Nejpomaks® can be administered by daily subcutaneous (SC) injections or daily short (30-minute) intravenous (IV) infusions. Also, the drug can be administered in the form of 24-hour intravenous or subcutaneous infusions.
The choice of route of administration should depend on the specific clinical situation, however, in most cases, the subcutaneous route of administration is preferred.
To avoid pain, with the introduction of the best time to change the injection site daily.
Standard schemes of cytotoxic chemotherapy
5 μg / kg body weight once a day daily subcutaneously or intravenously drip for 30 minutes until after the expected maximum decrease in the level of neutrophils, their number will not recover to normal, when the drug can be canceled .
The first dose of Neupomax® should be administered no earlier than 24 hours after the end of the course of cytotoxic chemotherapy. Duration of therapy up to 14 days. After induction and consolidation therapy for acute myelogenous leukemia, the duration of Neimomax® may increase to 38 days, depending on the type, dosage and chemotherapy used.
Usually a transient increase in the number of neutrophils is observed 1-2 days after the initiation of treatment with filgrastim. To achieve a stable therapeutic effect, it is not recommended to interrupt treatment until normal neutrophil values are reached after the expected maximum decrease in their level. With an absolute amount of neutrophils exceeding 10,000 / μl, treatment with Neimaxax® is stopped,
Myeloablative therapy followed by autologous or allogeneic bone marrow transplantation
The initial dose is 10 μg / kg per day intravenously drip for 30 minutes or 24 hours, or as a 24-hour infusion.
The first dose of Neuromax® should be administered no earlier than 24 hours after cytotoxic chemotherapy, and for bone marrow transplantation - no later than 24 hours.
The duration of therapy is no more than 28 days. The daily dose of the drug is corrected depending on the dynamics of the neutrophil content. With an absolute neutrophil count of more than 1000 / μL for three consecutive days, the dose of Neuromax® is reduced to 5 μg / kg / day. If the absolute amount of neutrophils exceeds 1000 / μL for 3 consecutive days, the administration of Neuromax® is stopped. If, during treatment, the absolute amount of neutrophils decreases to less than 1000 / μL, the dose of Neupomax® is increased again, according to the above scheme.
Mobilization of peripheral blood stem cells in patients with neoplastic diseases
At 10 mcg / kg once a day sc, or by continuous 24-hour infusion for 6 consecutive days. In this case, usually 2 leukapheresis is performed in a row, on the 5th and 6th days. In the case of additional leukapheresis, the administration of Neupomax® should be continued until the last leukapheresis is carried out.
Mobilization of PSKC after myelosuppressive chemotherapy
At 5 mcg / kg per day by daily subcutaneous injections, starting from the first day after completion of chemotherapy and until the number of neutrophils reaches normal values.
Leukapheresis should be performed only when the absolute number of neutrophils exceeds normal values (> 2000 / μl).
Mobilization of PSKC in healthy donors for allogeneic transplantation
At 10 mg / kg / day n / k for 4-5 days and carrying 1 or 2 leukapheresis usually yields more 4x106 Cd34+ cells / kg body weight of the recipient.
Data on the safety and efficacy of filgrastim in healthy donors under the age of 16 and older than 60 years are not available.
Severe chronic neutropenia (THC)
Neypomaks® administered in an initial dose of 12 mg / kg / day in congenital neutropenia and 5 mg / kg / day, or in idiopathic neutropenia periodic subcutaneously once or by several administrations daily as long as the number of neutrophils not be stably exceed 1500 / ml. Once the therapeutic effect is achieved, the minimum effective dose is determined to maintain this level. After 1-2 weeks of treatment, the initial dose can be doubled or halved, depending on the patient's response to therapy. Subsequently, every 1-2 weeks, individual dose adjustment can be performed to maintain the average number of neutrophils in the range of 1500-10000 / μL.In patients with severe infections, a scheme with a faster increase in dose can be used. The safety of filgrastim with prolonged treatment of patients with TCN doses greater than 24 μg per day is not established.
Neutropenia in HIV infection
The initial dose of 1-4 μg (0.1-0.4 million IU) / kg subcutaneously once a day until the normalization of the number of neutrophils. The maximum daily dose should not exceed 10 mcg / kg. After achieving therapeutic effect, it is recommended to apply Neupomax® in a maintenance dose: 300 mcg p / c every other day. Subsequently, the doses are corrected in each individual case separately to maintain an average number of neutrophils greater than 2000 / μL.
Application in children's practice
Recommendations for dosing for sick children are the same as for adults.
Elderly patients, patients with impaired renal or hepatic function
Neutomax® dose adjustment is not required.
Breeding instructions
When administered subcutaneously the drug should not be diluted further.
When preparing a solution for infusions Neupomax® is diluted with only 5% dextrose solution. Dilution 0.9% solution of sodium chloride is not allowed (pharmaceutical incompatibility).
Neupomax ® diluted in a concentration of 2 to 15 μg / ml can be adsorbed by glass and plastics. In this case, to prevent absorption in the solution, add serum human albumin in the required amount to reach its concentration in the final solution of 2 mg / ml. For a diluted solution of Nejpomax® at a concentration of more than 15 μg / ml, the addition of albumin is not required.
Neupomax ® should not be diluted to a concentration of less than 2 μg / ml.