Drug Class: Colony stimulating factors
Usual Adult Dose for Febrile Neutropenia
6 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
Comment: Do not administer between 14 days before and 24 hours after the administration of cytotoxic chemotherapy.
Use: To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia
Usual Adult Dose for Neutropenia Associated with Chemotherapy
6 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
Comment: Do not administer between 14 days before and 24 hours after the administration of cytotoxic chemotherapy.
Use: To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia
Usual Adult Dose for Neutropenia Associated with Radiation
6 mg subcutaneously once a week
- Duration of treatment: 2 weeks
Comments:
- Administer the first dose as soon as possible after suspected or confirmed exposure to radiation levels greater than 2 gray (Gy) and administer the second dose one week after the first dose.
- A baseline complete blood count (CBC) should be obtained before dosing; however, therapy should not be delayed if a CBC is not readily available.
- The healthcare provider should estimate the level of radiation exposure in the patient based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.
Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation
Usual Pediatric Dose for Febrile Neutropenia
Pediatric patients:
- Body weight less than 10 kg: 0.1 mg/kg subcutaneously once per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 10 to 20 kg: 1.5 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 21 to 30 kg: 2.5 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 31 to 44 kg: 4 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 45 kg or greater: 6 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
Comments:
- The prefilled syringe is not designed to allow administration of doses less than 0.6 mL (6 mg) because it does not have graduation marks, which are necessary to accurately measure doses less than 0.6 mL; therefore, administration to patients requiring less than 0.6 mL is not recommended.
- Do not administer between 14 days before and 24 hours after administration of cytotoxic chemotherapy.
Use: To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia
Usual Pediatric Dose for Neutropenia Associated with Chemotherapy
Pediatric patients:
- Body weight less than 10 kg: 0.1 mg/kg subcutaneously once per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 10 to 20 kg: 1.5 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 21 to 30 kg: 2.5 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 31 to 44 kg: 4 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
- Body weight 45 kg or greater: 6 mg subcutaneously ONCE per chemotherapy cycle, beginning at least 24 hours after completion of chemotherapy
Comments:
- The prefilled syringe is not designed to allow administration of doses less than 0.6 mL (6 mg) because it does not have graduation marks, which are necessary to accurately measure doses less than 0.6 mL; therefore, administration to patients requiring less than 0.6 mL is not recommended.
- Do not administer between 14 days before and 24 hours after administration of cytotoxic chemotherapy.
Use: To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia
Usual Pediatric Dose for Neutropenia Associated with Radiation
Children:
- Body weight less than 10 kg: 0.1 mg/kg subcutaneously once a week
- Body weight 10 to 20 kg: 1.5 mg subcutaneously once a week
- Body weight 21 to 30 kg: 2.5 mg subcutaneously once a week
- Body weight 31 to 44 kg: 4 mg subcutaneously once a week
- Body weight 45 kg or greater: 6 mg subcutaneously once a week
Comments:
- Administer the first dose as soon as possible after suspected or confirmed exposure to radiation levels greater than 2 Gy and administer the second dose one week after the first dose.
- A baseline CBC should be obtained before dosing; however, therapy should not be delayed if a CBC is not readily available.
- The healthcare provider should estimate the level of radiation exposure in the patient based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.
Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation
Renal Dose Adjustments
No adjustment recommended.
Liver Dose Adjustments
Data not available
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to the active component, filgrastim, or any of the ingredients
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- Avoid shaking; this drug should be allowed to come to room temperature prior to administration.
- Manually-administered injections should be given into the abdomen, thigh, or upper arm.
- On-body injectors (OBI) should be applied to intact, non-irritated skin on the back of the arm or abdomen.
Storage requirements:
- Store refrigerated (2C to 8C) and protect from light.
- The manufacturer product information should be consulted regarding the specific duration of room temperature excursions.
Reconstitution/preparation techniques:
- OBIs: The manufacturer product information should be consulted regarding preparation.
General:
- Therapy should be initiated and supervised by physicians experienced in oncology and/or hematology.
- Limitation of use: This drug is not indicated for the mobilization of peripheral blood progenitor cells for hematopoietic stem cell transplantation.
- Formulation limitation of use: OBI is not recommended for use in patients with hematopoietic subsyndrome of acute radiation syndrome and/or in pediatric patients.
Monitoring:
- GENITOURINARY: Urinalysis in patients who develop glomerulonephritis
- HEMATOLOGIC: Complete blood counts (including platelet and hematocrit counts)
Patient advice:
- Inform patients that this drug may cause dizziness, and they should avoid driving or operating machinery if these side effects occur.
- Patients who miss a dose should be instructed to contact their healthcare provider.
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
Frequently asked questions
- Why do you take Claritin with Neulasta?
- How many biosimilars have been approved in the United States?
- How long do the side effects of the Neulasta (pegfilgrastim) shot last?
- Does Neulasta cause bone pain?
- When does Neulasta reach peak levels?
- When can I remove the Neulasta Onpro?
- Can you shower with Neulasta on body injector?
- What is the difference between Fulphila and Neulasta?
- What is the difference between Udenyca and Neulasta?
- How is Fulphila injected / administered?
- Is Fulphila a chemo drug?
- What is the difference between Udenyca and Fulphila?
- What does cbqv stand for in pegfilgrastim?
