Sargramostim Disease Interactions

Transient supraventricular arrhythmia has been reported occasionally during sargramostim administration, particularly in patients with a history of cardiac arrhythmias. Therapy with sargramostim should be administered cautiously in patients with preexisting cardiac disease.

Sargramostim may cause fluid retention. Edema, capillary leak syndrome, and pleural and/or pericardial effusion have been reported. Therapy with sargramostim should be administered cautiously in patients with preexisting fluid retention, pulmonary infiltrates, or congestive heart failure. Fluid retention caused or worsened by sargramostim is often reversible following discontinuation of therapy or reduction in dosage, with or without diuretic administration.

Sargramostim is a growth factor for hematopoietic progenitor cells. Therefore, it should not be used in patients with leukocytosis. During sargramostim treatment, if the absolute neutrophil count (ANC) exceeds 20,000 cells/mm3 or white blood cell count (WBC) exceeds 50,000 cells/mm3, therapy should be interrupted or the dosage reduced by half, depending on the clinical condition of the patient. Blood counts generally return to normal or baseline levels within 3 to 7 days of stopping therapy.

Sargramostim can cause infusion-related reactions characterized by respiratory distress, hypoxia, flushing, hypotension, syncope, and/or tachycardia following the first administration of the drug in a particular cycle. Monitor closely during infusion for symptoms, particularly in patients with pre-existing lung disease. These signs have resolved with symptomatic treatment and usually do not recur with subsequent doses. If patients display dyspnea or other acute symptoms, reduce the rate of infusion by 50%, and if symptoms persist or worsen therapy should be discontinued.

The use of sargramostim as lyophilized powder reconstituted with Bacteriostatic Water for Injection can cause serious and fatal adverse reactions including "gasping syndrome" in neonates and infants of low birth weight. The "gasping syndrome" is characterized by central nervous system depression, metabolic acidosis, and gasping respirations. Avoid administering solutions containing benzyl alcohol (including this drug reconstituted with Bacteriostatic Water for Injection) to neonates and low birth weight infants. Instead, administer reconstituted with Sterile Water for Injection.