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Filgrastim Dosage

Applies to the following strength(s): 300 mcg/mL ; 300 mcg/0.5 mL ; 480 mcg/0.8 mL ; 480 mcg/1.6 mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Neutropenia Associated with Chemotherapy

5 mcg/kg/day as a single daily subcutaneous bolus injection, or short IV infusion (15 to 30 minutes), or by continuous IV infusion; doses may be increased by 5 mcg/kg for each chemotherapy cycle according to the duration and severity of the absolute neutrophil count (ANC) nadir; stop therapy if the ANC increases beyond 10,000/mm3

Duration of therapy: Up to 2 weeks or until the ANC has reached 10,000/mm3 following the expected chemotherapy-induced neutrophil nadir (a transient increase in neutrophil count is typically seen 1 to 2 days after initiation of therapy)

Comments:
-A CBC and platelet count should be obtained before instituting therapy and monitored twice weekly during therapy.
-Do not administer this drug during the period 24 hours before or 24 hours after the administration of cytotoxic chemotherapy.
-The duration of therapy needed to attenuate chemotherapy-induced neutropenia may be dependent on the myelosuppressive potential of the chemotherapy regimen used.

Uses:
-To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever
-To reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML)

Usual Adult Dose for Bone Marrow Transplantation

10 mcg/kg/day IV over no longer than 24 hours

During the period of neutrophil recovery, titrate the daily dosage against the neutrophil response:
-If ANC greater than 1000/mm3 for 3 consecutive days, reduce the dose to 5 mcg/kg/day.
-If ANC remains greater than 1000/mm3 for 3 more consecutive days, discontinue therapy.
-If ANC decreases to less than 1000/mm3, resume therapy at 5 mcg/kg/day. Note: If ANC decreases to less than 1000/mm3 at any time during the 5 mcg/kg/day administration, increase the dose to 10 mcg/kg/day, and then follow the above steps.

Comments:
-Administer the first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion.
-Frequent CBCs and platelet counts are recommended (at least 3 times per week) following marrow transplantation.

Use: To reduce the duration of neutropenia and neutropenia-related clinical sequelae (e.g., febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation

Usual Adult Dose for Peripheral Progenitor Cell Transplantation

10 mcg/kg/day subcutaneously for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis

Duration of therapy: Although the optimal duration of administration and leukapheresis schedule have not been established, administration for 6 to 7 days with leukaphereses on days 5, 6, and 7 was found to be safe and effective.

Comment:
-Neutrophil counts should be monitored after 4 days of therapy, and therapy should be discontinued if the white blood cell (WBC) count rises to greater than 100,000/mm3.

Use: For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis

Usual Adult Dose for Neutropenia

Congenital Neutropenia:
Initial dose: 6 mcg/kg subcutaneously twice a day
Median dose: 6 mcg/kg/day subcutaneously
Maximum dose: In rare instances, patients have required doses greater than 100 mcg/kg/day subcutaneously

Idiopathic or Cyclic Neutropenia:
Initial dose: 5 mcg/kg subcutaneously once a day
Median dose:
-Cyclic neutropenia: 2.1 mcg/kg/day subcutaneously
-Idiopathic neutropenia: 1.2 mcg/kg/day subcutaneously

Comments:
-Prior to starting therapy in patients with suspected chronic neutropenia, the diagnosis of severe chronic neutropenia (SCN) should be confirmed by evaluating serial CBCs with differential and platelet counts, and evaluating bone marrow morphology and karyotype. Starting therapy prior to confirmation of a correct diagnosis of SCN may impair diagnostic efforts and may thus impair or delay evaluation and treatment of an underlying condition (other than SCN) causing the neutropenia.
-Chronic daily administration is required to maintain clinical benefit.
-The dose should be individually adjusted based on the patient's clinical course as well as ANC.
-During the initial 4 weeks of therapy and during the 2 weeks following any dose adjustment, a CBC with differential and platelet count should be performed twice weekly.
-Once a patient is clinically stable, a CBC with differential and platelet count should be performed monthly for the first year of treatment. Thereafter, if clinically stable, routine monitoring with regular CBCs (i.e., as clinically indicated but at least quarterly) is recommended.
-For those patients with congenital neutropenia, annual bone marrow and cytogenetic evaluations should be performed throughout the duration of treatment.

Use: For chronic administration to reduce the incidence and duration of sequelae of neutropenia (e.g., fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia

Usual Adult Dose for Neutropenia Associated with Radiation

10 mcg/kg subcutaneously once daily for patients exposed to myelosuppressive doses of radiation; administer as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 gray (Gy)

Duration of therapy: Continue administration until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs or exceeds 10,000/mm3 after a radiation-induced nadir

Comments:
-Estimate the patient's absorbed radiation dose (i.e., level of radiation exposure) based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.

-Obtain a baseline CBC and then serial CBCs approximately every third day until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs; therapy should not be delayed if a CBC is not readily available.

Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation

Usual Pediatric Dose for Neutropenia Associated with Chemotherapy

5 mcg/kg/day as a single daily subcutaneous bolus injection, or short IV infusion (15 to 30 minutes), or by continuous IV infusion; doses may be increased by 5 mcg/kg for each chemotherapy cycle according to the duration and severity of the absolute neutrophil count (ANC) nadir; stop therapy if the ANC increases beyond 10,000/mm3

Duration of therapy: Up to 2 weeks or until the ANC has reached 10,000/mm3 following the expected chemotherapy-induced neutrophil nadir (a transient increase in neutrophil count is typically seen 1 to 2 days after initiation of therapy)

Comments:
-A CBC and platelet count should be obtained before instituting therapy and monitored twice weekly during therapy.
-Do not administer this drug during the period 24 hours before or 24 hours after the administration of cytotoxic chemotherapy.
-The duration of therapy needed to attenuate chemotherapy-induced neutropenia may be dependent on the myelosuppressive potential of the chemotherapy regimen used.

Uses:
-To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever
-To reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML)

Usual Pediatric Dose for Bone Marrow Transplantation

10 mcg/kg/day IV over no longer than 24 hours

During the period of neutrophil recovery, titrate the daily dosage against the neutrophil response:
-If ANC greater than 1000/mm3 for 3 consecutive days, reduce the dose to 5 mcg/kg/day
-If ANC remains greater than 1000/mm3 for 3 more consecutive days, discontinue therapy
-If ANC decreases to less than 1000/mm3, resume therapy at 5 mcg/kg/day Note: If ANC decreases to less than 1000/mm3 at any time during the 5 mcg/kg/day administration, increase the dose to 10 mcg/kg/day, and then follow the above steps.

Comments:
-Administer the first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion.
-Frequent CBCs and platelet counts are recommended (at least 3 times per week) following marrow transplantation.

Use: To reduce the duration of neutropenia and neutropenia-related clinical sequelae (e.g., febrile neutropenia) in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation

Usual Pediatric Dose for Peripheral Progenitor Cell Transplantation

10 mcg/kg/day subcutaneously for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis

Duration of therapy: Although the optimal duration of administration and leukapheresis schedule have not been established, administration for 6 to 7 days with leukaphereses on days 5, 6, and 7 was found to be safe and effective.

Comments:
-Neutrophil counts should be monitored after 4 days of therapy, and therapy should be discontinued if the white blood cell (WBC) count rises to greater than 100,000/mm3.

Use: For the mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis

Usual Pediatric Dose for Neutropenia

Congenital Neutropenia:
Initial dose: 6 mcg/kg subcutaneously twice a day
Median dose: 6 mcg/kg/day subcutaneously

Idiopathic or Cyclic Neutropenia:
Initial dose: 5 mcg/kg subcutaneously once a day
Median dose:
-Cyclic neutropenia: 2.1 mcg/kg/day subcutaneously
-Idiopathic neutropenia: 1.2 mcg/kg/day subcutaneously

Comments:
-Prior to starting therapy in patients with suspected chronic neutropenia, the diagnosis of severe chronic neutropenia (SCN) should be confirmed by evaluating serial CBCs with differential and platelet counts, and evaluating bone marrow morphology and karyotype. Starting therapy prior to confirmation of a correct diagnosis of SCN may impair diagnostic efforts and may thus impair or delay evaluation and treatment of an underlying condition (other than SCN) causing the neutropenia.
-Chronic daily administration is required to maintain clinical benefit.
-The dose should be individually adjusted based on the patient's clinical course as well as ANC.
-During the initial 4 weeks of therapy and during the 2 weeks following any dose adjustment, a CBC with differential and platelet count should be performed twice weekly.
-Once a patient is clinically stable, a CBC with differential and platelet count should be performed monthly for the first year of treatment. Thereafter, if clinically stable, routine monitoring with regular CBCs (i.e., as clinically indicated but at least quarterly) is recommended.
-For those patients with congenital neutropenia, annual bone marrow and cytogenetic evaluations should be performed throughout the duration of treatment.

Use: For chronic administration to reduce the incidence and duration of sequelae of neutropenia (e.g., fever, infections, oropharyngeal ulcers) in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenia

Usual Pediatric Dose for Neutropenia Associated with Radiation

10 mcg/kg subcutaneously once daily for patients exposed to myelosuppressive doses of radiation; administer as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 gray (Gy)

Duration of therapy: Continue administration until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs or exceeds 10,000/mm3 after a radiation-induced nadir

Comments:
-Estimate the patient's absorbed radiation dose (i.e., level of radiation exposure) based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.
-Obtain a baseline CBC and then serial CBCs approximately every third day until the ANC remains greater than 1000/mm3 for 3 consecutive CBCs; therapy should not be delayed if a CBC is not readily available.

Use: To increase survival in patients acutely exposed to myelosuppressive doses of radiation

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

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