plerixafor

Therapeutic Classification: n/a

Pharmacologic Classification: hematopoietic stem cell mobilizers

Indications ⬆ ⬇

REMS

Mobilizes hematopoietic stem cells to peripheral blood for collection and use in autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma; used in combination with granulocyte-colony stimulation factor (G-CSF).

Action ⬆ ⬇

Inhibits the CXCR-4 chemokine receptor, blocking it's binding ability. Inhibition decreases adherence of stem cells to bone marrow, freeing them up to mobilize to peripheral blood.

Therapeutic Effects:

Mobilization of stem cells to peripheral blood allowing collection.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following subcut administration.

Distribution: Largely confined to extravascular fluid space.

Metabolism/Excretion: Not metabolized by the liver; 70% unchanged in urine.

Half-life: 5.3 hr.

Time/Action Profile ⬆ ⬇

(mobilization of cells)

ROUTE	ONSET	PEAK	DURATION
Subcut	rapid	10–14 hr*	unknown

*With G-CSF pretreatment.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity
Leukemia
OB: Pregnancy (may cause fetal harm)
Lactation: Lactation.

Use Cautiously in:

Renal impairment (dose ↓ required if CCr 50 mL/min)
Rep: Women of reproductive potential
Pedi: Safety and effectiveness not established in children
Geri: Consider age-related ↓ in renal function and greater sensitivity to drug effects in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: erythema, sweating.

GI: SPLENIC RUPTURE, diarrhea, nausea, vomiting, abdominal distention/pain, constipation, dry mouth, dyspepsia, flatulence, splenic enlargement.

Hemat: leukemia/tumor cell mobilization, thrombocytopenia.

Local: injection site reactions.

MS: musculoskeletal pain.

Neuro: oral hypoesthesia , dizziness, fatigue, headache, insomnia.

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS).

Interactions ⬆ ⬇

Drug-Drug:

None noted.

Route/Dosage ⬆ ⬇

SC (Adults >83 kg): Following pretreatment with G-CSF for 4 days — 0.24 mg/kg once daily given 11 hr prior to each apheresis and continued for up to 4 days (not to exceed 40 mg/day); use actual body weight to calculate dose.
SC (Adults 83 kg): Following pretreatment with G-CSF for 4 days — 0.24 mg/kg or 20 mg once daily given 11 hr prior to each apheresis and continued for up to 4 days; use actual body weight to calculate dose.

Renal Impairment

SC (Adults 84–159 kg): Following pretreatment with G-CSF for 4 days (CCr 50 mL/min) — 0.16 mg/kg once daily given 11 hr prior to each apheresis and continued for up to 4 days (not to exceed 27 mg/day).

Renal Impairment

SC (Adults 83 kg): Following pretreatment with G-CSF for 4 days (CCr 50 mL/min) — 0.16 mg/kg or 13 mg once daily given 11 hr prior to each apheresis and continued for up to 4 days.

Availability ⬆ ⬇

Solution for injection: 24 mg/1.2 mL;

Assessment ⬆ ⬇

Assess for splenic enlargement and potential rupture (left upper abdominal pain and/or scapular or shoulder pain) periodically during therapy.
Monitor for signs and symptoms of anaphylaxis (urticaria, periorbital swelling, dyspnea, hypoxia) during and for at least 30 min following administration. Discontinue therapy and treat symptomatically if symptoms occur.

Lab Test Considerations:

Obtain a negative pregnancy test before starting therapy.
- Monitor WBC and platelets during therapy. May cause leukocytosis and thrombocytopenia.

Implementation ⬆ ⬇

Begin therapy after patient has received 4 days of G-CSF daily and approximately 11 hrs prior to initiation of apheresis.
SC: Administer subcut daily for 4 days. Solution is clear, colorless to pale yellow; do not use solutions that are cloudy, discolored or contain a precipitate. Vials are single use; discard any unused medication.

Patient/Family Teaching ⬆ ⬇

Explain purpose of medication to patient.
Advise patient to notify health care professional if signs and symptoms of systemic reactions (urticaria, periorbital swelling, dyspnea, hypoxia) or splenic rupture (left upper abdominal pain and/or scapular or shoulder pain) occur.
Instruct patient to notify health care professional immediately if vasovagal reactions (orthostatic hypotension, syncope) occur during or shortly after injection.
Advise patient to notify health care professional if itching, rash, or reactions at injection site occur; may be treated with OTC medications.
May cause GI disorders (diarrhea, nausea, vomiting, flatulence, abdominal pain). Advise patient to notify health care professional if GI disorders are severe.
Rep: Plerixafor is teratogenic. Caution females of reproductive potential to use effective contraception during and for 1 wk after final dose of therapy and to avoid breastfeeding during and for 1 wk after last dose. Advise patient to notify health care professional if pregnancy is planned or suspected.

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Pronunciation ⬇

Classifications ⬆ ⬇