Usual Adult Dose for Neutropenia Associated with Chemotherapy

5 mcg/kg via subcutaneous injection once a day

• Duration of therapy: Treatment should continue until the expected neutrophil nadir is

passed and the neutrophil count has recovered to the normal range.

Comments:

• Avoid administration during the period 24 hours before through 24 hours after the administration of cytotoxic chemotherapy.
• Monitor complete blood count (CBC) prior to chemotherapy and then 2 times a week until recovery.

Use: To reduce the duration of severe neutropenia in patients receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia

Usual Pediatric Dose for Neutropenia Associated with Chemotherapy

1 month and older: 5 mcg/kg via subcutaneous injection once a day

• Duration of therapy: Treatment should continue until the expected neutrophil nadir is

passed and the neutrophil count has recovered to the normal range.

Comments:

• Avoid administration during the period 24 hours before through 24 hours after the administration of cytotoxic chemotherapy.
• Monitor CBC prior to chemotherapy and then 2 times a week until recovery.

Use: To reduce the duration of severe neutropenia in patients receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia

Renal Dose Adjustments

Data not available

Glomerulonephritis:

• Suspected glomerulonephritis: Evaluate for cause.
• Causality likely: Healthcare providers should consider dose reduction OR interruption of treatment.

Liver Dose Adjustments

Data not available

Dose Adjustments

Sickle cell crisis occurrence: Discontinue treatment.

Serious allergic reactions: Permanently discontinue treatment.

Suspected/confirmed splenic rupture, or aortitis, or acute respiratory distress syndrome (ARDS): Discontinue treatment.

Precautions

CONTRAINDICATIONS:

• Patients with a history of serious allergic reactions to filgrastim or pegfilgrastim products.

Safety and efficacy have not been established in patients younger than 1 month.

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• This drug should not be injected into skin that is tender, red, bruised/hard, or has scars/stretch marks.
• Recommended injection sites include: The abdomen (except the 5 cm area surrounding the navel), middle of the thighs, upper outer areas of the buttocks, and/or the back of the upper arms. Injection sites should be changed every day.
• Discolored solutions or those containing particulates should not be used.

Storage requirements:

• Refrigerate at 2C to 8C and protect from light. Avoid shaking.
• Unused drug should be discarded.

General:

• Use of pre-filled syringes without safety needle guard devices should be restricted to properly trained patients/caregivers; healthcare providers should receive pre-filled syringes with safety needle guard devices.
• Some formulations are not made with natural rubber latex; the manufacturer product information should be consulted regarding excipients.
• Doses increasing the absolute neutrophil count (ANC) beyond 10,000/mm3 did not result in additional clinical benefit.

Monitoring:

• HEMATOLOGIC: CBC at least 2 times a week

Patient advice:

• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be instructed to immediately report signs/symptoms of spleen enlargement/rupture, ARDS, glomerulonephritis, and/or allergic reactions to their healthcare provider.