neupogen

[Susan Patterson]

need help, does anyone have information regarding the best way to give this drug, SQ or IV? I have feeling SQ is better, but i really need some scientific evidence or at least some best practice type notification. thank you.

[Penelope_Pitstop, BSN, RN]

I'm not an oncology nurse by any means, but I was referring to my healthcare system's formulary for another question and decided to look up Neupogen while I was at it.

My formulary states that SQ is the preferred route.

And it also lists these references:

Andres E, Kurtz JE, Martin-Hunyadi C, et al, "Nonchemotherapy Drug-Induced Agranulocytosis in Elderly Patients: The Effects of Granulocyte Colony-Stimulating Factor," Am J Med, 2002, 112(6):460-4.[PubMed 11959056]

Calandra G, McCarty J, McGuirk J, et al, "AMD3100 Plus G-CSF Can Successfully Mobilize CD34+ Cells From Non-Hodgkin's Lymphoma, Hodgkin's Disease and Multiple Myeloma Patients Previously Failing Mobilization With Chemotherapy and/or Cytokine Treatment: Compassionate Use Data," Bone Marrow Transplant, 2008, 41(4):331-8.[PubMed 17994119]

Flomenberg N, Devine SM, DiPersio JF, et al, "The Use of AMD3100 Plus G-CSF for Autologous Hematopoietic Progenitor Cell Mobilization is Superior to G-CSF Alone," Blood, 2005, 106(5): 1867-74.[PubMed 15890685]

Jacobson PA, West NJ, Spadoni V, et al, "Sterility of Filgrastim (G-CSF) in Syringes," Ann Pharmacother, 1996, 30(11):1238-42.[PubMed 913403]

Jädersten M, Montgomery SM, Dybedal I, et al, "Long-Term Outcome of Treatment of Anemia in MDS with Erythropoietin and G-CSF," Blood, 2005, 106(3):803-11.[PubMed 15840690]

Kuwabara T, Kobayashi S, and Sugiyama Y, "Pharmacokinetics and Pharmacodynamics of a Recombinant Human Granulocyte Colony-Stimulating Factor," Drug Metab Rev, 1996, 28(4):625-58. [PubMed 8959393]

National Comprehensive Cancer Network® (NCCN), "Clinical Practice Guidelines in Oncology™: Myelodysplastic Syndromes," Version 2.2008. Available at Login - NCCN Subscriptions Products

National Comprehensive Cancer Network® (NCCN), "Clinical Practice Guidelines in Oncology™: Myeloid Growth Factors," Version 1.2008. Available at Login - NCCN Subscriptions Products.

Nemunaitis J, "A Comparative Review of Colony-Stimulating Factors," Drugs, 1997, 54(5):709-29. [PubMed 9360058]

Rosenberg PS, Alter BP, Bolyard AA, et al, "The Incidence of Leukemia and Mortality From Sepsis in Patients With Severe Congenital Neutropenia Receiving Long-Term G-CSF Therapy," Blood, 2006, 107(12): 4628-35.[PubMed 16497969]

Singh RF, Corelli RL, and Guglielmo BJ, "Sterility of Unit Dose Syringes of Filgrastim and Sargramostim," Am J Hosp Pharm, 1994, 51(15):2811-2.[PubMed 7531941]

Smith TJ, Khatcheressian J, Lyman GH, et al, "2006 Update of Recommendations for the Use of White Blood Cell Growth Factors: An Evidence-Based Clinical Practice Guideline," J Clin Oncol, 2006, 24(19):3187-205. [PubMed 16682719]

[luvmypatients]

We give neupogen a lot to our patients and I have only seen it done SQ. I was not even aware IV was an option.

[Schwarte]

I haven't ever seen it given IV either. SQ for sure!

[BBQvegan]

Yeah, we give it SQ, too. Of course, the MD has to order the route of administration.

[mervat]

We give it SQ most of the times , but we give it IV sometimes especially when pt's platelets are too low.

When u give it IV should be diluted with 25 ml of D5 and given over 10-15 min

[dln1x0n]

I work on a bone marrow transplant unit and have only ever given neupogen IV. I know our oncology unit gives it SQ though.

[msjellybean]

Most of our Neupogen is given SQ. But when we have a pt whose platelets are low, we do it IV mixed in D5.

[Susan Patterson]

Thank you all awesome answers and references, again, very much appreciated.

[Alloush, BSN, MSN]

Salam

99% of the time we give it as SQ ( slowlyyyy ).

when the patient doesnt pick up and remains neutropenic we give it IV. we dilute according to the pharmacy policy. and each dose has different dilution. we stop all running IVs and IV medications. we give it over 1 hr with continous monitoring.

mayeb in adults things are different.

[globalRN]

I only order it as s/c.

even thrombocytopenic patients can have it sc

IV..complications so i don't choose this route

[Daliadreamer]

We only give it SC; I was not even aware it could be given IV. Most of the time, if our patients are inpatient, we give neupagen. Neulasta is given IV as an outpatient in the Cancer Care Clinic. This can only be given as an outpatient though, so sometimes the MD will have the patient on Neupogen in the hospital, and then discharge them early so that they can get their Neulasta as an outpatient. Oh, insurance.