Formulary
Filgrastim: Indications, Dosing, Side Effects and Interactions
For all granulocyte-colony stimulating factors Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils.
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Filgrastim: Indications, Dosing, Side Effects and Interactions
For all granulocyte-colony stimulating factors Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils.
Drug action
For all granulocyte-colony stimulating factors Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils.
Indications and dose
**Reduction in duration of neutropenia and incidence of febrile neutropenia in cytotoxic chemotherapy**
- **Adult** (By Subcutaneous Injection, Or By Intravenous Infusion): for malignancy (except chronic myeloid leukaemia and myelodysplastic syndromes) (specialist use only) 5 micrograms/kg daily until neutrophil count in normal range, usually for up to 14 days (up to 38 days in acute myeloid leukaemia), to be started at least 24 hours after cytotoxic chemotherapy. Preferably given by subcutaneous injection; if given by intravenous infusion, administer over 30 minutes.
**Reduction in duration of neutropenia (and associated sequelae) in myeloablative therapy followed by bone-marrow transplantation (specialist use only)**
- **Adult** (By Subcutaneous Infusion, Or By Intravenous Infusion): 10 micrograms/kg daily, to be started at least 24 hours following cytotoxic chemotherapy and within 24 hours of bone-marrow infusion, then adjusted according to neutrophil count- consult product literature, doses administered over 30 minutes or 24 hours via intravenous route and over 24 hours via subcutaneous route.
**Mobilisation of peripheral blood progenitor cells**
- **Adult** (By Subcutaneous Injection): for autologous infusion, used following adjunctive myelosuppressive chemotherapy-to improve yield (specialist use only) 5 micrograms/kg daily until neutrophil count in normal range, to be started the day after completing chemotherapy, for timing of leucopheresis, consult product literature.
**Mobilisation of peripheral blood progenitor cells in normal donors**
- **Adult** (By Subcutaneous Injection): for allogeneic infusion (specialist use only) 18-59 years 10 micrograms/kg daily for 4-5 days, for timing of leucopheresis, consult product literature.
**Severe congenital neutropenia and history of severe or recurrent infections (distinguish carefully from other haematological disorders) (specialist use only)**
- **Adult** (By Subcutaneous Injection): Initially 12 micrograms/kg daily, adjusted according to response, can be given in single or divided doses, consult product literature and local protocol.
**Severe cyclic neutropenia, or idiopathic neutropenia and history of severe or recurrent infections (distinguish carefully from other haematological disorders) (specialist use only)**
- **Adult** (By Subcutaneous Injection): Initially 5 micrograms/kg daily, adjusted according to response, can be given in single or divided doses, consult product literature and local protocol.
**Persistent neutropenia in HIV infection (specialist use only)**
- **Adult** (By Subcutaneous Injection): Initially 1 microgram/kg daily, subsequent doses increased as necessary until neutrophil count in normal range, then adjusted to maintain neutrophil count in normal range-consult product literature; maximum 4 micrograms/kg per day.
**Reduction in duration of neutropenia and incidence of febrile neutropenia in cytotoxic chemotherapy for malignancy (except chronic myeloid leukaemia and myelodysplastic syndromes) (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection, or by intravenous infusion): 5 micrograms/kg daily until neutrophil count in normal range, usually for up to 14 days (up to 38 days in acute myeloid leukaemia), to be started at least 24 hours after cytotoxic chemotherapy. Preferably given by subcutaneous injection; if given by intravenous infusion, administer over 30 minutes.
**Reduction in duration of neutropenia (and associated sequelae) in myeloablative therapy followed by bone-marrow transplantation (specialist use only) for filgrastim**
- **Child** (By subcutaneous infusion, or by intravenous infusion): 10 micrograms/kg daily, to be started at least 24 hours following cytotoxic chemotherapy and within 24 hours of bone-marrow infusion, then adjusted according to neutrophil count- consult product literature, doses administered over 30 minutes or 24 hours via intravenous route and over 24 hours via subcutaneous route.
**Mobilisation of peripheral blood progenitor cells for autologous infusion, used alone (specialist use only) for filgrastim**
- **Child** (By subcutaneous infusion, or by subcutaneous injection): 10 micrograms/kg daily for 5-7 days, to be administered over 24 hours if given by subcutaneous infusion.
**Mobilisation of peripheral blood progenitor cells for autologous infusion, used following adjunctive myelosuppressive chemotherapy-to improve yield (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection): 5 micrograms/kg daily until neutrophil count in normal range, to be started the day after completing chemotherapy, for timing of leucopheresis, consult product literature.
**Mobilisation of peripheral blood progenitor cells in normal donors for allogeneic infusion (specialist use only) for filgrastim**
- **Child 16-17 years** (By subcutaneous injection): 10 micrograms/kg daily for 4-5 days, for timing of leucopheresis, consult product literature.
**Severe congenital neutropenia and history of severe or recurrent infections (distinguish carefully from other haematological disorders) (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection): Initially 12 micrograms/kg daily, adjusted according to response, can be given in single or divided doses, consult product literature and local protocol.
**Severe cyclic neutropenia, or idiopathic neutropenia and history of severe or recurrent infections (distinguish carefully from other haematological disorders) (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection): Initially 5 micrograms/kg daily, adjusted according to response, can be given in single or divided doses, consult product literature and local protocol.
**Persistent neutropenia in HIV infection (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection): Initially 1 microgram/kg daily, subsequent doses increased as necessary until neutrophil count in normal range, then adjusted to maintain neutrophil count in normal range-consult product literature; maximum 4 micrograms/kg per day.
**Neonatal neutropenia (specialist use only) for filgrastim**
- **Neonate** (By subcutaneous injection): 10 micrograms/kg daily, to be discontinued if white cell count exceeds 50 x 109/litre.
**Glycogen storage disease type 1b (specialist use only) for filgrastim**
- **Child** (By subcutaneous injection): Initially 5 micrograms/kg daily, dose to be adjusted as necessary.
Cautions
For all granulocyte-colony stimulating factors Malignant myeloid conditions; pre-malignant myeloid conditions; risk of splenomegaly and rupture-spleen size should be monitored; sickle-cell disease Cautions, further information Acute respiratory distress syndrome There have been reports of pulmonary infiltrates leading to acute respiratory distress syndrome-patients with a recent history of pulmonary infiltrates or pneumonia may be at higher risk. Cautions For filgrastim Osteoporotic bone disease (monitor bone density if given for more than 6 months); secondary acute myeloid leukaemia
Contraindications
Severe congenital neutropenia who develop leukaemia or have evidence of leukaemic evolution
Side effects
For all granulocyte-colony stimulating factors Common or very common Arthralgia; cutaneous vasculitis; dyspnoea; haemoptysis; headache; hypersensitivity; leucocytosis; pain; spleen abnormalities; thrombocytopenia Uncommon Acute febrile neutrophilic dermatosis; capillary leak syndrome; hypoxia; interstitial pneumonia; pulmonary fibrosis; pulmonary oedema; respiratory disorders; sickle cell anaemia with crisis Side-effects, further information Treatment should be withdrawn in patients who develop signs of pulmonary infiltration. Side-effects For filgrastim Common or very common Anaemia; diarrhoea; dysuria; haemorrhage; hepatomegaly; hyperuricaemia; hypotension; osteoporosis; rash Uncommon Fluid imbalance; graft versus host disease; interstitial lung disease; peripheral vascular disease; pseudogout; rheumatoid arthritis aggravated; urine abnormalities
Interactions
**Other interactions (2):**
- Preliminary evidence from a small number of patients treated concomitantly with Neupogen and 5-Fluorouracil indicates that the severity of neutropenia may be exacerbated.
- Since lithium promotes the release of neutrophils, lithium is likely to potentiate the effect of Neupogen.
Pregnancy
For all granulocyte-colony stimulating factors Manufacturers advise avoid-toxicity in animal studies.
Breast feeding
For all granulocyte-colony stimulating factors There is no evidence for the use of granulocyte-colony stimulating factors during breast-feeding and manufacturers advise avoiding their use.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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