Home Drug Guide Sargramostim

Drug Guide

Generic Name

Sargramostim

Brand Names Leukine

Classification

Therapeutic: Hematopoietic growth factor

Pharmacological: Granulocyte-macrophage colony-stimulating factor (GM-CSF)

FDA Approved Indications

Neutropenia post-hematopoietic stem cell transplant
Neutropenia induced by chemotherapy in acute myeloid leukemia (AML) patients
Autologous marrow transplantation to shorten neutropenia

Mechanism of Action

Stimulates proliferation and differentiation of granulocyte and macrophage progenitor cells by binding to GM-CSF receptors, enhancing hematopoiesis.

Dosage and Administration

Adult: Based on indication; generally, 250 mcg/m2/day subcutaneously or intravenously, adjusted according to clinical response.

Pediatric: Dosage varies; consult specific protocols depending on condition and weight.

Geriatric: No specific adjustments, but caution due to potential comorbidities.

Renal Impairment: Adjust dosage based on clinical response and tolerability.

Hepatic Impairment: No specific adjustments established.

Pharmacokinetics

Absorption: Subcutaneous and intravenous administration; rapid onset.

Distribution: Distributed in plasma and tissues; crosses biological membranes.

Metabolism: Metabolized and cleared primarily via renal pathways.

Excretion: Renal excretion of metabolites.

Half Life: Approx. 2-4 hours in plasma.

Contraindications

Hypersensitivity to Sargramostim or other GM-CSF products.

Precautions

Use with caution in patients with bone marrow disorders, or those at risk for leukemic proliferation. Avoid in patients with eosinophilia, pulmonary infiltrates, or active infections.

Adverse Reactions - Common

Bone pain (Frequent)
Fever, chills (Often)
Malaise, fatigue (Common)

Adverse Reactions - Serious

Capillary leak syndrome (Rare)
Severe allergic reactions including anaphylaxis (Rare)
Progression of leukemia or other malignancies (Rare)

Drug-Drug Interactions

Chemotherapy agents that suppress marrow

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts regularly to assess hematopoietic response. Observe for signs of allergic reactions.

Diagnoses:

Risk for infection due to neutropenia
Impaired skin integrity

Implementation: Administer as ordered, preferably subcutaneously. Evaluate for side effects and response.

Evaluation: Assess for improvement in neutrophil counts and resolution of clinical symptoms. Watch for adverse effects.

Patient/Family Teaching

Report any fever, chills, or signs of allergic reaction immediately.
Maintain good hygiene to reduce infection risk.
Understand the purpose of the medication and comply with dosing schedules.

Special Considerations

Black Box Warnings:

Potential for leukemic transformation or other hematologic malignancies (monitor closely).

Genetic Factors: N/A

Lab Test Interference: May elevate baseline white cell counts, complicating interpretation.

Overdose Management

Signs/Symptoms: Severe leukocytosis, capillary leak syndrome.

Treatment: Discontinue drug, provide supportive care, and monitor hematologic status.

Storage and Handling

Storage: Store refrigerated at 2-8°C (36-46°F). Protect from light.

Stability: Stable for up to 3 months when refrigerated.