PEGFILGRASTIM

PEGFILGRASTIM
(peg-fil-gras'tim)
Neulasta
Classifications: blood former; hematopoietic growth factor;
Therapeutic: hematopoietic growth factor

Prototype: Epoetin alfa
Pregnancy Category: C

Availability

10 mg/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, antibody-dependent killing, and the increased expression of some functions associated with cell-surface antigens).

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.

Contraindications

Hypersensitivity to E. coli–derived proteins, 14 d before or 24 h after administration of chemotherapy; myeloid cancers; splenomegaly; ARDS; pregnancy (category C); children weighing <45 kg.

Cautious Use

Sickle cell disease. For use in peripheral blood stem cells (PBSC) mobilization; neutropenic patients with sepsis; leukemia; concurrent lithium therapy; lactation.

Route & Dosage

Neutropenia
Adult (>45 kg): SC 6 mg once per chemotherapy cycle at least 24 h after chemotherapy

Administration

Subcutaneous
  • Do not administer pegfilgrastim in the period 14 d before or 24 h after cytotoxic chemotherapy.
  • Use only one dose per vial; do not reenter the vial.
  • Prior to injection, pegfilgrastim may be allowed to reach room temperature for a maximum of 6 h. Discard any vial left at room temperature for >6 h.
  • Aspirate prior to injection to avoid injection into a blood vessel. Inject SC; do not inject intradermally. Recommended injection sites include outer area of upper arms, abdomen (excluding 2-in. area around navel), front of middle thighs, and upper outer areas of the buttocks.
  • Do not recap needle. Slide needle guard over needle until it is completely covered and needle guard clicks into place.
  • Store refrigerated at 2°–8° C (36°–46° F). Do not freeze. Avoid shaking.

Adverse Effects (≥1%)

Body as a Whole: Bone pain, hyperuricemia, fever. Hematologic: Anemia. GI: Nausea, anorexia, increased LFTs. Body as a Whole: Bone pain, hyperuricemia, fever.

Interactions

Drug: Can interfere with activity of cytotoxic agents; do not use 14 d before or <24 h after cytotoxic agents; lithium may increase release of neutrophils.

Pharmacokinetics

Absorption: Readily absorbed from SC site. Half-Life: 15–80 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 pegfilgrastim 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 pegfilgrastim.
  • Monitor temperature q4h. Incidence of infection should be reduced after administration of pegfilgrastim.
  • 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, request analgesics to control pain.
  • Note: Proper drug administration and disposal is important. A puncture-resistant container for the disposal of used syringes and needles should be utilized.

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

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