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Filgrastim Injection (Human granulocyte colony stimulating factor)

What is Granulocyte?
Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm. They are also called polymorph nuclear leukocytes (PMN or PML) because of the varying shapes of the nucleus, which is usually lobed into three segments. In common parlance, the term polymorph nuclear leukocyte often refers specifically to neutrophil granulocytes, the most abundant of the granulocytes.
Granulocytes or PMN are released from the bone marrow by the regulatory complement proteins.

Classification
There are three types of granulocytes, distinguished by their appearance under Wright's stain:blood components

Neutrophil granulocytes (a type of blood cell
    needed to fight infection)

Eosinophil granulocytes

Basophil granulocytes
 
Their names are derived from their staining characteristics; for example, the most abundant granulocyte is the neutrophil granulocyte, which has neutrally-staining cytoplasmic granules.

Other white blood cells which are not granulocytes ("agranulocytes") are mainly lymphocytes and monocytes.

Toxic materials produced or released
Examples of toxic materials produced or released by degranulation by granulocytes on the ingestion of microorganism includes:
Low pH vesicles (3.5-4.0)
Toxic oxygen-derived products (e.g. superoxide, hydrogen peroxide, hydroxy radicals, singlet oxygen, hypohalite)
Toxic nitrogen oxides (nitric oxide)
Antimicrobial agents (Defensins and cationic proteins)
Enzymes
Lysozyme: dissolves cell walls of some gram positive bacteria
Acid hydrolases: further digest bacteria

What is Filgrastim?
Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes. It is produced by recombinant DNA technology. The gene for human granulocyte colony-stimulating factor is inserted into the genetic material of Escherichia coli.
The G-CSF then produced by E. coli is only slightly different from G-CSF naturally made in humans.

Why is this medication prescribed?
Filgrastim is used to decrease the chance of infection in people who have certain types of cancer and are receiving chemotherapy medications that may decrease the number of neutrophils, in people who are undergoing bone marrow transplants, and in people who have severe chronic neutropenia (condition in which there are a low number of neutrophils in the blood).
Filgrastim is also used to prepare the blood for leukapheresis.
Filgrastim is in a class of medications called colony-stimulating factors. It works by helping the body make more neutrophils.

How should this medicine be used?
Filgrastim comes as a solution (liquid) to inject under the skin or into a vein. It is usually given once a day, but may be given twice a day when it is used to treat severe chronic neutropenia. The length of your treatment depends on the condition that you have and how well your body responds to the medication. If you are using Filgrastim to decrease the risk of infection during chemotherapy, you will receive your first dose of Filgrastim at least 24 hours after you receive a dose of chemotherapy, and will continue to receive the medication every day for up to 2 weeks. If you are using Filgrastim to decrease the risk of infection during a bone marrow transplant, you will receive the medication at least 24 hours after you receive chemotherapy and at least 24 hours after the bone marrow is infused. If you are using Filgrastim to prepare your blood for leukapheresis, you will receive your first dose of Filgrastim at least 4 days before the first leukapheresis and will continue to receive the medication until the last leukapheresis. If you are using Filgrastim to treat severe chronic neutropenia, you may need to use the medication for a long period of time.

Filgrastim may be given to you by a nurse or other healthcare provider, or you may be told to inject the medication at home. If you will be injecting Filgrastim at home, inject the medication at about the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use Filgrastim exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

If you will be injecting Filgrastim yourself, a health care provider will show you how to inject the medication. Be sure that you understand these directions. Ask your health care provider if you have any questions about where on your body you should inject Filgrastim, how to give the injection, what type of syringe to use, or how to dispose of used needles and syringes after you inject the medication.

Your doctor may start you on a low dose of Filgrastim and gradually increase your dose. Your doctor may also decrease your dose, depending on how your body reacts to the medication.

If you are using Filgrastim to treat severe chronic neutropenia, you should know that Filgrastim will control your condition but will not cure it. Continue to take Filgrastim even if you feel well. Do not stop taking Filgrastim without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine
Filgrastim is also used to decrease the chance of infection in people who have human immunodeficiency virus (HIV) or people who are taking certain medications that decrease the number of neutrophils. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should the patient follow?
Before using Filgrastim:
Tell your doctor and pharmacist if you are allergic to Filgrastim, pegFilgrastim (Neulasta)
Medications made from E. coli bacteria, or any other medications. Ask your pharmacist if you do not know if a medication
     you are allergic to is made from E. coli bacteria.
Tell your doctor if you or the person who will be injecting Filgrastim for you is allergic to latex.
Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and
     herbal products you are taking or plan to take. Be sure to mention lithium (Eskalith, Lithobid). Your doctor may need to
     change the doses of your medications or monitor you carefully for side effects.
Tell your doctor if you are being treated with radiation therapy and if you have or have ever had chronic myeloid leukemia,
     myelodysplasia or an enlarged spleen.
Tell your doctor if you have sickle cell disease. If you have sickle cell disease, you may be more likely to have a crisis during
     your treatment with Filgrastim. Drink plenty of fluids during your treatment with Filgrastim and call your doctor right away if
     you have a sickle cell crisis during your treatment.
Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using
     Filgrastim, call your doctor.
If you are having surgery, including dental surgery, tell the doctor or dentist that you are using Filgrastim.

you should know that Filgrastim decreases the risk of infection, but does not prevent all infections that may develop during or after chemotherapy. Call your doctor if you develop signs of infection such as fever; chills; rash; sore throat; diarrhea; or redness, swelling, or pain around a cut or sore.

What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?
If you will be injecting Filgrastim at home, talk to your doctor about what you should do if you forget to inject the medication on schedule.

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