Granokrin (Solution) Instructions for Use

ATC Code

L03AA02 (Filgrastim)

Active Substance

Filgrastim (Rec.INN registered by WHO)

Clinical-Pharmacological Group

Leukopoiesis stimulant

Pharmacotherapeutic Group

Leukopoiesis stimulator

Pharmacological Action

G-CSF. Immunomodulator. It is a highly purified non-glycosylated protein. It regulates the production of functional neutrophils and their release into the blood from the bone marrow.

It causes a noticeable increase in neutrophils within 24 hours and a slight increase in monocytes.

Pharmacokinetics

The V_d is about 150 ml/kg. It does not accumulate.

The T_1/2 is about 3.5 hours, and the clearance is about 0.6 ml/min/kg.

Indications

To reduce the duration of neutropenia and the frequency of febrile neutropenia in patients receiving cytotoxic chemotherapy for malignant diseases (except for chronic myeloid leukemia and myelodysplastic syndrome), and to reduce the duration of neutropenia and its clinical consequences in patients receiving myeloablative therapy followed by bone marrow transplantation.

For the mobilization of autologous hematopoietic progenitor cells in the peripheral blood (including after myelosuppressive therapy), to accelerate the recovery of hematopoiesis by administering these cells after myelosuppression or myeloablation.

Long-term therapy to increase the number of neutrophils and reduce the frequency and duration of infectious complications in children and adults with severe congenital, cyclic, or idiopathic neutropenia (absolute neutrophil count <500/µL) and a history of severe or recurrent infections.

ICD codes

Dosage Regimen

Administer subcutaneously or intravenously; dosage is individualized based on indication, chemotherapy regimen, and patient response.

For chemotherapy-induced neutropenia, initiate 24 hours after cytotoxic chemotherapy completion; typical dose is 5 mcg/kg/day.

Continue daily administration until the absolute neutrophil count (ANC) reaches the target post-nadir level; discontinue therapy if the ANC exceeds 10,000/µL after the expected neutrophil nadir.

For peripheral blood progenitor cell (PBPC) mobilization, administer 10 mcg/kg/day subcutaneously for 4-5 days before leukapheresis; initiate dosing at least 4 days before the first leukapheresis procedure.

For severe chronic neutropenia (SCN), the initial recommended dose is 5 mcg/kg/day subcutaneously; adjust the dose based on patient response and ANC monitoring to maintain the ANC between 1,500/µL and 10,000/µL.

Monitor complete blood count (CBC) and platelet count regularly; perform urinalysis and monitor spleen size during long-term therapy.

Immediately discontinue treatment if the white blood cell count rises above 50,000/µL during neutropenia management or above 100,000/µL during PBPC mobilization.

Adverse Reactions

From the musculoskeletal system: muscle or bone pain is possible.

From the urinary system: dysuria is possible.

From the cardiovascular system: transient arterial hypotension is possible.

From laboratory parameters: reversible increase in levels of LDH, ALP and GGT, uric acid in blood plasma.

Other: rarely, predominantly after IV administration – symptoms indicating allergic-type reactions (about half of them were associated with the administration of the first dose).

Contraindications

Severe congenital neutropenia (Kostmann syndrome) with cytogenetic abnormalities, hypersensitivity to filgrastim.

Use in Pregnancy and Lactation

The safety of use during pregnancy has not been established, so the expected benefit of therapy for the mother and the potential risk to the fetus should be assessed.

If it is necessary to use during lactation, breastfeeding should be discontinued.

Use in Hepatic Impairment

Not recommended for use in patients with severe hepatic impairment, as the efficacy and safety of filgrastim in this category of patients have not been studied.

Use in Renal Impairment

Not recommended for use in patients with severe renal impairment, as the efficacy and safety of filgrastim in this category of patients have not been studied.

Pediatric Use

The safety and efficacy of use in newborns have not been established.

Geriatric Use

No specific studies on the efficacy and safety of filgrastim use in elderly patients have been conducted.

Special Precautions

Not recommended for use in patients with severe renal or hepatic impairment, as the efficacy and safety of filgrastim in this category of patients have not been studied.

Patients with concomitant bone pathology and osteoporosis receiving Filgrastim continuously for more than 6 months are recommended to monitor bone density.

Human G-CSF can cause the growth of myeloid cells in vitro. Similar effects may be observed in vivo and for some non-myeloid cells. The safety and efficacy of filgrastim use in patients with myelodysplastic syndrome and chronic myeloid leukemia have not been established, so it is not indicated for these diseases. A differential diagnosis between blast transformation of chronic myeloid leukemia and acute myeloid leukemia should be carried out with particular care.

During treatment, it is necessary to regularly determine the white blood cell count. If, after passing the expected minimum, it exceeds 50,000/µL, Filgrastim should be immediately discontinued. If Filgrastim is used to mobilize peripheral blood hematopoietic progenitor cells, it is discontinued if the white blood cell count exceeds 100,000/µL.

It should be used with particular caution in patients receiving high-dose cytotoxic chemotherapy.

Monotherapy with filgrastim does not prevent thrombocytopenia and anemia caused by myelosuppressive chemotherapy. It is recommended to regularly determine the platelet count and hematocrit. Particular caution should be exercised when using single-component or combined chemotherapy regimens known for their ability to cause severe thrombocytopenia.

Before using filgrastim for severe chronic neutropenia, a differential diagnosis with other hematological diseases, such as aplastic anemia, myelodysplasia, and myeloid leukemia, should be carried out with particular care. Before starting treatment, a complete blood count with differential white blood cell count and platelet count should be performed, and the morphological picture of the bone marrow and karyotype should be examined.

The blood picture, including the platelet count, should be carefully monitored, especially during the first few weeks of treatment with filgrastim. In case of thrombocytopenia (platelet count consistently below 100,000/µL), the issue of temporary discontinuation of filgrastim or dose reduction should be considered. Other changes in the blood count requiring careful monitoring are also observed, including anemia and a transient increase in the number of myeloid progenitor cells.

During treatment, spleen size should be regularly monitored, and urinalysis should be performed.

When assessing the number of progenitor cells mobilized in patients with filgrastim, special attention should be paid to the quantification method. The results of flow cytometric analysis of CD34⁺ cell counts vary depending on the specific methodology, and caution should be exercised regarding recommendations on their number based on studies conducted in other laboratories.

No specific studies on the efficacy and safety of filgrastim use in elderly patients have been conducted.

Storage Conditions

Store at 2°C (36°F) to 8°C (46°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.