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Colony Stimulating Factors
darbepoietin alfa (Aranesp ®): |
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Correction of anemia associated with CRF: Initial: 0.45
mcg/kg (IV, SQ) once weekly. Dosage should be titrated to limit
increases in hemoglobin to <1 g/dL over any 2-week interval, with a
target concentration of <12 g/dL. Maintenance: Titrated to hematologic
response. Some patients may require doses <0.45 mcg/kg once weekly.
Selected patients may be managed by administering SQ doses every 2
weeks.
Note: In patients receiving epoetin alfa 2-3 times per week, darbepoetin alfa is administered once weekly. In patients who are receiving epoetin alfa once weekly, darbepoetin should be administered once every 2 weeks. Dosage adjustment: Goal: Dose should be adjusted to achieve and maintain a target hemoglobin not to exceed 12 g/dL. Inadequate response: Hemoglobin increases <1 g/dL over 4 weeks and iron stores are adequate: Increase by ~25% of the previous dose; increases should not be made more frequently than once monthly. Excessive response: Hemoglobin increases >1 g/dL in any 2-week period: Decrease dose Hemoglobin increases and approaches the target value of 12 g/dL: Decrease weekly dosage by ~25%. If hemoglobin continues to increase, hold dose temporarily until hemoglobin begins to decrease, then restart at a dose 25% below the previous dose. Correction of anemia associated with cancer patients receiving chemotherapy: Initial: 2.25 mcg/kg SQ once weekly. Adjust dose as follows to achieve and maintain a target hemoglobin: Inadequate response: Hemoglobin increases <1 g/dL after 6 weeks of therapy: Increase dose to 4.5 mcg/kg. Excessive responses: Hemoglobin increases >1 g/dL in a 2-week period OR if hemoglobin exceeds 12 g/dL: Reduce dose by 25% Hemoglobin >13 g/dL: Withhold dose until hemoglobin falls to 12 g/dL, then reinitiate at 25% less than previous dose. Darbepoetin's T1/2 is approximately 3 times that of epoetin alfa. |
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erythropoietin (Epogen ®): |
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Anemia: (Renal failure): Initial dose: 50-100 units/kg
IV/SC 3 x/week. Titration: Reduce dose by 25% when hemoglobin approaches
12 g/dL or when hemoglobin increases 1 g/dL in any 2-week period.
Increase dose by 25% if hemoglobin does not increase by 2 g/dL after 8
weeks of therapy and hemoglobin is below suggested target range;
suggested target hematocrit range: 10-12 g/dL. Maintenance dose:
Individualize to target range. AZT-treated, HIV infected patients: 100 units/kg IV/SC 3 times/week x 8 weeks. Increase dose by 50-100 units/kg 3 times/week if response is not satisfactory in terms of reducing transfusion requirements or increasing hemoglobin after 8 weeks of therapy. Evaluate response every 4-8 weeks thereafter and adjust the dose accordingly by 50-100 units/kg increments 3 times/week. If patient has not responded satisfactorily to a 300 unit/kg dose 3 times/week, a response to higher doses is unlikely. Stop dose if hemoglobin exceeds 13 g/dl and resume treatment at a 25% dose reduction when hemoglobin drops to 12 g/dl. Cancer patients on chemotherapy (Treatment of patients with erythropoietin levels >200 mU/mL is not recommended). 150 units/kg SC 3 times/week or 40,000 units once weekly. Dose adjustment: If response is not satisfactory after a sufficient period of evaluation (8 weeks of 3 times/week and 4 weeks of once weekly therapy), the dose may be increased every 4 weeks (or longer) up to 300 units/kg 3 times/week, or when dosed weekly, increased all at once to 60,000 units weekly. If patient does not respond, a response to higher doses is unlikely. Surgery patients: Prior to initiating treatment, obtain a hemoglobin to establish that is >10 mg/dL or 13 mg/dL: Initial dose: 300 units/kg/day SC x 10 days before surgery, on the day of surgery, and for 4 days after surgery. Alternative dose: 600 units/kg in once weekly doses (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery. |
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filgrastim (G-CSF, Neupogen ®): |
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| Neutropenia (chemotherapy-induced): 5 mcg/kg SC/IV for </= 2 weeks until post-nadir NC is greater or equal to 10,0000/ml. Can increase by 5 mcg/kg/day with each cycle as needed. | |
oprelvekin (Neumega ® ): |
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| Thrombocytopenia: 50 mcg/kg SC once daily starting 6-24 hours after chemo and continuing until post-nadir platelet count is greater or equal to 50,000 cells/mcL. | |
pegfilgrastim (Neulasta ®): |
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| Neutropenia (chemotherapy-induced): Recommended dosage: 6mg S.C. administered once per chemotherapy cycle. Should not be administered in the period between 14 days before and 24 hours after administration of cytotoxic chemotherapy. The 6 mg fixed dose formulation should not be used in infants, children, and smaller adolescents weighing less than 45 kg. Indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia. | |
sargramostim (GM-CSF): |
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| See package insert. | |
Disclaimer |
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Listed dosages are for - Adult patients ONLY. PLEASE READ THE
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GlobalRPH does not directly or indirectly practice medicine or provide
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kind for the information and data accessed through the Service or for
any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. |
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