Pegfilgrastim

A to Z Drug Facts

  Action Stimulates neutrophil production within bone marrow.

  Indications Decrease incidence of infection, manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with febrile neutropenia.

  Contraindications Hypersensitivity to Escherichia coli-derived proteins, filgrastim, pegfilgrastim, or any component of the product.

  Route/Dosage

ADULTS: SC 6 mg once per chemotherapy cycle. Do not administer in period between 14 days before and 24 hr after administration of cytotoxic chemotherapy. Do not administer the 6 mg fixed-dose formulation in infants, children, and smaller adolescents weighing less than 45 kg.

  Interactions

Drugs Potentiating the Release of Neutrophils (eg, Lithium): Use drugs that potentiate the release of neutrophils with caution.

  Lab Test Interferences None well documented.

  Adverse Reactions

CNS: Fatigue; headache; insomnia; dizziness. DERMATOLOGIC: Alopecia. GI: Nausea; diarrhea; vomiting; constipation; anorexia; taste perversion; dyspepsia; abdominal pain; stomatitis. HEMATOLOGIC: Granulocytopenia; leukocytosis. MUSCULOSKELETAL: Skeletal pain; myalgia; arthralgia; medullary bone pain. OTHER: Fever; generalized weakness; peripheral edema; mucositis; neutropenic fever.

  Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Do not administer 6 mg fixed-dose formulation in infants, children, and smaller adolescents weighing less than 45 kg. Adult Respiratory Distress Syndrome: Adult respiratory distress syndrome may occur. Allergic Reactions: Allergic-type reactions, including anaphylaxis, skin rash, and urticaria may occur. Sickle Cell Disease: Use with caution because severe sickle cell crisis may occur in patients with sickle cell disease. Splenic Rupture: Because splenic rupture may occur, do not use pegfilgrastim for peripheral blood progenitor cell mobilization.

  Administration/Storage

• Administer via SC route only. Not for IM or IV administration.
• Avoid shaking syringe.
• Dose is administered once per chemotherapy cycle but not in the time period from 14 days before to 24 hr after administration of cytotoxic chemotherapy.
• Do not administer if particulate matter, cloudiness, or discoloration noted.
• Store prefilled syringes in original carton in refrigerator (36° to 46°F). Do not freeze. If accidentally frozen, allow to thaw in refrigerator before using. Discard syringe if frozen a second time. May allow syringe to reach room temperature before administering. If removed from refrigerator, keep syringe in original carton to protect from light and use within 48 hr. Discard syringe if left at room temperature for greater than 48 hr.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of the following: allergy to E. coli-derived proteins or filgrastim; sickle cell disease.
• Ensure that CBC and platelet count are obtained before therapy and periodically during treatment.
• Monitor patient for signs and symptoms of splenic enlargement (eg, left upper abdominal pain, shoulder tip pain). Inform health care provider immediately if noted.
• Monitor patient for signs and symptoms of adult respiratory distress syndrome (eg, fever, respiratory distress). Inform health care provider immediately if noted.
• Monitor patient with sickle cell disease for signs and symptoms of sickle cell crisis. Notify health care provider immediately if noted and be prepared to treat appropriately.
• Monitor patient for signs and symptoms of anaphylactic or serious allergic reactions. Be prepared to treat appropriately.
• Monitor patient for CNS, GI, and general body side effects. Report to health care provider if noted and significant.

  Patient/Family Education

• Explain name, dose, action and potential side effects of drug. If patient or caregiver will be administering at home, review “Information for Patients and Caregivers” insert with the patient or caregiver. Ensure that the patient or caregiver understands how to store, prepare, and administer the dose, and dispose of used equipment and supplies. The first injection should be performed under the supervision of a qualified health professional.
• Caution patient or caregiver that medication is not to be administered during the time interval beginning 14 days before to 24 hr after administration of chemotherapy.
• Advise patient or caregiver to immediately report any of the following to their health care provider: fever or other signs of infection; sore throat; left upper stomach pain; shoulder tip pain; difficulty breathing; rash or hives.
• Advise patient or caregiver to report intolerable injection site reactions or unusual symptoms to their health care provider.
• Instruct women to notify health care provider if becoming pregnant, planning on becoming pregnant, or breastfeeding.
• Instruct patient not to take any prescription or otc medications or dietary supplements unless advised by health care provider.
• Remind patient or caregiver that office visits and laboratory tests will be required to monitor therapy and to be sure to keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts