Filgrastim

Filgrastim is used to prevent infections after chemotherapy. It is a growth factor that stimulates the bone marrow to produce white blood cells. These cells protect the body against infections.

Filgrastim is a granulocyte-colony stimulating factor which binds to cell surface receptors on haematopoietic cells thus stimulating the development of granulocytes to increase their migration and cytotoxicity.

• Chemotherapy-induced Neutropenia: Reduces incidence of infection in non-myeloid malignancies receiving myelosuppressive chemotherapy.
• Acute Myeloid Leukemia: Reduces time to neutrophil recovery and duration of fever in AML patients.
• Bone Marrow Transplantation: Reduces duration of neutropenia and neutropenia-related clinical sequelae.
• Severe Chronic Neutropenia: Reduces incidence and duration of sequelae in congenital, cyclic or idiopathic neutropenia.
• HIV Infection: Prevention and treatment of persistent neutropenia in advanced HIV infection.

Haematopoietic Agents

Granulocyte-Colony Stimulating Factor (G-CSF)

Filgrastim is a 175 amino acid human granulocyte colony-stimulating factor (G-CSF) manufactured by recombinant DNA technology. Filgrastim regulates the production of neutrophils within the bone marrow and affects neutrophil progenitor proliferation and differentiation. It also causes the enhanced phagocytic ability, priming of the cellular metabolism associated with respiratory burst, antibody-dependent killing and the increased expression of some cell surface antigens.

Filgrastim binds to receptors on hematopoietic cells, stimulating the development and activity of granulocytes, which enhances the body's defense against infections.

Adult Dose (Parenteral):

• Chemotherapy-induced neutropenia: 5 mcg/kg/day SC or IV (start not <24 hr after last antineoplastic); continue until neutrophil count normal (up to 14 days or more).
• Bone Marrow Transplantation: 10 mcg/kg/day IV infusion over 30 min or 4 hr or continuous IV or SC infusion over 24 hr.
• PBPC Mobilization: 10 mcg/kg/day SC for 4-7 days.
• Congenital Neutropenia: 12 mcg/kg/day (single or divided doses).
• HIV and Persistent Neutropenia: Initially 1 mcg/kg/day; may increase to 4 mcg/kg/day; maintenance: 300 mcg daily.

Your doctor or nurse will give you this medicine; do not self administer. Administered via SC or IV route. Store in refrigerator, protect from light, do not shake. For a more comfortable injection, leave syringe at room temperature for 30 minutes before use.

If you miss a dose of Filgrastim, please consult your doctor.

Common Side Effects:

• Bone pain
• Weakness
• Headache
• Rash
• Nausea
• Increased lactate dehydrogenase
• Vomiting
• Increased uric acid
• Oropharyngeal pain
• Hair loss
• Fatigue
• Diarrhea
• Constipation
• Decreased appetite
• Cough
• Breathing problems

Precautions:

• Filgrastim may cause fatigue which may affect driving ability.
• Do not administer within 24 hours before and after chemotherapy.
• Possibility of Filgrastim acting as a growth factor for any tumor type cannot be excluded.
• Complete blood count recommended twice per week during treatment.
• Stop and inform doctor if fever, shortness of breath, fast breathing, or trouble breathing occurs.
• Pain or redness in injection area is common; inform doctor if lump, swelling, or bruising doesn't go away.

Contraindications:

• Hypersensitivity to E. coli derived proteins, Filgrastim or any component
• Myeloid malignancies
• Not to be used within 24 hr of cytotoxic chemotherapy
• Severe congenital neutropenia (Kostman's syndrome) with abnormal cytogenetics

Drug Interactions:

• Myelosuppressive antineoplastic agents: Caution required.
• Lithium (may potentiate neutrophil release): Use with caution.

Food Interactions: It is not known whether it is safe to consume alcohol with Filgrastim; consult your doctor.

Use in Pregnancy: Category C; animal studies have shown harmful effects; should be used only if clearly needed.

Use in Lactation: Filgrastim is probably safe; limited data suggests no significant risk to the baby.

Pediatric Use: Pediatric dosing established for chemotherapy, AML, SCN, etc.

Geriatric Use: No specific dosage adjustment is necessary for elderly patients.

Renal Impairment: Safe to use in patients with kidney disease; no dose adjustment recommended.

Hepatic Impairment: Safe to use in patients with liver disease; no dose adjustment recommended.

Overdose: Patients in BMT studies received up to 138 mcg/kg/day without toxic effects; maximum tolerated dose not determined.

Storage: Refrigerate at 2-8 degree C. Protect from light. Do not freeze and avoid shaking.

Filgrastim