Granogen

Granogen (Filgrastim) is a medicine that is used to stimulate the production of neutrophils, a type of white blood cell, in the body. It is a synthetic form of human granulocyte-colony-stimulating factor (G-CSF), which is normally produced by the body.

Filgrastim is used in various clinical situations where there is a decrease in the number of neutrophils, such as:

1. Chemotherapy: After chemotherapy, the level of neutrophils in the blood may decrease, increasing the risk of infections. Filgrastim is used to stimulate their production and reduce the recovery time of the immune system.
2. Bone marrow transplantation: Patients undergoing bone marrow transplantation are often prescribed Filgrastim to speed up the recovery of neutrophil levels after the procedure.
3. Radiation therapy: After radiation therapy, a decrease in the number of neutrophils may also be observed, and Filgrastim can be used to speed up their recovery.

The drug is usually administered into the body intravenously or subcutaneously. It is important to note that Filgrastim should only be used as prescribed and under the supervision of a physician, as improper use or dosage may result in serious side effects.

Indikasjoner Granogena

1. Prevention and treatment of neutropenia: The drug is used to prevent and treat neutropenia, a condition in which the level of neutrophils in the blood is low, especially during chemotherapy or radiation therapy in patients with cancer.
2. Acceleration of recovery after bone marrow transplantation: After bone marrow transplantation, the drug can be used to accelerate the recovery of neutrophil levels.
3. Infection prevention: During treatment with chemotherapy or bone marrow transplantation, Granogen can be used to prevent the development of infections associated with decreased neutrophil levels.
4. Stimulation of neutrophil production before peripheral blood collection: When routine collection of peripheral blood for subsequent use in transplantation, the use of Filgrastim can stimulate the production of neutrophils and increase their number in the collected blood.

Utgivelsesskjema

Granogen is usually available in the form of a powder or solution for injection.

Farmakodynamikk

1. Stimulation of granulocyte production: Filgrastim directly affects the bone marrow, stimulating the proliferation and differentiation of granulocytes (for example, neutrophils), which leads to an increase in their number in the blood.
2. Acceleration of recovery of neutrophil leukocyte count: In conditions that are accompanied by neutropenia (decreased levels of neutrophils in the blood), such as chemotherapy or bone marrow transplantation, filgrastim promotes rapid recovery of neutrophil levels and reduces the time until leukopenic complications occur.
3. Increasing the functional activity of neutrophils: Filgrastim can also improve the functional characteristics of neutrophils, such as their ability to phagocytose and migrate to sites of infection.
4. Increasing the survival time of neutrophils: The use of filgrastim can increase the survival time of neutrophils in the blood, which also helps to increase their number and functional activity.

Farmakokinetikk

1. Absorption: Filgrastim is usually administered subcutaneously or intravenously. After subcutaneous administration, the drug is rapidly and completely absorbed into systemic bleeding.
2. Distribution: Filgrastim has a high affinity for receptors on the surface of neutrophils. It is evenly distributed throughout all tissues of the body, including the bone marrow, where neutrophil production is stimulated.
3. Metabolism: Filgrastim is metabolized in the body, primarily in the liver, but metabolism is minor. Most doses of the drug are excreted unchanged.
4. Excretion: Filgrastim is primarily excreted through the kidneys. It has a short half-life, meaning that it is quickly eliminated from the body.

Dosering og administrasjon

1. Method of application:

   • Granogen is usually administered to the patient intravenously or subcutaneously.
   • Intravenous injections may be performed by a medical professional in a clinic or hospital.
   • Subcutaneous injections can be performed at home according to the instructions of your doctor or healthcare team.

2. Dosage:

   • The dosage of Granogen is determined by the doctor depending on the type of disease, the severity of symptoms and the individual characteristics of the patient.
   • The usual starting dose is 5 mcg/kg of the patient's body weight once daily.
   • Depending on the response to treatment, the dosage may be adjusted by your doctor.

3. Duration of treatment:

   • The duration of treatment with Granogen is also determined by the doctor and depends on the nature of the disease and the patient’s response to treatment.
   • Treatment can be short-term (for example, during chemotherapy) or long-term (for example, for chronic forms of neutropenia).

Bruk Granogena under graviditet

The use of Granogen during pregnancy requires caution, especially during chemotherapy due to maternal cancer. Data on the effects of filgrastim during pregnancy are limited and it is often avoided in pregnant women.

One study found that there were no statistically significant differences in mean age at birth, congenital anomalies, or birth weight between neonates exposed  filgrastim/pegfilgrastim in combination with chemotherapy, and neonates exposed to chemotherapy alone. This study found no increased risk of birth defects or other long-term medical problems in children exposed to filgrastim in utero (Cardonick et al., 2012).

Due to limited data and potential risks, the use of filgrastim during pregnancy should only occur after careful discussion with a physician who can evaluate the potential risks and benefits of its use.

Kontra

1. Hypersensitivity: People with a known hypersensitivity to filgrastim or to any of the ingredients of the drug should not use Granogen.
2. Uncertain Tumor Diseases: Granogen may stimulate tumor growth and its use may therefore be contraindicated in patients with undetermined tumor diseases.
3. Major granulocytopenia: The use of Granogen may be contraindicated in patients with multiple myeloma or other types of diseases accompanied by a significant decrease in the level of granulocytes in the blood.
4. Allergic reactions: Some patients may experience allergic reactions to filgrastim, which may be a contraindication for its further use.
5. Pregnancy and breastfeeding: Data on the safety of filgrastim during pregnancy and breastfeeding are limited, so its use during this period should only be done on the advice of a physician.
6. Children: The safety and effectiveness of Granogen in children may not have been sufficiently studied, so its use in children may require consultation with a doctor.

Bivirkninger Granogena

1. Bone pain: Some patients may experience bone or muscle pain while using Filgrastim.
2. Headache: Headache may occur in some patients as a result of using the drug.
3. Abdominal pain: Some patients may experience pain or discomfort in the abdominal area.
4. Muscle spasms: Filgrastim may cause muscle spasms or painful muscle contractions.
5. Osteoporosis: Long-term use of Filgrastim may lead to osteoporosis, which increases the risk of fractures.
6. Fluid retention: Some patients may experience fluid retention in the body, leading to swelling.
7. Hyperthermia: Rarely, patients may experience an increase in body temperature.
8. Allergic reactions: In rare cases, allergic reactions such as skin rash, itching, swelling of the face or larynx, and angioedema may occur.

Overdose

1. Myeloproliferative disorders: Excessive stimulation of bone marrow by filgrastim may lead to the development of myeloproliferative disorders such as leukemia or myelofibrosis.
2. Leukostasis syndrome: In rare cases, some patients may develop leukostasis syndrome, characterized by extremely high levels of white blood cells in the blood and their activation, which can lead to thromboembolic complications.
3. Pain symptoms and muscle spasms: Some patients may experience pain symptoms, including muscle spasms and bone pain, after taking filgrastim.
4. Symptoms of an allergic reaction: Allergic reactions such as hives, itching, swelling of the throat or face, difficulty breathing, and anaphylaxis may occur.
5. Acute respiratory complications: In rare cases, acute respiratory complications such as acute respiratory failure, pneumonia, or acute pulmonary distress syndrome may occur.

Interaksjoner med andre legemidler

1. Drugs that affect the bone marrow: Medicines such as chemotherapy or radiotherapy may affect the bone marrow, which may affect the effectiveness of Granogen.
2. Drugs that increase neutropenia: Drugs that cause neutropenia (decreased neutrophil levels) may affect the body's response to filgrastim.
3. Drugs that affect the immune system: Drugs such as immunosuppressants may affect the immune system and interact with Granogen.
4. Drugs that affect renal function: Because filgrastim is eliminated from the body through the kidneys, drugs that affect renal function may alter its metabolism and elimination.
5. Drugs that affect the circulatory system: Medicines such as anticoagulants may interact with Granogen due to their effects on the circulatory system.