Pharmacy Guideline

Administration Guidelines for Paediatric IV / SC G-CSF

The G-CSF kept at the Trust SASH is now Ffilgrastim (Nivestim brand). Lenograstim. Filgrastim is no longer on thenformulary,therefore patients who are admitted on lenograstimfilgrastim from other hospitals may continue to use their own supply. If the supplyit runs out, then it would be advisable to change it to fFilgrastimn it will have to be changed to filgrastimlenograstim unless otherwise indicated by their tertiary consultant or have contraindications to filgrastim.

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150mcg/m2 lenograstim in trials was therapeutically equivalent to 5mcg/kg filgrastim. (Medicines for Children 2003)

Filgrastim

Nivestim brand of filgrastim is supplied as a pre-filled syringe which is stored in the fridge. It comes in three different sizes:

  • 12 mega units (120 micrograms)/ 0.2 ml[TT1]
  • 30 mega units (300 micrograms)/ 0.5 ml
  • (48 mega units (480 micrograms)/ 0.5 ml mainly only for adult patients)

Administration of filgrastim (Neupogen) for cytotoxic-induced neutropenia

Dose for 1 month–18 years for cytotoxic-induced neutropenia

: Child 1 month–18 years 5micrograms/kg daily

by subcutaneous injection or by Intravenous infusion over 30 minutes

Administration

For subcutaneous injection, use undiluted prefilled syringe

or

or intravenous infusion over 30 minutes- , dilute with gGlucose 5% to a concentration 15mcg/mL or greater of greater than 15micrograms/mL; not compatible with Sodium Chloride solutions. Infusion must be given over 30 minutes.(see table below)

Incompatable with other diluents.

Dilution of filgrastim (Nivestim) pre-filled syringe to give concentration 15mcg/mL for iv administration
Filgrastim pre-filled syringe / Maximum volume to dilute in
Nivestim 12 mega unit (120mcg) in 0.2ml / 8ml glucose 5%
Nivestim 30 mega unit (300mcg) in 0.5ml / 20ml glucose 5%

Information from SPC:For a filgrastim concentration of less than 1500000units/mL (15micrograms/mL) albumin solution (human albumin solution) is added to produce a final albumin concentration of 2mg/mL; should not be diluted to a filgrastim concentration of less than 200000units/mL (2micrograms/mL) and should not be diluted with sodium chloride solution

Example calculation for filgrastim for IVfor IV administration:

For a 7 yearyear, old child, weighing 21kg,

the dDose of filgrastim required=

5mcg x 21kg = 105mcg

To administer the dose IV, using the 300mcg/mL 1mL vial, withdraw 0.35mL (105mcg). Dilute in a volume of less than 7mL glucose 5% (concentration 15.mcg/mL or greater) and give over 30 minutes.Dilute to 15mcg/mL as per table above, then withdraw 7ml (105mcg) and give over 30 minutes.

References

  • British National Formulary for Children
  • Summary of Product Characteristics: Nivestim

BNF for children 201708.

Medicines for Children 2003

Lenograstim

Administration of lenograstim (Granocyte) for cytotoxic-induced neutropenia

Dose: Child 2–18 years 150micrograms/m2 daily sc or IV Injection

Although the BNF-C states lenograstim is to be given by s/c injection for cytotoxic-induced neutropenia, it can also be given by the intravenous route.

For subcutaneous injection:

Reconstitute vial with 1ml water for injection (supplied in pre-filled syringe)

Agitate gently until complete dissolution (about 5 seconds). Do not shake vigorously.

Withdraw the required volume from the vial using the 19G needle.

Administer immediately, using the 26G needle by SC injection.

For IV administration:

Reconstitute vial with 1ml water for injection as above

Withdraw the required volume from the vial and dilute in sodium chloride 0.9% to provide a concentration of greater than 2mcg/ml (if using the 105mcg vial) and a concentration greater than 2.5mcg/ml if using the 263mcg vial. Administer by intravenous infusion over 30mins.

Example calculation lenograstim for IV administration:

For a 7 yearyear, old child, weighing 21kg with a BSA of 0.82m2 the dose of Lenograstim required = 150mcg x 0.82 = 123mcg.

Reconstitute 263mcg vial with 1ml WFI (which is in the prefilled syringe) to give 263mcg/ml. Agitate gently until complete dissolution. Withdraw 0.47ml (123mcg) and dilute in a volume of 5- 48ml sodium chloride 0.9% (to give a concentration greater than 2.5mcg/ml) and give by iv infusion over 30mins.

Filgrastim

Administration of filgrastim (Neupogen) for cytotoxic-induced neutropenia

Dose: Child 1 month–18 years 5micrograms/kg daily sc injection or by Intravenous infusion over 30 minutes

Administration

For subcutaneous injection or intravenous infusion, dilute with Glucose 5% to a concentration of greater than 15micrograms/mL; not compatible with Sodium Chloride solutions. Infusion must be given over 30 minutes.

Example calculation filgrastim for IV administration:

For a 7 year old child, weighing 21kg the dose of filgrastim required=

5mcg x 21 = 105mcg

To administer the dose IV, using the 300mcg/mL 1mL vial, withdraw 0.35mL (105mcg). Dilute in a volume of less than 7mL glucose 5% (concentration 15.mcg/mL or greater) and give over 30 minutes.

References

BNF for children 201708

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Medicines for Children 2003

Administration guidelines for paediatric IV/ SC G-CSF

Updated on 120/1/2017

(A Cedro-Sogliani/checked by Tracy Townsend)

Nisha Jugal (Rotational Clinical Pharmacist) and Nicola Leitch (Lead Pharmacist WACH) Checked by Tracy Townsend (Lead Pharmacist Medicines Information)

Updated 16th January 2009

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[TT1]this strength to be ordered when required, on JAC but not stock holding