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INTRODUCTION

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filgrastim (fil-gra-stim)

Neupogen

Other Names:

Granulocyte colony-stimulating factor (G-CSF)

Classification

Therapeutic: colony-stimulating factors

Pharmacologic: hematopoietic growth factors

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Indications
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Prevention of febrile neutropenia and associated infection in patients who have received bone marrow–depressing antineoplastics for the treatment of nonmyeloid malignancies. Reduction of time for neutrophil recovery and duration of fever in patients undergoing induction and consolidation chemotherapy for acute myelogenous leukemia. Reduction of time to neutrophil recovery and sequelae of neutropenia in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation. Mobilization of hematopoietic progenitor cells into peripheral blood for collection by leukapheresis. Management of severe chronic neutropenia. Unlabeled Use: Neutropenia associated with HIV infection.

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Action
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A glycoprotein, filgrastim binds to and stimulates immature neutrophils to divide and differentiate. Also activates mature neutrophils. Therapeutic Effects: Decreased incidence of infection in patients who are neutropenic from chemotherapy or other causes. Improved harvest of progenitor cells for bone marrow transplantation.

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Adverse Reactions/Side Effects
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Hemat: excessive leukocytosis. Local: pain, redness at SC site. MS: medullary bone pain.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of increased white blood cell counts (leukocytosis), including fever, weakness, weight loss, loss of appetite, dizziness, fainting, dyspnea, bleeding/bruising, or pain or tingling in the arms, legs, or abdomen. Report these signs to the physician or nursing staff immediately.

  • Assess any bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by fracture or biomechanical problems.

  • Monitor subcutaneous injection site for pain, swelling, and inflammation. Report prolonged or excessive injection-site reactions to the physician.

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Interventions
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  • For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

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Patient/Client-Related Instruction
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  • Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

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Pharmacokinetics
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Absorption: Well absorbed after SC administration.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: 3.5 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
IV, SC unknown unknown 4 days*

*Return of neutrophil count to baseline.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to filgrastim or Escherichia coli–derived proteins.

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Use Cautiously in: Malignancy with myeloid characteristics; Preexisting cardiac disease; Pregnancy, lactation, or children (safety not established).

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Interactions
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Drug-Drug: Simultaneous use with antineoplastics may have adverse effects on rapidly proliferating neutrophils—avoid ...

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