Indications
Prevention of febrile neutropenia and associated infection
in patients who have received bone marrow–depressing
antineoplastics for the treatment of nonmyeloid
malignancies. Reduction of time for neutrophil
recovery and duration of fever in patients undergoing
induction and consolidation chemotherapy for acute
myelogenous leukemia. Reduction of time to neutrophil
recovery and sequelae of neutropenia in patients with
nonmyeloid malignancies undergoing myeloablative
chemotherapy followed by bone marrow transplantation.
Mobilization of hematopoietic progenitor cells
into peripheral blood for collection by leukapheresis.
Management of severe chronic neutropenia. Survival
improvement in patients acutely exposed to myelosuppressive
doses of radiation. Unlabeled Use: Neutropenia
associated with HIV infection. Neonatal neutropenia.
Action
A glycoprotein, filgrastim binds to and stimulates immature
neutrophils to divide and differentiate. Also activates
mature neutrophils. Therapeutic Effects: Decreased
incidence of infection in patients who are
neutropenic from chemotherapy or other causes. Improved
harvest of progenitor cells for bone marrow
transplantation. Improved survival in patients exposed
to myelosuppressive doses of radiation.
Pharmacokinetics
Absorption: Well absorbed after subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Adults—3.5 hr; Neonates—4.4 hr.
TIME/ACTION PROFILE
ROUTE ONSET PEAK DURATION
IV, subcut unknown unknown 4 days†
†Return of neutrophil count to baseline.
Contraindications/Precautions
Contraindicated in: Hypersensitivity to filgrastim
or Escherichia coli-derived proteins.
Use Cautiously in: Malignancy with myeloid characteristics;
Pre-existing cardiac disease; OB: Use only if
potential benefit justifies potential risk to fetus; Lactation:
Unlikely to adversely affect breast-fed infant.
Adverse Reactions/Side Effects
CV: vasculitis. GI: SPLENIC RUPTURE, splenomegaly.
EENT: hemoptysis. GU: glomerulonephritis. Hemat:
excessive leukocytosis, sickle cell crises, thrombocytopenia.
Resp: ACUTE RESPIRATORY DISTRESS SYNDROME,
pulmonary infiltrates. Local: ALLERGIC REACTIONS, pain,
redness at subcut site. MS: medullary bone pain.
Interactions
Drug-Drug: Simultaneous use with antineoplastics
may have adverse effects on rapidly proliferating neutrophils—
avoid use for 24 hr before and 24 hr after
chemotherapy. Lithium may potentiate the release of
neutrophils; concurrent use should be undertaken cautiously.
Route/Dosage
After Myelosuppressive Chemotherapy
IV, Subcut (Adults and Children): 5 mcg/kg/day as
a single subcut injection, by short IV infusion, or via
continuous IV infusion for up to 2 wk or until ANC
reaches 10,000/mm3. Initiate at least 24 hr after
chemotherapy. Dose may beqby 5 mcg/kg during each
cycle of chemotherapy, depending on blood counts.
After Bone Marrow Transplantation
IV (Adults): 10 mcg/kg/day as a continuous IV infusion
for up to 24 hr; initiate at least 24 hr after chemotherapy
and at least 24 hr after bone marrow transplantation.
Subsequent dose is adjusted according to blood
counts.
Peripheral Blood Progenitor Cell Collection
and Therapy
Subcut (Adults): 10 mcg/kg/day for at least 4 days before
first leukapheresis and continued until last leukapheresis;
Discontinue if WBC 100,000 cells/mm3.
Severe Chronic Neutropenia
Subcut (Adults): Congenital neutropenia—6 mcg/
kg twice daily. Idiopathic/cyclical neutropenia—5
mcg/kg daily (pif ANC remains 10,000/mm3).
After Myelosuppressive Radiation
Subcut (Adults): 10 mcg/kg once daily; initiate as
soon as possible after exposure to radiation doses
greater than 2 gray; continue until ANC remains 1000/
mm3 for 3 consecutive blood counts (performed q 3
days) or is 10,000/mm3 after a radiation-induced nadir.
Neonatal Neutropenia
IV, Subcut (Neonates): 5–10 mcg/kg/day once daily
for 3–5 days.
Availability
Injection: 300 mcg/1 mL, 480 mcg/1.6 mL. Prefilled
syringe: 300 mcg/0.5 mL, 480 mcg/0.8 mL.
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