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Neulasta
pegfilgrastim (G-CSF)
Adult Dosing .
Dosage forms: INJ (Onpro on-body injector): 6 mg; INJ (pre-filled syringe): 6 mg per 0.6 mL
febrile neutropenia prophylaxis, chemo-induced
- [6 mg SC x1]
- Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo
hematopoietic subsyndrome of acute radiation syndrome
- [6 mg SC qwk x2 doses]
- Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: do not use on-body injector
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (Onpro on-body injector): 6 mg; INJ (pre-filled syringe): 6 mg per 0.6 mL
febrile neutropenia prophylaxis, chemo-induced
- [<10 kg]
- Dose: 0.1 mg/kg/dose SC x1; Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo; pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [10-20 kg]
- Dose: 1.5 mg SC x1; Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo; pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [21-30 kg]
- Dose: 2.5 mg SC x1; Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo; pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [31-44 kg]
- Dose: 4 mg SC x1; Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo; pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [>45 kg]
- Dose: 6 mg SC x1; Start: >24h after chemo; Info: for pts w/ non-myeloid malignancies; do not give w/in 14 days before chemo
hematopoietic subsyndrome of acute radiation syndrome
- [<10 kg]
- Dose: 0.1 mg/kg/dose SC qwk x2 doses; Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [10-20 kg]
- Dose: 1.5 mg SC qwk x2 doses; Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [21-30 kg]
- Dose: 2.5 mg SC qwk x2 doses; Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [31-44 kg]
- Dose: 4 mg SC qwk x2 doses; Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: pre-filled syringe product not recommended for direct admin. of doses <6 mg; do not use on-body injector
- [>45 kg]
- Dose: 6 mg SC qwk x2 doses; Start: ASAP after suspected or confirmed exposure to radiation doses >2 Gy; Info: do not use on-body injector
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to E. coli protein (some forms)
- caution: hypersensitivity to acrylic adhesive (on-body injector form)
- caution: sickle cell dz
- caution: myelodysplasia
- caution: myeloid malignancy
- caution: breast CA
- caution: lung CA
Drug Interactions .
Overview
pegfilgrastim (G-CSF)
colony stimulating factor
- immunomodulatory effects (colony stimulating factor)
Avoid/Use Alternative
- betibeglogene autotemcel
- lovotibeglogene autotemcel
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- ado-trastuzumab emtansine
- aldesleukin
- alemtuzumab
- arsenic trioxide
- asciminib
- azacitidine
- belantamab mafodotin
- belinostat
- bendamustine
- bevacizumab
- blinatumomab
- bortezomib
- bosutinib
- brentuximab vedotin
- brexucabtagene autoleucel
- busulfan
- cabazitaxel
- capecitabine
- carboplatin
- carfilzomib
- carmustine
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clofarabine
- copanlisib
- crizotinib
- cyclophosphamide
- cytarabine
- dacarbazine
- dactinomycin
- daratumumab
- dasatinib
- daunorubicin
- decitabine
- docetaxel
- dostarlimab
- doxorubicin
- duvelisib
- eflornithine
- elranatamab
- enfortumab vedotin
- entrectinib
- epcoritamab
- epirubicin
- eribulin
- etoposide
- everolimus
- fam-trastuzumab deruxtecan
- fedratinib
- floxuridine
- fludarabine
- fluorouracil
- gemcitabine
- gemtuzumab ozogamicin
- glasdegib
- glofitamab
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- imatinib
- inotuzumab ozogamicin
- iobenguane I 131
- irinotecan
- isatuximab
- ivosidenib
- ixabepilone
- lenalidomide
- lifileucel
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- lurbinectedin
- lutetium Lu 177 dotatate
- lutetium Lu 177 vipivotide tetraxetan
- melphalan
- mercaptopurine
- methotrexate
- midostaurin
- mitomycin
- mitotane
- mitoxantrone
- mogamulizumab
- momelotinib
- mosunetuzumab
- nelarabine
- niraparib
- obinutuzumab
- ofatumumab
- olaparib
- omacetaxine mepesuccinate
- osimertinib
- oxaliplatin
- paclitaxel
- pacritinib
- palbociclib
- panobinostat
- pegvaliase
- pemetrexed
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- pralatrexate
- procarbazine
- quizartinib
- ramucirumab
- ribociclib
- rituximab
- rucaparib
- ruxolitinib
- sacituzumab govitecan
- selinexor
- selumetinib
- sirolimus albumin-bound
- streptozocin
- tafasitamab
- tagraxofusp
- talazoparib
- talquetamab
- tazemetostat
- teclistamab
- temozolomide
- temsirolimus
- thalidomide
- thioguanine
- thiotepa
- tisagenlecleucel
- topotecan
- trabectedin
- trastuzumab
- trifluridine
- umbralisib
- venetoclax
- vinblastine
- vincristine
- vinorelbine
- zanubrutinib
- ziv-aflibercept
Caution Advised
- bleomycin
Adverse Reactions .
Serious Reactions
- splenic rupture
- ARDS
- anaphylaxis
- hypersensitivity rxn
- sickle cell crisis
- myelodysplastic syndrome
- AML
- thrombocytopenia
- glomerulonephritis
- capillary leak syndrome
- aortitis
- alveolar hemorrhage
- cutaneous vasculitis
- acute febrile neutrophilic dermatosis
Common Reactions
- bone pain
- extremity pain
Safety/Monitoring .
Monitoring Parameters
Post-Chemo Neutropenia: CBC w/ diff before chemo, then periodically
Hematopoietic Subsyndrome of Acute Radiation Syndrome: CBC w/ diff at baseline
Look/Sound-Alike Drug Names
Neulasta confused with: Lunesta; Neumega; Neupogen; Nuedexta
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; possible risk of fetal harm based on conflicting animal data
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though low risk of infant harm based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: other; CYP450: unknown
Excretion: other; Half-life: 30.1h (pts <5 yo), 20.2h (pts 6-11 yo), 21.2h (pts 12 yo and older), 15-80h (adults)
Subclass: Colony Stimulating Factors (CSFs) ; Supportive Care: Myelosuppression
Mechanism of Action
binds to receptors on hematopoietic cells, increasing neutrophil production and activation
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Amgen, Inc.
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/neulasta
subcutaneous solution:
- 6 mg/0.6 mL (1 syringe): $6,556.00
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