As an adjunct to antineoplastic therapy: Filgrastim is given in a dose of 5 micrograms/kg daily starting not less than 24 hours after the last dose of antineoplastic. It can be given as single daily subcutaneous injection, as a continuous intravenous or subcutaneous infusion, or as a daily intravenous infusion over 15 to 30 minutes. Treatment is continued until the neutrophil count has stabilised within the normal range which may take up to 14 days or more. A formulation of filgrastim conjugated with monomethoxy polyethylene glycol (pegfilgrastim) may also be used to reduce the incidence of neutropenia associated with antineoplastic therapy; it is given subcutaneous injection in a single dose of 6 mg, given not less than 24 hours after the last dose of antineoplastic.
Bone marrow transplantation: The initial dose of Filgrastim following bone marrow transplantation is 10 micrograms/kg daily, adjusted according to response. This may be given intravenous infusion over 30 minutes or 4 hours, or by continuous intravenous or subcutaneous infusion over 24 hours.
For mobilisation of peripheral blood progenitor cells: A dose of 10 micrograms/kg daily of Filgrastim may be given subcutaneously as a single daily injection or by continuous infusion for 4 to 7 days until leucapheresis; if given after myelosuppressive chemotherapy this dose is halved to 5 micrograms/kg daily by subcutaneous injection.
Patients with congenital neutropenia: The initial dose is 12 micrograms/kg daily and in patients with idiopathic or cyclic neutropenia the initial dose is 5 micrograms/kg daily. In these forms of neutropenia the dose is given subcutaneously in single or divided doses and should be adjusted according to response.
Patients with HIV Infection and persistent neutropenia: The initial dose is 1 microgram/kg daily by subcutaneous injection. The dose may be titrated up to a maximum of 4 micrograms/kg daily until a normal neutrophil count is achieved and then adjusted for maintenance according to response. Maintenance doses of 300 micrograms daily on 1 to 7 days a week have been used.
The Filgrastim doses described previously for patients receiving antineoplastic therapy and for chronic neutropenias may also be given to Children. Pegfilgrastim should not be used in children or adolescents weighing less than 4 kg.
Dilution: Filgrastim (ReliGrast) should not be diluted with saline solution for IV administration as the product will precipitate.