filgrastim (granulocyte colony-stimulating factor, G-CSF)

(fill grass' stim)

Neupogen

Pregnancy Category C

Drug class
Colony-stimulating factor

Therapeutic actions
Human granulocyte colony-stimulating factor produced by recombinant DNA
technology; increases the production of neutrophils within the bone marrow with little
effect on the production of other hematopoietic cells.

Indications
• To decrease the incidence of infection in patients with nonmyeloid malignancies
receiving myelosuppressive anticancer drugs associated with a significant
incidence of severe neutropenia with fever
• To reduce the time to neutrophil recovery and duration of fever following
induction or consolidation chemotherapy treatment of acute myeloid leukemia
(AML)
• To reduce the duration of neutropenia following bone marrow transplant
• Treatment of severe chronic neutropenia
• Mobilization of hematopoietic progenitor cells into the blood for leukapheresis
collection
• Orphan drug uses: Treatment of myelodysplastic syndrome, aplastic anemia

Contraindications and cautions

• Contraindicated with hypersensitivity to Escherichia coli products, pregnancy.
• Use cautiously with lactation, pregnancy.

Available forms
Injection—300 mcg/mL

Dosages
ADULTS
Starting dose is 5 mcg/kg/day SC or IV as a single daily injection. May be increased in
increments of 5 mcg/kg for each chemotherapy cycle. 4–8 mcg/kg/day is usually
effective.
• Bone marrow transplant: 10 mcg/kg/day IV or continuous SC infusion.
• Severe chronic neutropenia: 6 mcg/kg SC bid (congenital neutropenia);
5 mcg/kg/day SC as single injection (idiopathic or cyclic neutropenia).
• Mobilization for harvesting: 10 mcg/kg/day SC at least 4 days before first
leukapheresis; continue to last leukapheresis.
PEDIATRIC PATIENTS
Safety and efficacy not established.
Pharmacokinetics
Route Peak Duration
SC 8 hr 4 days
IV 2 hr 4 days

Metabolism: Unknown; T1/2: 210–231 min

Distribution: Crosses placenta; may enter breast milk

IV facts
Preparation: No special preparation required. Refrigerate; avoid shaking. Prior to
injection, allow to warm to room temperature. Discard vial after one use, and do not
reenter vial; discard any vial that has been at room temperature > 6 hr.
Infusion: Inject directly IV slowly over 15–30 min, or inject slowly into tubing of
running IV over 4–24 hr.
Incompatibilities: Do not mix in solutions other than D5W. Incompatible with numerous
drugs in solution; check manufacturer's details before any combination.

Adverse effects
• CNS: Headache, fever, generalized weakness, fatigue
• Dermatologic: Alopecia, rash, mucositis
• GI: Nausea, vomiting, stomatitis, anorexia, diarrhea, constipation
• Other: Bone pain, generalized pain, sore throat, cough

Nursing considerations
Assessment
• History: Hypersensitivity to E. coli products, pregnancy, lactation
• Physical: Skin color, lesions, hair; T; abdominal exam, status of mucous
membranes; CBC with differential, platelets

Interventions
• Obtain CBC and platelet count prior to and twice weekly during therapy; doses
may be increased after chemotherapy cycles according to the duration and
severity of bone marrow suppression.
• Do not give within 24 hr before and after chemotherapy.
• Give daily for up to 2 wk until the neutrophil count is 10,000/mm3; discontinue
therapy if this number is exceeded.
• Store in refrigerator; allow to warm to room temperature before use; if vial is at
room temperature for > 6 hr, discard. Use each vial for one dose; do not reenter
the vial. Discard any unused drug.
• Do not shake vial before use. If SC dose exceeds 1 mL, consider using two sites.

Teaching points
• Store drug in refrigerator; do not shake vial. Each vial can be used only once; do
not reuse syringes or needles (proper container for disposal will be provided).
 Another person should be instructed in the proper administration technique. Use
sterile technique.
• Avoid exposure to infection while you are receiving this drug (avoid crowds and
people known to have infections).
• Keep appointments for frequent blood tests to evaluate effects of drug on your
blood count.
• These side effects may occur: Bone pain (analgesia may be ordered), nausea and
vomiting (eat frequent small meals), loss of hair (it is very important to cover
head in extreme temperatures).
• Report fever, chills, severe bone pain, sore throat, weakness, pain or swelling at
injection site.

Adverse effects in Italic are most common; those in Bold are life-threatening.