Filgrastim
NEUPOGEN
Pronunciation: fil-GRA-stim (NOO-poe-jen)
“Pilgrim stimulator, Neutrophil generator”
What it isRecombinant G-CSF stimulating neutrophil production; chemotherapy-induced neutropenia and stem-cell mobilization.
Why this oneIts short action allows day-by-day control and stem-cell mobilization, unlike long-acting pegfilgrastim.
What limits itBone pain is common; leukocytosis and splenic enlargement need attention, and left-upper-quadrant pain may signal rupture.
FDA-approved for
- chemotherapy-induced neutropenia (1991)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Myelosuppressive chemotherapy | cancer | 5 mcg/kg/day SC or IV | escalate by 5 mcg/kg per cycle | |
| Bone marrow transplant | cancer | 10 mcg/kg/day IV | ||
| Autologous PBPC mobilization/collection | adult | 10 mcg/kg/day SC | ||
| Congenital neutropenia | SCN | 6 mcg/kg SC BID | ||
| Cyclic or idiopathic neutropenia | SCN | 5 mcg/kg SC QD | ||
| Acute radiation exposure (hematopoietic syndrome) | all | 10 mcg/kg/day SC |
Renal Undefined
Hepatic Undefined
Instructions
- Administer at least 24 hours after cytotoxic chemotherapy; do not give within 24 hours before chemotherapy.
- Obtain CBC and platelet count before and monitor during therapy.
- Consider stopping if ANC rises beyond 10,000/mm3 (chemotherapy setting).
- Route (SC, short IV, or continuous IV) depends on indication.
Available strengths
- inj 300 mcg/.5 mL
- inj 480 mcg/.8 mL
Cautions
- Splenic rupture (including fatal cases)
- Acute respiratory distress syndrome
- Serious allergic reactions/anaphylaxis
- Fatal sickle cell crises
- Glomerulonephritis
- MDS/AML in breast/lung cancer with chemo/radiotherapy
- Thrombocytopenia
- Leukocytosis
- Capillary leak syndrome
- Alveolar hemorrhage and hemoptysis
- Cutaneous vasculitis
- Large/medium vessel arteritis
Adverse reactions
- Pyrexia
- Pain
- Rash
- Cough
- Dyspnea
- Bone pain
- Headache
- Anemia
- Epistaxis
- Diarrhea
Pregnancy No established association with adverse outcomes; no malformations in animals.
Lactation Transfers into human milk but poorly secreted and not orally absorbed by neonates.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 300 mcg/.5 mL | inj | per unit | $531.65/mL | not offered |
| 480 mcg/.8 mL | inj | per unit | $533.41/mL | not offered |
Generic entry2036 est.
NO BOXED WARNINGS
Principal riskBone pain; rare splenic rupture
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.