White blood cell disorders:
Indications for NEULASTA:
To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anticancer drugs associated with clinically significant incidence of febrile neutropenia. To increase survival in patients acutely exposed to myelosuppressive doses of radiation.
Adults and Children:
See full labeling. ≥45kg: Chemotherapy-induced neutropenia: Do not give between 14 days before and 24 hours after chemotherapy. 6mg SC once per chemotherapy cycle. Acute radiation syndrome (use prefilled syringe only): 2 doses, each of 6mg SC; give 1st dose as soon as possible after exposure to radiation levels >2 gray (Gy), then a 2nd dose one week later. Children (<10kg): 0.1mg/kg; (10–20kg): 1.5mg; (21–30kg): 2.5mg; (31–44kg): 4mg. Direct administration of prefilled syringe with doses <6mg is not recommended.
Monitor for splenomegaly, splenic rupture, acute respiratory distress syndrome (ARDS); evaluate if fever, lung infiltrates, or respiratory distress occurs; discontinue if ARDS diagnosed. Permanently discontinue if serious allergic reactions develop. Sickle cell disorders; discontinue if sickle cell crisis occurs. Monitor for glomerulonephritis; consider dose reduction or interruption if treatment-related. Monitor CBCs, platelet counts during therapy. Discontinue if aortitis is suspected. Myeloid malignancies. Myelodysplasia. Monitor for MDS/AML in those with breast or lung cancer. Possible transient (+) bone imaging changes in nuclear imaging. Latex allergy (needle cap). On-body injector: potential for device failure resulting in missed or partial doses; not recommended for acute radiation syndrome; not studied in children; acrylic adhesive allergy. Pregnancy. Nursing mothers.
Granulocyte colony stimulating factor.
Bone or extremity pain; anaphylaxis, ARDS, splenic rupture, glomerulonephritis, leukocytosis, aortitis, capillary leak syndrome (monitor closely if occurs); thrombocytopenia, on-body injector: application-site reactions (eg, hemorrhage, pain, discomfort, bruise, erythema), contact dermatitis, local skin reactions (eg, rash, pruritus, urticaria).
Generic Drug Availability:
Single-dose prefilled syringe—1; Onpro Kit—1 (prefilled syringe + On-body injector)