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Discussion

Neupogen

Hi, I am an new RN and just got hired into a chemotherapy clinic. First off, it is sink or swim...no orientation and not really helpful people, doctors are snobs and nurses are all STRESSED OUT. It is my foot in door job :eek:

I am desperately trying to learn my job outside work time. So I need to give a drug called Neupogen, a G-CSF med. I cannot seem to find online or anywhere WHY the drug has to be given 24hours after chemo. Does anyone know the reason. I just tell my patients it has to be, but they ask why? Thanks :nurse:

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    • Featured Replies

    Simultaneous use with antineoplastic drugs will have an adverse effect on the rapidly proliferating neutrophils. That is why it should be avoided for 24 hours before and 24 hours after chemo. (Davis Drug Guide 201) In chemo you are killing the cells... so you wouldn't want to stimulate the cells to grow because they would just die anyway.

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    • Admin

    If Neupogen is taken anytime within 24 hours before or after chemotherapy, the risk of infection is actually increased.

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    • Author

    OK, makes sense, but I still don't understand the "24" hours thing. Why choose 24hours as opposed to 48 etc...Does this have to do with the chemotherapy's drug half life?

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    Sounds like a great chance to test one of those high payed pharmacists! :)

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    • Author

    I hear ya...i would really like to...I got my RN is March from 6 years of LPN and wanted to try something new. Just got hired about 2 months ago into this Oncology clinic as a sort of "get foot in door" with hospital and it is sink or swim with it. Not very many friendly and helpful people...pharmacists and techs just don't have any time for me and they are soooo snobby. Nurses also say don't ask doctors any "stupid" questions. That is why I have to research day and night for my own answers. Please tell me it gets better in nursing? Thanks for all the great replies. :lol2:

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    • Experts

    neutropenia - a low neutrophil count (i.e. an absolute neutrophil count below 1.0 x 103); a short period of neutropenia is a common side effect of most chemotherapy, it tends to occur about 10 days after chemotherapy and lasts several days (these days are known as the nadir); the nadir can be shortened with daily subcutaneous injections of neupogen starting 24 hours after the last chemotherapy drug and continuing for at least 7 days or until the wbc comes up; antibiotic prophylaxis is sometimes necessary to prevent infections during periods of neutropenia; many precautions must be taken when neutropenic: patients can't be near fresh flowers or plants, they have to eat a low-microbial diet meaning no fresh uncooked foods or foods with active cultures like cheese or yogurt, also have to wash hands so often that they get all dry even when i use lotion; there are several other terms you will hear in conjunction with neutropenia like "immunosuppressed" and "immunocompromised" all of which basically suggest that a person has a weak immune system and little defense against infection.

    the safety and efficacy of neupogen has not been established....because of the rapidly dividing cells to cytotoxic chemotherapy and neupogen is made from e coli.......the risk of severe infection is greater during this period and actually it's 24 hours prior to and after chemo.

    http://www.rxlist.com/neupogen-drug.htm

    http://pi.amgen.com/united_states/neupogen/neupogen_pi_hcp_english.pdf

    http://pi.amgen.com/united_states/neupogen/neupogen_pi_hcp_english.pdf

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    hi there. not much help however, i do know that if given within 24 hrs in can actually increase the risk of infection. i don't know why this is i just remember a doc telling me that.:)

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    IDK if this matters or not- BUT I got Neupogen (or Neulasta) only on the weekends, since I had to resume chemo on Mondays. The doc wanted the Neupogen in long enough to "work" so I'd have enough WBCs to keep getting the chemo.

    Another side: both hurt like h***. Like no kidding. The onc. explained it as the bone marrow having so much pressure inside because of the production of WBCs, that it caused the bone to feel like it was being blown up from the inside. It was BAD. So don't forget that when doing teaching or expecting side effects :)

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    The sooner the better? chemotherapy reduces your neutrophil count (causing neutropenia), thus weakening your immune system. since it's a colony stimulating factor, it'll help with production of neutrophil and will "decrease" your chance of getting an infection after chemotherapy. It's not uncommon to see these administered every day for at least a week until the pt.'s neutrophil count goes back to accepted levels. As a side note, these things are $300 a pop =)

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    ignore my last post, just re-read your question -_-. i'm assuming it's because of the half-life of chemotherapeutics? you wouldn't want to be killing actively proliferating neutrophils

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