Pegfilgrastim
NEULASTA
Pronunciation: peg-fil-GRA-stim (noo-LAS-ta)
What it isPegylated G-CSF receptor agonist; prevention of chemotherapy-associated febrile neutropenia.
Why this oneThe pegylation is the product: self-regulating clearance by neutrophils turns daily filgrastim injections into a single next-day dose (or on-body injector).
What limits itBone pain is common; splenic rupture and acute respiratory distress are uncommon but serious. Do not administer too close to cytotoxic chemotherapy.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Chemotherapy-induced febrile neutropenia (myelosuppressive chemo) | adults and pediatric | 6 mg SC once per chemotherapy cycle (adults any weight and pediatrics ≥45 kg); weight-based if <45 kg | 6 mg per cycle | 6 mg per cycle |
| Hematopoietic subsyndrome of acute radiation syndrome | adults and pediatric | 6 mg SC, two doses one week apart (adults any weight and pediatrics ≥45 kg); weight-based if <45 kg | two 6 mg doses one week apart | 6 mg per dose |
Renal Undefined
Hepatic Undefined
Instructions
- Administer subcutaneously.
- For chemotherapy use, do not administer between 14 days before and 24 hours after chemotherapy.
- Pediatric patients <45 kg: use weight-based dosing per Table 1.
- For ARS, give first dose as soon as possible after exposure >2 Gy; second dose one week later.
Available strengths
- inj 4 mg/.4 mL
- inj 6 mg/.6 mL
Cautions
- Fatal splenic rupture
- Acute respiratory distress syndrome
- Serious hypersensitivity reactions including anaphylaxis
- Acrylic adhesive reactions with on-body injector
- Fatal sickle cell crises
- Glomerulonephritis
- Leukocytosis
- Thrombocytopenia
- Capillary leak syndrome
- MDS and AML
- On-body injector device failures
- Large and medium vessel arteritis
Adverse reactions
- Bone pain
- Pain in extremity
Pregnancy Insufficient human data; animal studies showed embryolethality/abortions in rabbits at higher doses.
Lactation No data on presence in human milk; filgrastim products are secreted poorly and not orally absorbed by neonates.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 4 mg/.4 mL | inj | per unit | not offered | |
| 6 mg/.6 mL | inj | per unit | $3369.51/mL | not offered |
NO BOXED WARNINGS
Principal riskSplenic rupture; acute respiratory distress syndrome
Classes and tags
Clinical profile
Defining liabilityBone pain and rare splenic, pulmonary or hypersensitivity toxicity