Filgrastim

Indications
 Parenteral
Chemotherapy-induced neutropenia
Adult: 5 mcg/kg daily as a single daily SC inj, as a continuous IV or SC infusion, or as a daily IV infusion over 15-30 minutes, starting not <24 hr after the last dose of antineoplastic. Continue treatment until neutrophil count has stabilised within the normal range which may take up to 14 days or more.
Parenteral
Bone marrow transplantation
Adult: 10 mcg/kg daily by IV infusion over 30 min or 4 hr or continuous IV or SC infusion over 24 hr. Adjust according to response.
Subcutaneous
Mobilisation of peripheral blood progenitor cells for autologous peripheral blood stem cell transplantation
Adult: 10 mcg/kg daily, as a single inj or by continuous infusion, for 4-7 days until the last leucapheresis procedure. If it is given after myelosuppressive chemotherapy: 5 mcg/kg daily by inj; given from the 1st day after chemotherapy completion until expected neutrophil nadir is passed and neutrophil count has returned to normal range, so that leucapheresis can be performed.
Subcutaneous
Congenital neutropenia
Adult: 12 mcg/kg daily in single or divided doses. Adjust according to response. In patients with cyclic or idiopathic neutropenia: 5 mcg/kg daily in single or divided doses. Adjust according to response.
Subcutaneous
HIV infection and persistent neutropenia
Adult: Initially, 1 mcg/kg daily. Dose may be increased to 4 mcg/kg daily until normal neutrophil count is achieved. Maintenance: 300 mcg daily. Max: 4 mcg/kg daily.
Contraindications
 Myeloid malignancies. Not to be used within 24 hr of cytotoxic chemotherapy admin due to the sensitivity of rapidly dividing myeloid cells. Severe congenital neutropaenia (Kostman's syndrome) with abnormal cytogenetics.
Warnings / Precautions
 Premalignant or malignant myeloid condition; sickle-cell disease; osteoporotic bone disease; withdraw treatment if there are signs of pulmonary infiltrates. Fluid retention or heart failure. Monitor CBC and platelet count during therapy. Monitor bone density in patients with osteoporosis (long-term treatment). Regular morphological and cytogenic bone-marrow examinations in severe congenital neutropenia. Pregnancy and lactation.
Adverse Reactions
 Musculoskeletal pain, bone pain, hypersensitivity reactions, splenic enlargement, hepatomegaly, thrombocytopaenia, anaemia, epistaxis, headache, nausea, vomiting, diarrhoea, urinary abnormalities (dysuria, proteinuria, haematuria), osteoporosis, exacerbation of rheumatoid arthritis, transient decrease in blood glucose, raised uric acid, cutaneous vasculitis, transient hypotension.
Potentially Fatal: Pulmonary infiltrates leading to resp failure or acute resp distress syndrome.
Drug Interactions
 Myelosuppressive antineoplastic agents. Drugs which may potentiate the release of neutrophils e.g. lithium.
See Below for More filgrastim Drug Interactions
Lab Interactions
 May lead to transient positive bone imaging changes.
Mechanism of Actions
 Filgrastim is a granulocyte-colony stimulating factor which binds to cell surface receptors on haemetopoietic cells thus stimulating the development of granulocytes to increase their migration and cytotoxicity.
Onset: Approximately 24 hr.
Absorption: Serum concentrations peak about 8 hr after SC admin.
Excretion: Elimination half-life: About 3.5 hr. Mainly eliminated by neutrophil-mediated clearance.
Storage Conditions
 Parenteral: Refrigerate at 2-8°C. Do not freeze. Subcutaneous: Refrigerate at 2-8°C. Do not freeze.
ATC Classification
 L03AA02 - filgrastim ; Belongs to the class of colony stimulating factors. Used as immunostimulants.
Storage
 Parenteral: Refrigerate at 2-8°C. Do not freeze. Subcutaneous: Refrigerate at 2-8°C. Do not freeze.
Available As
  • Filgrastim 1 mg
  • Filgrastim 300 mcg

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