W; incompatible with NS. Stability: Store at 2°C-8°C (36°F-46°F). Avoid shaking prior to injection, filgrastim may be allowed to reach room temperature for a maximum of 24 hours. Any vial or prefilled syringe left at room temperature for more than 24 hours should be discarded.

Adverse Effects

Anorexia, headache, asthaenia, fever, musculoskeletal pain, bone pain, rash, alopecia, thrombocytopenia, leukocytosis. interstitial pneumonia, cutaneous vasculitis, acute febrile neutrophilic dermatitis. Splenic enlargement, hepatomegaly, transient hypotension, epistaxis, urinary abnormalities, osteoporosis, exacerbation of rheumatoid arthritis, anaemia, transient decrease in blood glucose, pseudogout and raised uric acid. Infection, muscle spasm, dizziness, insomnia, oropharyngeal pain, cough, dyspnoea, GI upset, fatigue, pyrexia, mucosal inflammation, hypertension, haemoptysis, dysuria, chest pain, hypoglycaemia, hypoaesthesia, paraesthesia, haematuria, peripheral oedema, cutaneous vasculitis, glomerulonephritis, lactic dehydrogenase and LFTs, inj site reactions. Reports of aortitis.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Severe congenital neutropenia (Kostmann's syndrome) with abnormal cytogenetics. Myelodysplastic syndrome, chronic myelogenous leukaemia, de novo acute myeloid leukaemia with good cytogenetics. Precautions: Patients with pre-malignant or malignant myeloid conditions. Withdraw in patients who develop pulmonary infiltration. Sickle-cell disease. Monitor spleen size because of risk of splenomegaly and rupture. Secondary AML. Underlying osteoporotic bone disease; monitor bone density if treatment duration exceeds six month. Risk of capillary leak syndrome. Monitor WBC, platelets and haematocrit. Severe chronic neutropenia: perform morphologic and cytogenetic bone marrow examinations approx annually and regular urinalysis. HIV, sickle cell disease. Elderly.

Interactions

Fluorouracil.

Advice to Patient

If patient is self-administering this medication, exact directions for subcutaneous administration and proper storage of medication must be followed. Contact prescriber if there is unusual fever or chills, unhealed sores, pain/redness/swelling at injection site, severe bone pain, unusual swelling of extremities or respiratory difficulty, pain in left upper quadrant of abdomen, shoulder-tip pain, chest pain or palpitations. Do not re-use needles, syringes or vials. Follow-up laboratory tests as advised by prescriber. Use soft toothbrush and cotton swab to reduce sore mouth.

Pharmacokinetics

Onset of action: 1-2 days. Duration: Neutrophil counts generally return to baseline within 4 days. Metabolism: Systemically degraded. Bioavailability: SC: 60%-70%. Half-life elimination: Neonates: 4.4 ± 0.4 hrs. Adults: Approx. 3.5 hrs. Time to peak, serum: SC: 2-8 hrs.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.