Granulocyte colony-stimulating factor (G-CSF) indicated to decrease the incidence of infection, manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy, and to reduce the time to neutrophil recovery following induction/consolidation chemotherapy of acute myeloid leukemia.
Also known as: G-CSF, Neupogen, Nivestim
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
Filgrastim + lithium: lithium may potentiate filgrastim-induced neutrophil release — use with caution and monitor neutrophil counts.
DailyMed (Neupogen) records: "Drugs which may potentiate the release of neutrophils, such as lithium, should be used with caution" (Drug Interactions section). Both drugs promote neutrophil release from the bone marrow, so the combination may potentiate neutrophilia and related complications.
Monitor neutrophil count (risk of excessive neutrophilia) during the combination.
Marked neutrophilia (count far above target) during the combination.
Use the combination with caution, monitoring the absolute neutrophil count; adjust filgrastim dose if neutrophilia is excessive.
DailyMed/FDA (NIH/NLM) — approved Neupogen label (Amgen), Drug Interactions section: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=97cc73cc-b5b7-458a-a933-77b00523e193
Filgrastim is given subcutaneously or intravenously; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
No relevant pharmacokinetic interaction; usual moderation during treatment.
Moderate alcohol intake.
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
Filgrastim can cause glomerulonephritis; patients with pre-existing renal disease are at increased risk of renal events.
Monitor renal function and proteinuria during treatment.
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
Filgrastim is associated with interstitial pneumonitis and adult respiratory distress syndrome, especially with concomitant chemotherapy.
Watch for respiratory symptoms and stop at signs of pneumonitis.
DailyMed approved label (NEUPOGEN, Amgen; setID 97cc73cc-b5b7-458a-a933-77b00523e193).
Data on filgrastim in pregnancy are limited; use only if the benefit outweighs the risk.
Avoid in pregnancy except in clearly indicated situations (e.g. severe neutropenia).
Excretion into breast milk is unknown; avoid during breastfeeding.
In women of childbearing age, rule out pregnancy before starting.
EMC-UK (MHRA) — approved Filgrastim SmPC: https://www.medicines.org.uk/emc/product/3000/smpc ; Prontuário Terapêutico do INFARMED (11th ed., 2012) — Annex 2, Drugs and Breastfeeding: Avoid; no useful information is available.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
G-CSF that regulates neutrophil production in the bone marrow, affecting proliferation, differentiation and selected end-cell functions of neutrophil progenitors (including enhanced phagocytosis and respiratory-burst priming). The effect is specific to the neutrophil lineage.
Binding to specific G-CSF receptors on hematopoietic progenitor cells, stimulating proliferation, differentiation commitment and functional activation of neutrophils.
Bioavailability of 60–70% after subcutaneous administration; serum peaks 2–8 h after dosing.
Predominantly renal clearance (eliminated mainly by the renal route).
Elimination half-life ~3.5 h (approximately 3.5 h after subcutaneous administration).
