Adult Dosing
Chemotherapy-induced neutropenia
- 5 mcg/kg/day SC/IV; start the dose >24 hrs after Chemotherapy
- Titration: May increase dose by 5 mcg/kg per Chemotherapy cycle
- May D/C is ANC >100 for 4 days and after nadir
Bone marrow transplant associated neutropenia
- 10 mcg/kg/day IV ; infuse over 4 hrs or 24 hrs; start the dose >24 hrs after chemotherapy and at >24 hrs after bone marrow infusion
- Titration: Dose adjustment is based upon neutrophil response
Peripheral blood progenitor cell (PBPC) mobilization
- 10 mcg/kg/day IV; start dose 4 days before 1st leukapheresis, continue through last leukapheresis
Severe chronic neutropenia
- Congenital neutropenia : 6 mcg/kg SC bid; maintain the dose as per clinical benefit
- Idiopathic or cyclic neutropenia: 5 mcg/kg/day SC; maintain the dose as per clinical benefit
Pediatric Dosing
- Safety and effectiveness has not been established in pediatric patients
[Outline]
- Therapy may cause allergic-type reactions
- Therapy may cause splenic rupture. Therefore carefully evaluate for an enlarged spleen or splenic rupture in patients who report left upper abdominal or shoulder tip pain
- Patients should be evaluated for the possibility of ARDS during therapy as acute respiratory distress syndrome (ARDS) has been reported in patients receiving the therapy. Institute appropriate therapy in such conditions
- Incidences of alveolar hemorrhage manifesting as pulmonary infiltrates and hemoptysis requiring hospitalization have been reported with the therapy. Therefore therapy is not indicated for PBPC mobilization in healthy donors
- Institute therapy only under physicians qualified by specialized training or experience in the treatment of patients with sickle cell disorders because severe sickle cell crises, in some cases resulting in death, have been associated with the use of therapy
- Safety and efficacy in treatment of neutropenia due to other hematopoietic disorders (myelodysplastic syndromes) has not been established; caution should be exercised in such cases.
- Patients treated with filgrastim are at risk of cytogenic abnormalities, transformation to MDS and AML
- Caution should be exercised when administering the therapy in patients with severe chronic neutropenia
- Do not use therapy in the period 24 hours before through 24 hours after the administration of cytotoxic chemotherapy because of the potential sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy
- Avoid concomitant use with chemotherapy and radiation therapy
- Therapy may cause moderate to severe cutaneous vasculitis
Cautions: Use cautiously in
- Pre-existing cardiac disease
- Myelodysplasia
- Malignancy with myeloid characteristics
- Sickle cell disease
Pregnancy Category:C
Breastfeeding: Safety unknown. Limited data indicate that filgrastim is poorly excreted into breastmilk; which is unlikely to adversely affect the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 4 March 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Neupogen 300 MCG/ML SOLN [Vial] (AMGEN)
1 ml = $275.99
3 ml = $802.99 - Neupogen 300 MCG/0.5ML SOLN [Syringe] (AMGEN)
0.5 0.5ml = $298
2.5 0.5ml = $1482.95 - Neupogen 480 MCG/0.8ML SOLN [Syringe] (AMGEN)
0.8 0.8ml = $514.98
3.2 0.8ml = $2007.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
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