Names and pronunciation
(peg-fill-grass′stim) Neulasta, Neulasta Onpro Kit Nyvepria Ziextenzo Udenyca (biosimilar) Fulphila (biosimilar)
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Drug reference
(peg-fill-grass′stim) Neulasta, Neulasta Onpro Kit Nyvepria Ziextenzo Udenyca (biosimilar) Fulphila (biosimilar)
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Func. class.: Hematopoietic agent
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Chem. class.: Granulocyte colony- stimulating factor
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Do not confuse: Neulasta/Lunesta/Neumega/Nuedexta
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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 count in patients with product-induced neutropenia
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CONTRAINDICATIONS: Hyper sensitivity to proteins of Escherichia coli, filgrastim Precautions: Pregnancy, breastfeeding, children <45 kg, adolescents, myeloid malignancies, sickle cell disease, leuko- cytosis, splenic rupture, ARDS, allergic- type reactions, peripheral blood stem cell (PBSC) mobilization
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SIDE EFFECTS CNS: Fever, fatigue, headache, dizziness, insomnia, peripheral edema GI: Splenic rupture HEMA: Leukocytosis INTEG: Alopecia MISC: Chest pain, hyperuricemia, ana- phylaxis, capillary leak syndrome GU: Glomerulonephritis MS: Skeletal pain RESP: Respiratory distress syndrome
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INTERACTIONS • Do not use product concomitantly, 2 wk before, or 24 hr after administration of cytotoxic chemotherapy Increase: release of neutrophils—lithium Drug/Lab Test Increase: uric acid, LDH, alk phos
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DOSAGE AND ROUTES • Adult/child >45 kg: SUBCUT 6 mg per chemotherapy cycle, give ≥24 hr after cytotoxic chemotherapy
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Available forms: Sol for inj 6 mg/0.6 mL
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Administer: SUBCUT route • Using single-use vials; after dose is withdrawn, do not reenter vial • Do not use 6-mg fixed dose in infants, children, or others <45 kg • Inspect sol for discoloration, particu- lates; if present, do not use • Do not administer during the period 14 days before and 24 hr after cytotoxic chemotherapy • Store in refrigerator; do not freeze; may store at room temperature up to 6 hr; avoid shaking, protect from light
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Assess: • Allergic reactions, anaphylaxis: rash, urticaria; discontinue product, have emergency equipment nearby • ARDS: dyspnea, fever, tachypnea, occa- sionally confusion; obtain ABGs, chest x- ray; product may need to be discontinued • Systemic rupture: upper left quadrant abdominal pain, dizziness, confusion, drop in B/P, pallor • Sickle cell crisis in those with sickle cell disease (may be fatal) • Capillary leak syndrome: edema, hemoconcentration, hypotension, hypoal- buminemia, treatment in ICU may be re- quired • Bone pain: give mild analgesics • Blood studies: CBC with differential, platelet count before treatment, 2× weekly; neutrophil counts may be in- creased for 2 days after therapy • B/P, respirations, pulse before and during therapy • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; pregnant women should enroll in Amgen’s Pregnancy Surveil- lance Program, 1-800-772-6436; cautious use in breastfeeding, excretion unknown
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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: • How to perform the technique for self- administration if product to be given at home: dose, side effects, disposal of contain- ers and needles; provide instruction sheet • To notify prescriber immediately of allergic reaction, trouble breathing, abdominal pain HIGH ALERT
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PHARMACOKINETICS Half-life: 15-80 hr; 20-38 hr (children)
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• Adult/child >45 kg: SUBCUT 6 mg per chemotherapy cycle, give ≥24 hr after cytotoxic chemotherapy
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