Filgrastim

Indications & Dose:

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)

• BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INFUSION

Adult: 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 bonemarrow transplantation (specialist use only)

• BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION

Adult: 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)

• BY SUBCUTANEOUS INJECTION

Adult: 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)

• BY SUBCUTANEOUS INJECTION

Adult: 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)

• BY SUBCUTANEOUS INJECTION

Adult

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)

• BY SUBCUTANEOUS INJECTION

Adult: 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)

• BY SUBCUTANEOUS INJECTION

Adult: 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)

• BY SUBCUTANEOUS INJECTION

Adult: 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

Contraindications:

Severe congenital neutropenia (Kostmann’s syndrome) with abnormal cytogenetics 

Side Effects:

Common or very common Anaemia dysuria epistaxis exacerbation of rheumatoid arthritis haematuria hepatomegaly mucositis osteoporosis proteinuria pseudogout raised uric acid splenic enlargement transient decrease in blood glucose transient hypotension urinary abnormalities

Uncommon Capillary leak

Cautions:

Osteoporotic bone disease (monitor bone density if given for more than 6 months) . secondary acute myeloid leukaemia 

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