Granulocyte Colony-Stimulating Factor Pregnancy: C

Filgrastim (G-CSF)

Brand names: Neupogen, Zarzio, Nivestim

Adult dose

Dose: 5 micrograms/kg once daily SC (chemotherapy neutropenia); 10 micrograms/kg/day (stem cell mobilisation)

Route: subcutaneous injection

Frequency: once daily

Max: Titrated to neutrophil response

Start 24h after last chemotherapy dose; continue until neutrophil count recovers (usually ANC >10 × 10⁹/L); do NOT give 24h before or after cytotoxic chemotherapy

Paediatric dose

Dose: 5 micrograms/kg

Route: subcutaneous

Frequency: once daily

Max: Titrated to ANC

Concentration: 300 micrograms/mL or 480 micrograms/mL micrograms/ml

Same weight-based dosing as adults; used for severe chronic neutropenia, SCN, and post-chemotherapy

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Same weight-based dosing as adults; used for severe chronic neutropenia, SCN, and post-chemotherapy

Clinical pearls

Severe bone pain common — reassure patients; use regular paracetamol/ibuprofen
Splenic rupture: rare but life-threatening — warn patients about sudden left shoulder pain
ASCO/ESMO guidelines: primary prophylaxis if chemotherapy carries >20% febrile neutropenia risk

Contraindications

Hypersensitivity to E. coli-derived proteins
AML (use with caution — may stimulate leukaemic cell growth)

Side effects

Bone pain (most common — dose-dependent, respond to paracetamol/NSAID)
Splenomegaly
Rare: splenic rupture
ARDS (rare)
Aortitis (rare)

Interactions

Lithium (enhanced granulopoiesis)
Fluorouracil (avoid concomitant)

Monitoring

FBC with differential (twice weekly)
Spleen size (if symptoms)
LFTs, uric acid (stem cell mobilisation)

Reference: BNFc; BNF 86; ASCO guidelines; ESMO guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways