Filgrastim

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Generic Name: Filgrastim Brand Name(s): Filgrastim.

Uses

What is Filgrastim used for?

Filgrastim is a man-made version of a certain natural substance made in your body. It is used to help your body make more white blood cells. White blood cells are important to help you fight off infections. Filgrastim is given to people whose ability to make white blood cells is reduced (for instance, due to chemotherapy, chronic neutropenia, or exposure to large amounts of radiation). It is also used in certain treatment procedures (such as bone marrow/stem cell transplant).

How should I take Filgrastim?

This medication is given by injection under the skin or into a vein as directed by your doctor, usually once a day. The dosage is based on your medical condition, weight, lab tests, and response to treatment.

If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product package. Take the medication out of the refrigerator at least 30 minutes before you inject it to allow it to reach room temperature. Do not shake the medication. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.

If you are injecting this drug under the skin, first clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin. Do not inject filgrastim into skin that is bruised, tender, red, hard, or that has scars or stretch marks.

Learn how to store and discard medical supplies safely.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.

If you are receiving cancer chemotherapy, you should not use this medication within 24 hours before or 24 hours after chemotherapy. Ask your doctor for specific directions about when to use this medication.

How do I store Filgrastim?

Filgrastim is best stored in the refrigerator. To prevent drug damage, do not freeze. There may be different brands of Filgrastim that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Filgrastim down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Filgrastim?

Before using filgrastim, tell your doctor or pharmacist if you are allergic to it; or to tbo-filgrastim, filgrastim-sndz, or pegfilgrastim; or if you have any other allergies. This product may contain inactive ingredients (such as dry natural rubber/latex in the needle cover on the prefilled syringe), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: sickle cell disease, spleen problems, radiation treatment.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Filgrastim during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Filgrastim. Filgrastim is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Filgrastim?

Aching or pain in the bones and muscles may occur. Taking a non-aspirin pain reliever such as acetaminophen may help relieve pain. Ask your doctor or pharmacist for more details. Redness, swelling, itching, or bruising at the injection site may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: easy bleeding/bruising, pink/bloody urine, bloody vomit, fast heartbeat, fever, purple or red spots on your skin.

Get medical help right away if you have any very serious side effects, including: breathing problems (such as trouble breathing, fast breathing, shortness of breath), unusual decrease in urination, unusual tiredness, swelling/puffiness of the body.

Rarely, serious (possibly fatal) damage to the spleen may occur. Get medical help right away if you develop stomach/abdominal pain or shoulder pain.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Filgrastim?

Filgrastim is very similar to tbo-filgrastim, filgrastim-sndz, and pegfilgrastim. Do not use tbo-filgrastim, filgrastim-sndz, or pegfilgrastim while using filgrastim.

This medication may interfere with certain lab tests (such as bone imaging tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Filgrastim may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Filgrastim?

Filgrastim may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Filgrastim?

Filgrastim may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Filgrastim.

What is the dose of Filgrastim for an adult?

Usual Adult Dose for Neutropenia Associated with Chemotherapy

5 mcg/kg/day as a single daily subcutaneous bolus injection, or short IV infusion (15 to 30 minutes), or by continuous IV infusion; doses may be increased by 5 mcg/kg for each chemotherapy cycle according to the duration and severity of the absolute neutrophil count (ANC) nadir; stop therapy if the ANC increases beyond 10,000/mm3

Duration of therapy: Up to 2 weeks or until the ANC has reached 10,000/mm3 following the expected chemotherapy-induced neutrophil nadir (a transient increase in neutrophil count is typically seen 1 to 2 days after initiation of therapy)

Comments:

-A CBC and platelet count should be obtained before instituting therapy and monitored twice weekly during therapy.

-Do not administer this drug during the period 24 hours before or 24 hours after the administration of cytotoxic chemotherapy.

-The duration of therapy needed to attenuate chemotherapy-induced neutropenia may be dependent on the myelosuppressive potential of the chemotherapy regimen used.

Uses:

-To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever

-To reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML)

Usual Adult Dose for Bone Marrow Transplantation

10 mcg/kg/day IV over no longer than 24 hours

During the period of neutrophil recovery, titrate the daily dosage against the neutrophil response:

-If ANC greater than 1000/mm3 for 3 consecutive days, reduce the dose to 5 mcg/kg/day.

-If ANC remains greater than 1000/mm3 for 3 more consecutive days, discontinue therapy.

-If ANC decreases to less than 1000/mm3, resume therapy at 5 mcg/kg/day. Note: If ANC decreases to less than 1000/mm3 at any time during the 5 mcg/kg/day administration, increase the dose to 10 mcg/kg/day, and then follow the above steps.

Comments:

-Administer the first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion.

-Frequent CBCs and platelet counts are recommended (at least 3 times per week) following marrow transplantation.

Use: To reduce the duration of neutropenia and neutropenia-related clinical sequelae (e.g., febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation

Usual Adult Dose for Peripheral Progenitor Cell Transplantation

10 mcg/kg/day subcutaneously for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis

Duration of therapy: Although the optimal duration of administration and leukapheresis schedule have not been established, administration for 6 to 7 days with leukaphereses on days 5, 6, and 7 was found to be safe and effective.

Comment:

-Neutrophil counts should be monitored after 4 days of therapy, and therapy should be discontinued if the white blood cell (WBC) count rises to greater than 100,000/mm3.

Use: For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis

Usual Adult Dose for Neutropenia

Congenital Neutropenia:

Initial dose: 6 mcg/kg subcutaneously twice a day

Median dose: 6 mcg/kg/day subcutaneously

Maximum dose: In rare instances, patients have required doses greater than 100 mcg/kg/day subcutaneously

Idiopathic or Cyclic Neutropenia:

Initial dose: 5 mcg/kg subcutaneously once a day

Median dose:

-Cyclic neutropenia: 2.1 mcg/kg/day subcutaneously

-Idiopathic neutropenia: 1.2 mcg/kg/day subcutaneously

Comments:

-Prior to starting therapy in patients with suspected chronic neutropenia, the diagnosis of severe chronic neutropenia (SCN) should be confirmed by evaluating serial CBCs with differential and platelet counts, and evaluating bone marrow morphology and karyotype. Starting therapy prior to confirmation of a correct diagnosis of SCN may impair diagnostic efforts and may thus impair or delay evaluation and treatment of an underlying condition (other than SCN) causing the neutropenia.

-Chronic daily administration is required to maintain clinical benefit.

-The dose should be individually adjusted based on the patient’s clinical course as well as ANC.

-During the initial 4 weeks of therapy and during the 2 weeks following any dose adjustment, a CBC with differential and platelet count should be performed twice weekly.

-Once a patient is clinically stable, a CBC with differential and platelet count should be performed monthly for the first year of treatment. Thereafter, if clinically stable, routine monitoring with regular CBCs (i.e., as clinically indicated but at least quarterly) is recommended.

-For those patients with congenital neutropenia, annual bone marrow and cytogenetic evaluations should be performed throughout the duration of treatment.

Use: For chronic administration to reduce the incidence and duration of sequelae of neutropenia (e.g., fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia

Usual Adult Dose for Neutropenia Associated with Radiation

10 mcg/kg subcutaneously once daily for patients exposed to myelosuppressive doses of radiation; administer as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 gray (Gy)

Duration of therapy: Continue administration until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs or exceeds 10,000/mm3 after a radiation-induced nadir

Comments:

-Estimate the patient’s absorbed radiation dose (i.e., level of radiation exposure) based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.

-Obtain a baseline CBC and then serial CBCs approximately every third day until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs; therapy should not be delayed if a CBC is not readily available.

Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended

What is the dose of Filgrastim for a child?

Usual Pediatric Dose for Neutropenia Associated with Chemotherapy

5 mcg/kg/day as a single daily subcutaneous bolus injection, or short IV infusion (15 to 30 minutes), or by continuous IV infusion; doses may be increased by 5 mcg/kg for each chemotherapy cycle according to the duration and severity of the absolute neutrophil count (ANC) nadir; stop therapy if the ANC increases beyond 10,000/mm3

Duration of therapy: Up to 2 weeks or until the ANC has reached 10,000/mm3 following the expected chemotherapy-induced neutrophil nadir (a transient increase in neutrophil count is typically seen 1 to 2 days after initiation of therapy)

Comments:

-A CBC and platelet count should be obtained before instituting therapy and monitored twice weekly during therapy.

-Do not administer this drug during the period 24 hours before or 24 hours after the administration of cytotoxic chemotherapy.

-The duration of therapy needed to attenuate chemotherapy-induced neutropenia may be dependent on the myelosuppressive potential of the chemotherapy regimen used.

Uses:

-To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever

-To reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML)

Usual Pediatric Dose for Bone Marrow Transplantation

10 mcg/kg/day IV over no longer than 24 hours

During the period of neutrophil recovery, titrate the daily dosage against the neutrophil response:

-If ANC greater than 1000/mm3 for 3 consecutive days, reduce the dose to 5 mcg/kg/day

-If ANC remains greater than 1000/mm3 for 3 more consecutive days, discontinue therapy

-If ANC decreases to less than 1000/mm3, resume therapy at 5 mcg/kg/day Note: If ANC decreases to less than 1000/mm3 at any time during the 5 mcg/kg/day administration, increase the dose to 10 mcg/kg/day, and then follow the above steps.

Comments:

-Administer the first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion.

-Frequent CBCs and platelet counts are recommended (at least 3 times per week) following marrow transplantation.

Use: To reduce the duration of neutropenia and neutropenia-related clinical sequelae (e.g., febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation

Usual Pediatric Dose for Peripheral Progenitor Cell Transplantation

10 mcg/kg/day subcutaneously for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis

Duration of therapy: Although the optimal duration of administration and leukapheresis schedule have not been established, administration for 6 to 7 days with leukaphereses on days 5, 6, and 7 was found to be safe and effective.

Comments:

-Neutrophil counts should be monitored after 4 days of therapy, and therapy should be discontinued if the white blood cell (WBC) count rises to greater than 100,000/mm3.

Use: For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis

Usual Pediatric Dose for Neutropenia

Congenital Neutropenia:

Initial dose: 6 mcg/kg subcutaneously twice a day

Median dose: 6 mcg/kg/day subcutaneously

Idiopathic or Cyclic Neutropenia:

Initial dose: 5 mcg/kg subcutaneously once a day

Median dose:

-Cyclic neutropenia: 2.1 mcg/kg/day subcutaneously

-Idiopathic neutropenia: 1.2 mcg/kg/day subcutaneously

Comments:

-Prior to starting therapy in patients with suspected chronic neutropenia, the diagnosis of severe chronic neutropenia (SCN) should be confirmed by evaluating serial CBCs with differential and platelet counts, and evaluating bone marrow morphology and karyotype. Starting therapy prior to confirmation of a correct diagnosis of SCN may impair diagnostic efforts and may thus impair or delay evaluation and treatment of an underlying condition (other than SCN) causing the neutropenia.

-Chronic daily administration is required to maintain clinical benefit.

-The dose should be individually adjusted based on the patient’s clinical course as well as ANC.

-During the initial 4 weeks of therapy and during the 2 weeks following any dose adjustment, a CBC with differential and platelet count should be performed twice weekly.

-Once a patient is clinically stable, a CBC with differential and platelet count should be performed monthly for the first year of treatment. Thereafter, if clinically stable, routine monitoring with regular CBCs (i.e., as clinically indicated but at least quarterly) is recommended.

-For those patients with congenital neutropenia, annual bone marrow and cytogenetic evaluations should be performed throughout the duration of treatment.

Use: For chronic administration to reduce the incidence and duration of sequelae of neutropenia (e.g., fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia

Usual Pediatric Dose for Neutropenia Associated with Radiation

10 mcg/kg subcutaneously once daily for patients exposed to myelosuppressive doses of radiation; administer as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 gray (Gy)

Duration of therapy: Continue administration until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs or exceeds 10,000/mm3 after a radiation-induced nadir

Comments:

-Estimate the patient’s absorbed radiation dose (i.e., level of radiation exposure) based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.

-Obtain a baseline CBC and then serial CBCs approximately every third day until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs; therapy should not be delayed if a CBC is not readily available.

Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation

How is Filgrastim available?

Filgrastim is available in the following dosage forms and strengths:

  • Injectable Solution

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Filgrastim, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: February 1, 2018 | Last Modified: February 1, 2018

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