FILGRASTIM

(fil-gras'tim)

Neupogen
Classifications: blood former; hematopoietic growth factor;
Therapeutic: antineutropenic; granulocyte colony-stimulating factor (g-csf)
Pregnancy Category: C

Availability

300 mcg/mL injection

Action

Human granulocyte colony-stimulating factor (G-CSF) produced by recombinant DNA technology. Endogenous G-CSF regulates the production of neutrophils within the bone marrow; primarily affects neutrophil proliferation, differentiation, and selected end-cell functional activity (including enhanced phagocytic activity and antibody-dependent killing).

Therapeutic Effect

Increases neutrophil proliferation and differentiation within the bone marrow.

Uses

To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a significant incidence of severe neutropenia with fever; to decrease neutropenia associated with bone marrow transplant; to treat chronic neutropenia; to mobilize peripheral blood stem cells (PBSCs) for autologous transplantation.

Contraindications

Hypersensitivity to Escherichia coli–derived proteins, simultaneous administration with chemotherapy, radiation, or myeloid cancers; ARDS; pregnancy (category C).

Cautious Use

Sickle cell disease; lactation.

Route & Dosage

Neutropenia
Adult/Child: IV 5 mcg/kg/d by 30 min infusion, may increase by 5 mcg/kg/d (max: 30 mcg/kg/d) SC 5 mcg/kg/d as single dose, may increase by 5 mcg/kg/d (max: 20 mcg/kg/d)

Bone Marrow Transplant
Adult: IV 10 mcg/kg/d given 24 h after cytotoxic therapy and 24 h after bone marrow transfusion

Administration

Subcutaneous & Intravenous

Do not administer filgrastim 24 h before or after cytotoxic chemotherapy.
Use only one dose per vial; do not reenter the vial.
Prior to injection, filgrastim may be allowed to reach room temperature for a maximum of 6 h. Discard any vial left at room temperature for >6 h.

PREPARE: Intermittent/Continuous: May dilute with 10–50 mL D5W to yield 15 mcg/mL or greater. If more diluent is used to yield concentrations of 5–15 mcg/mL, 2 mL of 5% human albumin must be added for each 50 mL D5W (prior to adding filgrastim) to prevent adsorption to plastic IV infusion materials.

ADMINISTER: Intermittent: Give a single dose over 15–30 min. Continuous: Give a single dose over 4–24 h.

INCOMPATIBILITIES Y-site: Amphotericin B, cefepime, cefoperazone, cefotaxime, cefoxitin, ceftizoxime, ceftriaxone, cefuroxime, clindamycin, dactinomycin, etoposide, fluorouracil, furosemide, gentamicin, heparin, imipenem, mannitol, methylprednisolone, metronidazole, mitomycin, piperacillin, prochlorperazine, thiotepa.

Store refrigerated at 2°–8° C (36°–46° F). Do not freeze. Avoid shaking.

Adverse Effects (≥1%)

CV: Abnormal ST segment depression. Hematologic: Anemia. GI: Nausea, anorexia. Body as a Whole: Bone pain, hyperuricemia, fever.

Diagnostic Test Interference

Elevations in leukocyte alkaline phosphatase, serum alkaline phosphatase, lactate dehydrogenase, and uric acid have been reported. These elevations appear to be related to increased bone marrow activity.

Interactions

Drug: Can interfere with activity of cytotoxic agents, do not use 24 h before or after cytotoxic agents.

Pharmacokinetics

Absorption: Readily from SC site. Onset: 4 h. Peak: 1 h. Elimination: Probably in urine. Half-Life: 1.4–7.2 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Obtain a baseline CBC with differential and platelet count prior to administering drug. Obtain CBC twice weekly during therapy to monitor neutrophil count and leukocytosis. Monitor Hct and platelet count regularly.
Discontinue filgrastim if absolute neutrophil count exceeds 10,000/mm³ after the chemotherapy-induced nadir. Neutrophil counts should then return to normal.
Monitor patients with preexisting cardiac conditions closely. MI and arrhythmias have been associated with a small percent of patients receiving filgrastim.
Monitor temperature q4h. Incidence of infection should be reduced after administration of filgrastim.
Assess degree of bone pain if present. Consult physician if nonnarcotic analgesics do not provide relief.

Patient & Family Education

Report bone pain and, if necessary, to request analgesics to control pain.
Note: Proper drug administration and disposal are important. A puncture-resistant container for the disposal of used syringes and needles should be available to the patient.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(112)