 |
Colony Stimulating Factors
|
|||||||||||||||
darbepoietin alfa (Aranesp ®):
|
|||||||||||||||
Correction of anemia associated with CRF: Initial: 0.45
mcg/kg (IV, SQ) once weekly. Dosage should be titrated to limit
increases in hemoglobin to <1 g/dL over any 2-week interval, with a
target concentration of <12 g/dL. Maintenance: Titrated to hematologic
response. Some patients may require doses <0.45 mcg/kg once weekly.
Selected patients may be managed by administering SQ doses every 2
weeks.
Note: In patients receiving epoetin alfa 2-3 times per week, darbepoetin alfa is administered once weekly. In patients who are receiving epoetin alfa once weekly, darbepoetin should be administered once every 2 weeks. Dosage adjustment: Goal: Dose should be adjusted to achieve and maintain a target hemoglobin not to exceed 12 g/dL. Inadequate response: Hemoglobin increases <1 g/dL over 4 weeks and iron stores are adequate: Increase by ~25% of the previous dose; increases should not be made more frequently than once monthly. Excessive response: Hemoglobin increases >1 g/dL in any 2-week period: Decrease dose Hemoglobin increases and approaches the target value of 12 g/dL: Decrease weekly dosage by ~25%. If hemoglobin continues to increase, hold dose temporarily until hemoglobin begins to decrease, then restart at a dose 25% below the previous dose. Correction of anemia associated with cancer patients receiving chemotherapy: Initial: 2.25 mcg/kg SQ once weekly. Adjust dose as follows to achieve and maintain a target hemoglobin: Inadequate response: Hemoglobin increases <1 g/dL after 6 weeks of therapy: Increase dose to 4.5 mcg/kg. Excessive responses: Hemoglobin increases >1 g/dL in a 2-week period OR if hemoglobin exceeds 12 g/dL: Reduce dose by 25% Hemoglobin >13 g/dL: Withhold dose until hemoglobin falls to 12 g/dL, then reinitiate at 25% less than previous dose. Darbepoetin's T1/2 is approximately 3 times that of epoetin alfa. |
|||||||||||||||
erythropoietin (Epogen ®):
|
|||||||||||||||
|
Anemia: (Renal failure): Initial dose: 50-100 units/kg
IV/SC 3 x/week. Titration: Reduce dose by 25% when hemoglobin approaches
12 g/dL or when hemoglobin increases 1 g/dL in any 2-week period.
Increase dose by 25% if hemoglobin does not increase by 2 g/dL after 8
weeks of therapy and hemoglobin is below suggested target range;
suggested target hematocrit range: 10-12 g/dL. Maintenance dose:
Individualize to target range. AZT-treated, HIV infected patients: 100 units/kg IV/SC 3 times/week x 8 weeks. Increase dose by 50-100 units/kg 3 times/week if response is not satisfactory in terms of reducing transfusion requirements or increasing hemoglobin after 8 weeks of therapy. Evaluate response every 4-8 weeks thereafter and adjust the dose accordingly by 50-100 units/kg increments 3 times/week. If patient has not responded satisfactorily to a 300 unit/kg dose 3 times/week, a response to higher doses is unlikely. Stop dose if hemoglobin exceeds 13 g/dl and resume treatment at a 25% dose reduction when hemoglobin drops to 12 g/dl. Cancer patients on chemotherapy (Treatment of patients with erythropoietin levels >200 mU/mL is not recommended). 150 units/kg SC 3 times/week or 40,000 units once weekly. Dose adjustment: If response is not satisfactory after a sufficient period of evaluation (8 weeks of 3 times/week and 4 weeks of once weekly therapy), the dose may be increased every 4 weeks (or longer) up to 300 units/kg 3 times/week, or when dosed weekly, increased all at once to 60,000 units weekly. If patient does not respond, a response to higher doses is unlikely. Surgery patients: Prior to initiating treatment, obtain a hemoglobin to establish that is >10 mg/dL or 13 mg/dL: Initial dose: 300 units/kg/day SC x 10 days before surgery, on the day of surgery, and for 4 days after surgery. Alternative dose: 600 units/kg in once weekly doses (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery. |
|||||||||||||||
filgrastim (G-CSF, Neupogen ®):
|
|||||||||||||||
|
Use - Stimulation of
granulocyte production in patients with malignancies, including myeloid
malignancies; receiving myelosuppressive therapy associated with a
significant risk of neutropenia; severe chronic neutropenia (SCN);
receiving bone marrow transplantation (BMT); undergoing peripheral blood
progenitor cell (PBPC) collection Mechanism of Action - Stimulates the production, maturation, and activation of neutrophils, G-CSF activates neutrophils to increase both their migration and cytotoxicity. Dosing: Dosing, even in morbidly obese patients, should be based on actual body weight. Rounding doses to the nearest vial size often enhances patient convenience and reduces costs without compromising clinical response. Myelosuppressive therapy: 5 mcg/kg/day - doses may be increased by 5 mcg/kg according to the duration and severity of the neutropenia. Bone marrow transplantation: 5-10 mcg/kg/day - doses may be increased by 5 mcg/kg according to the duration and severity of neutropenia; recommended steps based on neutrophil response: When ANC >1000/mm3 for 3 consecutive days: Reduce filgrastim dose to 5 mcg/kg/day If ANC remains >1000/mm3 for 3 more consecutive days: Discontinue filgrastim If ANC decreases to <1000/mm3 : Resume at 5 mcg/kg/day If ANC decreases <1000/mm3 during the 5 mcg/kg/day dose, increase filgrastim to 10 mcg/kg/day and follow the above steps Peripheral blood progenitor cell (PBPC) collection: 10 mcg/kg/day or 5-8 mcg/kg twice daily in donors. The optimal timing and duration of growth factor stimulation has not been determined. Severe chronic neutropenia: Congenital: 6 mcg/kg twice daily Idiopathic/cyclic: 5 mcg/kg/day Administration May be administered undiluted by SubQ or by I.V. infusion over 15-60 minutes in D5W; incompatible with sodium chloride solutions Monitoring Parameters CBC and platelet count should be obtained twice weekly. Leukocytosis (white blood cell counts >/=100,000/mm3 ) has been observed in ~2% of patients receiving G-CSF at doses >5 mcg/kg/day. Monitor platelets and hematocrit regularly. Supplied: Injection, solution [preservative free]: 300 mcg/mL (1 mL, 1.6 mL) [vial; contains sodium 0.035 mg/mL and sorbitol] Injection, solution [preservative free]: 600 mcg/mL (0.5 mL, 0.8 mL) [prefilled Singleject® syringe; contains sodium 0.035 mg/mL and sorbitol] Comparative Effects G-CSF vs GM-CSF
|
|||||||||||||||
oprelvekin (Neumega ® ):
|
|||||||||||||||
|
Use - Prevention of
severe thrombocytopenia and the reduction of the need for platelet
transfusions following myelosuppressive chemotherapy Mechanism of Action - Oprelvekin stimulates multiple stages of megakaryocytopoiesis and thrombopoiesis, resulting in proliferation of megakaryocyte progenitors and megakaryocyte maturation Dosage SubQ: Note: First dose should not be administered until 24-36 hours after the end of chemotherapy. Discontinue the drug at least 48 hours before beginning the next cycle of chemotherapy. Children: 75-100 mcg/kg once daily for 10-21 days (until postnadir platelet count >/= 50,000 cells/ uL) Note: The manufacturer states that, until efficacy/toxicity parameters are established, the use of oprelvekin in pediatric patients (particularly those <12 years of age) should be restricted to use in controlled clinical trials. Adults: 50 mcg/kg once daily for 10-21 days (until postnadir platelet count >/= 50,000 cells/uL) Administration Subcutaneously in either the abdomen, thigh, or hip (or upper arm if not self-injected). Discontinue treatment with oprelvekin >/= 2 days before starting the next planned cycle of chemotherapy. Supplied Injection, powder for reconstitution: 5 mg |
|||||||||||||||
pegfilgrastim (Neulasta ®):
|
|||||||||||||||
|
Use - Decrease the
incidence of infection, by stimulation of granulocyte production, in
patients with nonmyeloid malignancies receiving myelosuppressive therapy
associated with a significant risk of febrile neutropenia Mechanism of Action - Stimulates the production, maturation, and activation of neutrophils, pegfilgrastim activates neutrophils to increase both their migration and cytotoxicity. Pegfilgrastim has a prolonged duration of effect relative to filgrastim and a reduced renal clearance. Dosage SubQ: Adolescents >45 kg and Adults: 6 mg once per chemotherapy cycle; do not administer in the period between 14 days before and 24 hours after administration of cytotoxic chemotherapy; do not use in patients, infants, children, and smaller adolescents weighing <45 kg Monitoring Parameters Complete blood count and platelet count should be obtained prior to chemotherapy. Leukocytosis (white blood cell counts 100,000/mm3 ) has been observed in <1% of patients receiving pegfilgrastim. Monitor platelets and hematocrit regularly. Supplied Injection, solution [preservative free]: 10 mg/mL (0.6 mL) [prefilled syringe] |
|||||||||||||||
sargramostim (GM-CSF):
|
|||||||||||||||
| See package insert. | |||||||||||||||
Disclaimer |
|||||||||||||||
|
Listed dosages are for - Adult patients ONLY. PLEASE READ THE
DISCLAIMER CAREFULLY BEFORE
ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE
TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
GlobalRPH does not directly or indirectly practice medicine or provide
medical services and therefore assumes no liability whatsoever of any
kind for the information and data accessed through the Service or for
any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. |
| Disclaimer Contact Us Privacy Policy Website Search | We comply with the HONcode standard for health trustworthy information: Verify here. Copyright © 2007 GlobalRPh Inc. |
 |
 |