filgrastim

REMS

Filkri, Granix, Neupogen, Nivestym, Nypozi, Releuko, Zarxio

Prevention of febrile neutropenia and associated infection in patients who have received bone marrow–depressing antineoplastics for the treatment of nonmyeloid malignancies.

Filkri, Neupogen, Nivestym, Nypozi, Releuko, Zarxio

Management of the following:
- Reduction of time for neutrophil recovery and duration of fever in patients undergoing induction and consolidation chemotherapy for acute myelogenous leukemia.
- Reduction of time to neutrophil recovery and sequelae of neutropenia in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation.
- Severe neutropenia in symptomatic patients with congenital neutropenia cyclic neutropenia or idiopathic neutropenia.

Neupogen, Nivestym, Nypozi, Releuko, Zarxio

Mobilization of hematopoietic progenitor cells into peripheral blood for collection by leukapheresis.

Filkri, Neupogen, Nypozi, Releuko, Zarxio

Survival improvement in patients acutely exposed to myelosuppressive doses of radiation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to filgrastim or Escherichia coli–derived proteins.

Use Cautiously in:

Congenital neutropenia (↑ risk of myelodysplastic syndrome or acute myeloid leukemia);
Patients with breast or lung cancer receiving chemotherapy and/or radiotherapy (↑ risk of myelodysplastic syndrome or acute myeloid leukemia);
Sickle cell disease (↑ risk of sickle cell crisis);
Malignancy with myeloid characteristics;
Pre-existing cardiac disease;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant.

Adv. Reactions/Side Effects ⬆ ⬇

CV: aortitis, vasculitis

GI: SPLENIC RUPTURE, splenomegaly

GU: glomerulonephritis

Hemat: ACUTE MYELOID LEUKEMIA, excessive leukocytosis, MYELODYSPLASTIC SYNDROME, sickle cell crises, thrombocytopenia

Local: pain at injection site

MS: medullary bone pain

Resp: ACUTE RESPIRATORY DISTRESS SYNDROME, hemoptysis, pulmonary infiltrates

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Simultaneous use with antineoplastics may have adverse effects on rapidly proliferating neutrophils; avoid use for 24 hr before and 24 hr after chemotherapy.
Lithium may potentiate the release of neutrophils; concurrent use should be undertaken cautiously.

Availability ⬆ ⬇

Solution for injection (prefilled syringes): 300 mcg/0.5 mL; 480 mcg/0.8 mL
Solution for injection (vials): 300 mcg/1 mL; 480 mcg/1.6 mL

Route/Dosage ⬆ ⬇

Receiving Myelosuppressive Chemotherapy

IV SUBQ (Adults and Children ): Filkri, Granix, Neupogen, Nivestym, Nypozi, Releuko, Zarxio: 5 mcg/kg/day as a single SUBQ injection, by short IV infusion, or via continuous IV infusion for up to 2 wk or until ANC reaches 10,000/mm³. Initiate ≥24 hr after chemotherapy. May ↑ by 5 mcg/kg during each cycle of chemotherapy, depending on blood counts.

Receiving Induction and/or Consolidation Chemotherapy for Acute Myelogenous Leukemia

IV SUBQ (Adults and Children ): Filkri, Neupogen, Nivestym, Nypozi, Releuko, Zarxio: 5 mcg/kg/day as a single SUBQ injection, by short IV infusion, or via continuous IV infusion for up to 2 wk or until ANC reaches 10,000/mm³. Initiate ≥24 hr after chemotherapy. May ↑ by 5 mcg/kg during each cycle of chemotherapy, depending on blood counts.

After Bone Marrow Transplantation

IV (Adults ): Filkri, Neupogen, Nivestym, Nypozi, Releuko, Zarxio: 10 mcg/kg/day as a continuous IV infusion for up to 24 hr; initiate ≥24 hr after chemotherapy and ≥24 hr after bone marrow transplantation. Subsequent dose is adjusted according to blood counts.

Peripheral Blood Progenitor Cell Collection and Therapy

SUBQ (Adults ): Neupogen, Nivestym, Nypozi, Releuko, Zarxio: 10 mcg/kg/day for ≥4 days before 1st leukapheresis and continued until last leukapheresis. Discontinue if WBC >100,000 cells/mm³.

Severe Neutropenia

SUBQ (Adults ): Filkri, Neupogen, Nivestym, Nypozi, Releuko, Zarxio: Congenital neutropenia: 6 mcg/kg twice daily. Idiopathic/cyclical neutropenia: 5 mcg/kg daily (↓ if ANC remains >10,000/mm³).

After Myelosuppressive Radiation

SUBQ (Adults ): Filkri, Neupogen, Nypozi, Releuko, Zarxio: 10 mcg/kg once daily; initiate as soon as possible after exposure to radiation doses >2 gray (Gy); continue until ANC remains >1000/mm³ for three consecutive blood counts (performed every 3 days) or is >10,000/mm³ after a radiation-induced nadir.

US Brand Names ⬆ ⬇

Filkri, Granix, Neupogen, Nivestym, Nypozi, Releuko, Zarxio

Action ⬆ ⬇

Binds to and stimulates immature neutrophils to divide and differentiate. Also activates mature neutrophils.

Therapeutic effects:

Decreased incidence of infection in patients who are neutropenic from chemotherapy or other causes.
Improved harvest of progenitor cells for bone marrow transplantation.
Improved survival in patients exposed to myelosuppressive doses of radiation.

Classifications ⬆ ⬇

Therapeutic Classification: colony-stimulating factors

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Adults: 3.5 hr; Neonates: 4.4 hr.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

ROUTE		ONSET		PEAK		DURATION
IV, SUBQ		unknown		unknown		4 days‡

‡Return of neutrophil count to baseline.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient on correct technique for injection, care, and disposal of equipment. Advise patient to notify health care provider regarding when to give a missed dose.
Instruct patient to notify health care provider immediately if signs and symptoms of spleen enlargement or rupture, allergic reaction, acute respiratory distress syndrome, glomerulonephritis (swelling of face or ankles, dark-colored urine or blood in urine, ↓ urine production), myelodysplastic syndrome, acute myeloid leukemia, or vasculitis (skin redness, purple spots on skin) occur. Discuss risk of sickle cell crisis with patients with sickle cell disease before administering.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.
Home Care Issues: Instruct patient on correct technique and proper disposal for home administration. Caution patient not to reuse needle, vial, or syringe. Provide patient with a puncture-proof container for needle and syringe disposal.

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Indications ⬇