Home Drug Guide Tbo-filgrastim

Drug Guide

Generic Name

Tbo-filgrastim

Brand Names Granix

Classification

Therapeutic: Hematologic agent, Leukopoietic Growth Factor

Pharmacological: Granulocyte Colony-Stimulating Factor (G-CSF)

FDA Approved Indications

Management of neutropenia in patients undergoing chemotherapy for malignancy.

Mechanism of Action

Tbo-filgrastim stimulates the production of neutrophils by binding to the G-CSF receptor on hematopoietic cells, promoting proliferation and differentiation.

Dosage and Administration

Adult: Patients typically receive 5 mcg/kg/day subcutaneously until neutrophil recovery.

Pediatric: Dosing in pediatric patients is similar, based on weight; specific protocols depend on clinical scenario.

Geriatric: Adjust based on renal function and overall clinical condition.

Renal Impairment: Use with caution; may require dose adjustment.

Hepatic Impairment: No specific adjustment necessary.

Pharmacokinetics

Absorption: By subcutaneous injection, peak levels in 1-2 hours.

Distribution: Distributed in extracellular fluids.

Metabolism: Metabolized by neutrophils and other cells; not significantly hepatic or renal.

Excretion: Renally excreted in unchanged form.

Half Life: Approximately 3.5 hours in healthy individuals.

Contraindications

Hypersensitivity to Tbo-filgrastim or other G-CSFs.

Precautions

Use with caution in patients with sickle cell disease, as it may increase risk of sickle cell crisis.
Monitor for capillary leak syndrome, splenic rupture, and leukocytosis.

Adverse Reactions - Common

Bone pain (Common)
Reactive neutrophilia (Common)

Adverse Reactions - Serious

Splenic rupture (Rare)
Allergic reactions including anaphylaxis (Rare)
Sickle cell crisis (in sickle cell patients) (Rare)

Drug-Drug Interactions

Chemotherapy agents that suppress bone marrow

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts (CBC), especially neutrophil counts.

Diagnoses:

Risk for infection due to neutropenia.
Pain related to bone marrow stimulation.

Implementation: Administer subcutaneously as prescribed, monitor for adverse effects.

Evaluation: Assess neutrophil response and resolution of neutropenia, watch for adverse reactions.

Patient/Family Teaching

Report signs of allergic reactions, skin rash, or difficulty breathing.
Notify if experiencing bone pain or unusual symptoms.
Follow injection site care instructions.

Special Considerations

Black Box Warnings:

Risks of splenic rupture and severe bone pain.

Genetic Factors: No specific genetic considerations, but caution in sickle cell disease.

Lab Test Interference: May elevate levels of leukocytes, affecting CBC results.

Overdose Management

Signs/Symptoms: Severe leukocytosis, bone pain, splenic rupture risk.

Treatment: Discontinue drug, provide supportive care, monitor blood counts, and manage symptoms.

Storage and Handling

Storage: Store refrigerated at 2-8°C (36-46°F); do not freeze.

Stability: Stable until expiration date on container if refrigerated, avoid exposure to light.