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INTRODUCTION

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palifermin (pa-lif-er-min)

Kepivance

Classification

Therapeutic: cytoprotective agents

Pharmacologic: keratinocyte growth factors (rDNA)

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Indications
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To decrease incidence/duration of severe oral mucositis associated with myelotoxic therapy requiring stem cell support for hematologic malignancies.

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Action
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Enhances proliferation of epithelial cells. Therapeutic Effects: Decreased incidence/duration of mucositis.

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Adverse Reactions/Side Effects
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Derm: skin toxicity. GI: oral toxicity. Metab: ↑ amylase, ↑ lipase. MS: arthralgia. Neuro: dysesthesia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor any skin reactions, including rash, itching, irritation, and exfoliation. Report any suspicious or toxic skin reactions to the physician or nursing staff.

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

  • Monitor and report any changes in taste or other unusual sensations such as burning, tingling, or painful responses to touch (dysesthesia).

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Patient/Client-Related Instruction
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  • Instruct patient to report any increase in oral lesions.

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Distributes into extravascular space.

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Metabolism and Excretion: Unknown.

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Half-life: 4.5 hr.

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TIME/ACTION PROFILE (levels)

ROUTE ONSET PEAK DURATION
IV unknown end of dose unknown

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

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Use Cautiously in: OB: Pregnancy (use only if maternal benefit outweighs fetal risk); Pedi: Children, lactation (safety not established).

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Interactions
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Drug-Drug: Binds to and inactivates heparin (flush tubing between use). Administration within 24 hr after myelotoxic therapy (chemotherapy/radiation) ↑ severity and duration of mucositis.

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Route/Dosage
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IV (Adults): 60 mcg/kg/day for 3 days before and 3 days after myelotoxic therapy.

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Availability
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Powder for injection: 6.25 mg/vial.

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