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(fill-GRAH-stim)
Neupogen
Class: Colony-stimulating factor

 Action Stimulates neutrophil production within bone marrow.

 Indications Decrease incidence of infection, manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs; cancer patients receiving myelosuppressive chemotherapy; cancer patients receiving bone-marrow transplant; patients with severe chronic neutropenia (SCN); peripheral blood progenitor cell (PBPC) collection and therapy in cancer patients. unlabeled use(s): Filgrastim may be beneficial in AIDS, drug-induced and congenital agranulocytosis, alloimmune neonatal neutropenia.

 Contraindications Hypersensitivity to Escherichia coli-derived proteins.

 Route/Dosage

Myelosuppressive chemotherapy

IV/SC: 5 mcg/kg/day as single daily injection; may increase in increments of 5 mcg/kg for each chemotherapy cycle.

Bone marrow transplant

IV/SC: 10 mcg/kg/day given as an IV infusion of 4 or 24 hr or as a continuous 24 hr SC infusion.

Severe chronic neutropenia

Congenital neutropenia: Starting dose: 6 mcg/kg twice daily SC qd.

Idiopathic or cyclic neutropenia: Starting dose: 5 mcg/kg as a single injection SC qd. Dose adjustments–Chronic daily administration is required to maintain clinical benefit. ANC should not be used as the sole indication of efficacy. Individually adjust the dose based on the patients’ clinical course as well as ANC. In the Phase III study, the target ANC was 1,500 to 10,000/mm3. However, patients may experience clinical benefit with ANCs below this target range. Reduce the dose if the ANC is persistently more than 10,000/mm3.

 Interactions

Drugs that may potentiate the release of neutrophils, such as lithium, should be used with caution. INCOMPATIBILITIES: Precipitate may form if diluted with saline.

 Lab Test Interferences None well documented.

 Adverse Reactions

HEMA: Leukocytosis. OTHER: Bone pain; reversible elevations in uric acid, LDH, and alkaline phosphatase.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Cardiac events: Monitoring patients with preexisting cardiac conditions is recommended. Chronic administration: Safety and efficacy not established. Hematologic effects: Regular monitoring of hematocrit and platelet count recommended due to possible increased risk of thrombocytopenia or anemia.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Do not give filgrastim 24 hr before or 24 hr after cytotoxic chemotherapy.
  • Do not shake medication.
  • Warm to room temperature before injection. Use within 24 hr.
  • Use only 1 dose per vial, and do not reenter vial.
  • Do not dilute with saline.
  • Give IV injection, diluted in D5W, over 15 to 30 min.
  • Store in refrigerator, but do not freeze. Discard any unused vial left at room temperature > 6 hr.

 Assessment/Interventions

  • Obtain complete patient history, including drug history and any known allergies.
  • Monitor hematocrit, CBC, and platelet count 2 to 3 times weekly.
  • Document any hypotensive effects.
  • Document CBC and platelet counts prior to chemotherapy and twice per week during therapy.
  • Inform physician and discontinue dose if absolute neutrophil count > 10,000/mm3.
OVERDOSAGE: SIGNS & SYMPTOMS
  Leukocytosis

 Patient/Family Education

  • Instruct in proper techniques for administration and storage.
  • Explain that most common adverse effect is bone pain.
  • Explain importance of follow-up laboratory work as directed.
  • Counsel patient on signs of thrombocytopenia (eg, bruising, petechiae, ecchymosis, epistaxis, bleeding from mucus membranes) and ways to avoid infection.

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