Pegfilgrastim
Indications
Pegfilgrastim is used in adults receiving chemotherapy for cancer to reduce the length of time that white blood cell counts stay low (neutropenia) and to lower the chance of fever with infection (febrile neutropenia). It is not used for chronic myeloid leukaemia or myelodysplastic syndromes, and is prescribed by a cancer specialist.
How It Works
Pegfilgrastim is a man-made, long-acting form of a natural protein called granulocyte colony-stimulating factor (G-CSF). G-CSF signals the bone marrow to make more neutrophils, the white blood cells that fight bacterial infection, and helps them mature and enter the blood. A chemical chain called polyethylene glycol (PEG) is attached to the protein so that it stays in the body much longer, which means only one injection is needed per chemotherapy cycle.
Dosage and Administration
Pegfilgrastim is given as an injection under the skin, usually by a doctor or nurse, or by the patient or a carer after proper training. The dose is as prescribed, usually a single injection once per chemotherapy cycle, given at least 24 hours after the chemotherapy has finished. It should not be given in the 14 days before the next chemotherapy cycle. Let the prefilled syringe reach room temperature for about 30 minutes before injecting, and do not shake it.
Interactions
No major drug interactions are known. It should not be given at the same time as chemotherapy because rapidly dividing bone marrow cells are sensitive to chemotherapy. Lithium may increase the release of neutrophils. Tell the doctor about any recent radiotherapy and all other medicines you take.
Contraindications
Do not use Pegfilgrastim if you are allergic to Pegfilgrastim, Filgrastim or any ingredient of the product.
Side Effects
The most common side effect is bone pain, often in the back, hips, legs or chest, which is usually mild to moderate and eased with simple painkillers such as Paracetamol. Others include muscle or joint pain, headache, nausea, and redness, pain or swelling at the injection site. Rare but serious effects include rupture of the spleen, a lung problem called acute respiratory distress syndrome, serious allergic reactions, capillary leak syndrome (fluid leaking from blood vessels), inflammation of the aorta, kidney inflammation and sickle cell crisis in people with sickle cell disease.
Get urgent medical help if you have pain in the upper left side of the tummy or at the tip of the left shoulder, shortness of breath or fast breathing, swelling of the face, lips or throat, a rash with dizziness, sudden swelling of the body with less urine, or fever with chills.
Pregnancy and Lactation
There is limited information on use in pregnancy. It should be used only if the doctor decides the benefit outweighs the possible risk. It is not known whether it passes into breast milk; discuss with your doctor whether to breastfeed during treatment.
Precautions and Warnings
- Your blood counts will be checked during treatment.
- Tell your doctor if you have sickle cell disease, a history of allergy to similar medicines, or lung problems.
- The needle cover of some syringes may contain latex.
- Inject into the tummy, thigh or upper arm, avoiding skin that is tender, bruised or hard.
- Dispose of used syringes in a sharps container.
Overdose
Overdose is unlikely as it is given once per cycle. Very high white blood cell counts may occur. If too much has been given, contact the doctor; treatment is supportive with blood count monitoring.
Therapeutic Class
Haematopoietic growth factor (long-acting granulocyte colony-stimulating factor).
Storage
Store in a refrigerator at 2 to 8°C in the original carton to protect from light. Do not freeze and do not shake. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.
All brands of Pegfilgrastim