Filgrastim is a recombinant human granulocyte colony-stimulating factor (G-CSF) composed of 175 amino acids. It promotes the production, maturation, and activation of neutrophils from bone marrow progenitors, enhancing immune functions like phagocytosis and antibody-mediated cytotoxicity.
It is primarily cleared by the kidneys, with nonlinear pharmacokinetics—its clearance depends on serum levels and neutrophil count. Peak levels occur within 2 to 8 hours after administration, and subcutaneous bioavailability is approximately 60–70%.
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1. Cancer Patients on Myelosuppressive Chemotherapy
Filastin helps reduce the risk of infection, such as febrile neutropenia, in patients with non-myeloid cancers who are receiving chemotherapy known to significantly lower neutrophil counts.
2. Patients with Acute Myeloid Leukemia (AML)
It shortens the duration of neutropenia and fever during induction or consolidation chemotherapy in AML patients.
3. Bone Marrow Transplant (BMT) Recipients
Filastin reduces both the length of neutropenia and associated complications (e.g., febrile neutropenia) in non-myeloid cancer patients undergoing high-dose chemotherapy followed by BMT.
4. Severe Chronic Neutropenia (SCN)
Used to reduce the frequency and duration of neutropenia-related complications such as infections, fevers, and mouth ulcers in patients with congenital, cyclic, or idiopathic neutropenia.
5. Acute Radiation Syndrome
Improves survival rates in patients exposed to myelosuppressive doses of radiation by promoting neutrophil recovery.
6. HIV-Related Neutropenia
Used in advanced HIV patients to prevent or treat persistent neutropenia and reduce the risk of bacterial infections when other options are insufficient.
0.5 MU (5 mcg)/kg/day SC or IV, starting no sooner than 24 hours after chemotherapy. Continue until neutrophil recovery (typically up to 14 days; up to 38 days for AML).
1.0 MU (10 mcg)/kg/day IV infusion. Start at least 24 hours post-chemotherapy and post-transplant. Titrate according to neutrophil counts.
1.0 MU (10 mcg)/kg/day SC for 5–7 days. Begin at least 4 days before leukapheresis.
Congenital: 0.6 MU (6 mcg)/kg twice daily SC
Cyclic/Idiopathic: 0.5 MU (5 mcg)/kg once daily SC
Titrate based on ANC and CBC monitoring.
1.0 MU (10 mcg)/kg/day SC once daily.
Start with 0.1 MU (1 mcg)/kg/day SC; titrate up to 0.4 MU (4 mcg)/kg/day to maintain ANC > 2.0 × 10⁹/L.
Chemotherapy patients: fever, pain, rash, cough, shortness of breath
AML: rash, nasal bleeding, general pain
BMT recipients: skin rash
PBPC mobilization: bone pain, fever, headache
SCN patients: anemia, nosebleeds, diarrhea, numbness, hair thinning
Interactions are not fully established. Use caution with drugs like lithium, which can also stimulate neutrophil production.
Hypersensitivity to Filgrastim or its components
Patients with Kostmann’s syndrome (severe congenital neutropenia.
Pregnancy Category C
Animal studies show potential risk; human data is lacking.
Unknown if excreted in human milk—use with caution during breastfeeding.
Do not use within 24 hours before or after chemotherapy
Regular CBC and ANC monitoring is required to avoid complications from high neutrophil counts
Risk of tumor stimulation in malignancy not excluded
Avoid diluting to concentrations below 5 mcg/mL
Can be diluted in 5% dextrose if needed
Store in a refrigerator at 2°C–8°C. Protect from light. Do not freeze. Avoid shaking the vial or pre-filled syringe.
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