Filgrastim

G-CSF, Granulocyte Colony-Stimulating factor

Mechanism :

Filgrastim binds to the G-CSF receptor and stimulates the production of neutrophils in the bone marrow. As a G-CSF analog, it controls proliferation of committed progenitor cells and influences their maturation into mature neutrophils. Filgrastim also stimulates the release of neutrophils from bone marrow storage pools and reduces their maturation time. Filgrastim acts to increase the phagocytic activity of mature neutrophils. In patients receiving cytotoxic chemotherapy, Filgrastim can accelerate neutrophil recovery, leading to a reduction in duration of the neutropenic phase; endogenous G-CSF is a glycoprotein produced by monocytes, fibroblasts, and endothelial cells.

Indication :

• Peripheral Blood Progenitor Cell Collection
• Myelosuppressive Chemotherapy Treatment
• Acute myeloid leukemia receiving induction or consolidation chemotherapy
• Cancer patients receiving bone marrow transplant
• Severe chronic neutropenia
• In general, filgrastim increases neutrophil counts in order to decrease the risk of infection or duration of neutropenia in the aforementioned patient populations.

Contraindications :

Patients with known hypersensitivity to E. coli derived products or to any constituent of the product.

Dosing :

Pediatric Dose for Neutropenia Associated with Chemotherapy:

Initial dose: 5 mcg/kg/day as a single daily SC bolus injection, or short intravenous infusion (15 to 30 minutes) or by continuous subcutaneous or intravenous infusion.

Maintenance dose: 4 to 8 mcg/kg/day.

Duration of therapy: Up to 2 weeks, until the absolute neutrophil count reaches 10,000/mm³.

Congenital Neutropenia:

Initial dose: 6 mcg/kg subcutaneously twice a day.

Median dose: 6.0 mcg/kg/day.

Idiopathic or Cyclic Neutropenia:

Initial dose: 5 mcg/kg subcutaneously once a day.

Median dose:

Cyclic neutropenia: 2.1 mcg/kg/day.

Idiopathic neutropenia: 1.2 mcg/kg/day.

Adverse Effect :

Mild-to-moderately severe medullary bone pain, nausea, vomiting, hair loss, bone pain, peritonitis, fatigue, fever, and diarrhea, headache, shortness of breath, weight loss, mouth sores, rash, heart attacks, abnormal heart rhythm. Uric acid, lactate dehydrogenase, and alkaline phosphatase levels may rise and spontaneously return to normal levels.

Interaction :

The safety, efficacy, and possible interactions of filgrastim used in combination with other cytokines have not been characterized in clinical trials. Drugs which may potentiate the release of neutrophils, such as lithium, should be used with caution.

Renal Dose :

Hepatic Dose :