Names and pronunciation
(fill-grass′stim) Grastofil , Neupogen, Nivestym, Zarxio, Granix
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Drug reference
(fill-grass′stim) Grastofil , Neupogen, Nivestym, Zarxio, Granix
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Func. class.: Biologic modifier
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Chem. class.: Granulocyte colony- stimulating factor
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ACTION: Stimulates proliferation and differentiation of neutrophils
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USES: To decrease infection in patients receiving antineoplastics that are myelosuppressive; to increase WBC in patients with product-induced neutrope- nia; bone marrow transplantation, acute radiation exposure
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Unlabeled uses: Neutropenia with HIV infection, aplastic anemia, ganciclovir- F induced neutropenia, zidovudine- induced neutropenia
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CONTRAINDICATIONS: Hyper- sensitivity to proteins of Escherichia coli Precautions: Pregnancy, breastfeeding, children, myeloid malignancies, radia- tion therapy, sepsis, sickle cell disease, chemotherapy, respiratory disease
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SIDE EFFECTS CNS: Fever, headache GI: Nausea, vomiting, diarrhea, mucosi- tis, anorexia, splenic rupture HEMA: Thrombocytopenia, excessive leukocytosis INTEG: Alopecia, exacerbation of skin conditions, urticaria, cutaneous vasculi- tis, allergic reactions MS: Osteoporosis, skeletal pain OTHER: Chest pain, hypotension RESP: Acute respiratory distress syn- drome, wheezing, alveolar hemorrhage
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INTERACTIONS Increase: adverse reactions—do not use this product concomitantly with antineo- plastics, lithium Drug/Lab Test Increase: uric acid, LDH, alk phos, WBC
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DOSAGE AND ROUTES After myelosuppressive chemotherapy (Neupogen, Nivestym, Zarxio) • Adult and child: IV/SUBCUT 5 mcg/ kg/day in a single dose × up to 14 days; may increase by 5 mcg/kg with each cycle After myelosuppressive doses of radiation (Neupogen) • Adult and child >7 mo: SUBCUT 10 mcg/kg/day, start as soon as possible af- ter receiving ≥2 Gy After bone marrow transplantation (Neupogen, Nivestym, Zarxio) • Adult: IV/SUBCUT 10 mcg/kg/day as INFUSION (IV) over 4 hr or 24 hr; be- gin 24 hr after chemotherapy and 24 hr after bone marrow transplantation Peripheral blood progenitor cell collection/therapy (Neupogen, Nivestym, Zarxios) • Adult: 10 mcg/kg/day as bolus or CONT INFUSION × ≥4 days before leukapheresis, continue to last leuka- pheresis; may alter dose if WBC >100,000 cells/mm3 Severe neutropenia (chronic) (Neupogen, Nivestym, Zarxios) • Adult: SUBCUT 5 mcg/kg daily Neonatal neutropenia • Neonate: IV/SUBCUT 5-10 mcg/kg/day × 3-5 days
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Available forms: Inj 300 mcg/mL, 480 mcg/1.6 mL; vials 300 mcg/0.5 mL, 480 mcg/0.8 mL
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Administer: • Given by subcut inj, short IV infusion, or continuous SC or IV infusion • Avoid use within 24 hr before or after chemotherapy • Do not shake commercial single-dose vials before withdrawing the dose; if the vial is shaken and froth or bubbles form, allow the vial to stand undisturbed for a few minutes until the froth or bubbles dissipate • Before injection, filgrastim may be al- lowed to reach room temperature for a maximum of 24 hr; any vial or syringe exposed to room temperature for more than 24 hr should be discarded • Visually inspect for particulate matter and discoloration before use • Store in refrigerator; do not freeze; may store at room temperature up to 24 hr SUBCUT route • Subcut inj: no dilution is necessary; inject by rapid subcut inj, taking care not to inject intradermally; inject into abdo- men, upper outer buttock, upper outer arms, rotate sites • Subcut continuous infusion: infuse subcut at a rate not to exceed 2 mL/hr (after bone transplant) IV route • May be diluted with 5% dextrose; do not dilute with NS; product can precipitate • May be diluted to concentrations 5-15 mcg/mL; should be protected from ad- sorption to plastic by the addition of al- bumin to a final albumin concentration of 2 mg/mL; do not dilute filgrastim to a concentration <5 mcg/mL • IV infusion: infuse IV over 15-30 min or as a continuous infusion, chemother- apy after bone transplant over 4-24 hr Y-site compatibilities: Acyclovir, allopuri- nol, amikacin, aminophylline, ampicillin, ampicillin/sulbactam, aztreonam, bleo- mycin, bumetanide, buprenorphine, bu- torphanol, calcium gluconate, CARBO- platin, carmustine, ceFAZolin, cefoTEtan, cefTAZidime, chlorproMAZINE, cimeti- dine, CISplatin, cyclophosphamide, cyt arabine, dacarbazine, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOXOrubicin, doxycycline, droperidol, enalaprilat, famotidine, floxuridine, flu conazole, fludarabine, gallium, ganciclo- vir, granisetron, haloperidol, hydrocortisone, HYDROmorphone, hy- drOXYzine, IDArubicin, ifosfamide, leu- covorin, LORazepam, mechlorethamine, melphalan, meperidine, mesna, metho- trexate, metoclopramide, miconazole, minocycline, mitoXANtrone, morphine, nalbuphine, netilmicin, ondansetron, plicamycin, potassium chloride, pro- methazine, ranitidine, sodium bicarbon- ate, streptozocin, ticarcillin, ticarcillin/ clavulanate, tobramycin, trimethoprim- sulfamethoxazole, vancomycin, vinBLAS- tine, vinCRIStine, vinorelbine, zidovudine
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Assess: • Blood studies: CBC, platelet count be- fore treatment and twice weekly; neutro- phil counts drop by 50% if filgrastim is discontinued the next day • B/P, respirations, pulse before and dur- ing therapy • Bone pain; give mild analgesics • Respiratory distress syndrome: fe- ver, dyspnea; withhold product if these occur • Allergic reactions: rash, wheezing, facial edema, dyspnea; may occur within 30 min of use; give antihistamines, bron- chodilators, and EPINEPHrine if needed • Splenic rupture: severe left upper ab- dominal pain • Pregnancy/breastfeeding: may cause fetal harm; if used in pregnancy, enroll in Amgen’s Surveillance Program, 1-800- 772-6436
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Evaluate: • Therapeutic response: absence of in- fection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the technique for self-adminis- tration: dose, side effects, disposal of containers and needles; provide instruc- tion sheet • That bone pain is common
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PHARMACOKINETICS SUBCUT: Onset 5-60 min, peak 2-8 hr, duration up to 1 wk IV: Onset 5-60 min, peak 24 hr, duration up to 1 wk
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• Adult and child: IV/SUBCUT 5 mcg/ kg/day in a single dose × up to 14 days; may increase by 5 mcg/kg with each cycle After myelosuppressive doses of radiation (Neupogen)
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• Adult and child >7 mo: SUBCUT 10 mcg/kg/day, start as soon as possible af- ter receiving ≥2 Gy After bone marrow transplantation (Neupogen, Nivestym, Zarxio)
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