filgrastim

Action and Spectrum

Actions and Spectrum: 

filgrastim works by attaching to certain receptors on the surface of bone marrow cells, which stimulates the proliferation and differentiation of those cells into white blood cells. As a result, the amount of neutrophils in the circulation rises, aiding in the battle against infections and other conditions that might cause neutropenia (low levels of neutrophils). 

The spectrum of filgrastim refers to the variety of problems that the medicine can be used to treat. It is primarily used to prevent or cure neutropenia induced by chemotherapy or radiation therapy in individuals with cancer. Moreover, it can be used to treat neutropenia in individuals with additional illnesses such HIV infection, severe persistent neutropenia, and bone marrow transplantation. 

Drug Interaction

Adverse Reaction

Frequency Defined  

>10% 

Vomiting (57%) 

Alopecia (18%) 

Nausea (57%) 

Fever (12%) 

Bone pain (22%-33%) 

Fatigue (11%) 

Diarrhea (14%) 

1-10% 

Anorexia 

Dyspnea 

Chest pain 

Constipation 

Sore throat 

Stomatitis 

Rash 

Headache 

Cough 

Post marketing reports 

Splenic rupture 

Glomerulonephritis 

Alveolar hemorrhage and hemoptysis 

cutaneous vasculitis 

Sweet syndrome (acute febrile neutrophilic dermatosis) 

Decreased bone density and osteoporosis in children with severe chronic neutropenia receiving long-term treatment 

Respiratory distress syndrome 

Myelodysplastic syndrome 

Acute myeloid leukemia 

Capillary leak syndrome 

Aortitis 

Sickle cell crisis 

ARDS 

Asthenia 

Frequency not defined 

Elevated alkaline phosphatase 

Elevated uric acid 

Elevated lactate dehydrogenase 

Black Box Warning

Black Box Warning 

A black box warning for filgrastim mentions the possibility of splenic rupture, a potentially fatal disease where the spleen may burst or rupture. 

Healthcare professionals are urged by the black box warning to keep an eye out for symptoms of splenic rupture in patients using filgrastim, such as left upper abdomen or shoulder discomfort. filgrastim should be stopped right away if splenic rupture is suspected. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Individuals who have previously experienced severe allergic responses to items containing human granulocyte colony-stimulating factor (G-CSF).

Caution: 

• Usage with care in patients with a history of sickle cell disease or myeloid malignancies. 
• In individuals with pulmonary or cardiac problems already present, use with caution. 
• In individuals with renal or hepatic impairment, use with care. 
• In individuals who have experienced splenic enlargement or rupture in the past, use with care. 
• Those who suffer capillary leak syndrome, high-dose chemotherapy, or radiation therapy should use care. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excretion into human milk is known 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were lack of studies on pregnant women and no evidence of risk to the foetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology 

A recombinant human substance called filgrastim, also known as granulocyte colony-stimulating factor (G-CSF), encourages the production of neutrophils, a kind of white blood cell, in the bone marrow. It is a glycoprotein that is created using recombinant DNA technology in Escherichia coli bacteria. 

Pharmacodynamics 

By attaching to certain receptors on the surface of neutrophil progenitor cells, filgrastim increases the growth, differentiation, and maturation of these progenitor cells into adult neutrophils. The medication also improves mature neutrophil survival and performance, including their capacity to go to infection sites and phagocytose pathogens. 

Pharmacokinetics 

Absorption   

filgrastim is delivered through subcutaneous injection or intravenous infusion. The subcutaneous mode of administration leads in slower absorption than the intravenous approach. When taken subcutaneously, filgrastim has a bioavailability of 60 to 70%. 

Distribution 

With a volume of distribution of around 150 mL/kg, filgrastim is most likely to be found in the extracellular fluid compartment. The medication does not bind appreciably to plasma proteins. 

Metabolism 

filgrastim is not metabolized by the liver or other organs. It is largely removed by the kidneys. 

Elimination and excretion 

filgrastim is mostly removed through renal excretion. In healthy people, filgrastim has an elimination half-life of around 3–4 hours. The elimination half-life may be extended in individuals with poor renal function, and dosage changes may be required. 

Adminstartion

Administration:  

filgrastim is commonly delivered by subcutaneous injection or intravenous infusion. 

The recommended dosage of filgrastim, given as an intravenous infusion or subcutaneous injection, is 5 mcg/kg of body weight per day for the treatment of chemotherapy-induced neutropenia in patients with non-myeloid malignancies. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: filgrastim    

Why do we use filgrastim? 

filgrastim is a medication used to increase the production of neutrophils, a type of white blood cell, in the bone marrow. 

Patients receiving chemotherapy for cancer can use filgrastim to prevent or lessen the occurrence and severity of neutropenia (low white blood cell count). 

filgrastim is used to increase the formation of stem cells in the bone marrow and enhance regeneration of donor cells in patients undergoing bone marrow transplantation.