What is Xelstrym (filgrastim)?

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What is Xelstrym?

Xelstrym is a transdermal patch formulation of dextroamphetamine, a central nervous system (CNS) stimulant approved by the FDA for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults and children 6 years and older. 1

Key Characteristics

Xelstrym is not filgrastim or any granulocyte colony-stimulating factor (G-CSF). The evidence provided about filgrastim 2, 3 is unrelated to Xelstrym and appears to be a database error in the question context.

Formulation and Dosing

  • Available strengths: 4.5 mg/9 hours, 9 mg/9 hours, 13.5 mg/9 hours, and 18 mg/9 hours 1
  • Pediatric dosing (6-17 years): Start at 4.5 mg/9 hours, titrate weekly by 4.5 mg increments up to maximum 18 mg/9 hours 1
  • Adult dosing: Start at 9 mg/9 hours, maximum 18 mg/9 hours 1
  • Application timing: Apply 2 hours before effect is needed, remove within 9 hours 1
  • Application sites: Hip, upper arm, chest, upper back, or flank—rotate sites with each new patch 1

Critical Safety Warnings

Boxed Warning: Abuse, Misuse, and Addiction

Xelstrym carries a high potential for abuse and misuse that can lead to substance use disorder, including addiction. Misuse and abuse can result in overdose and death. 1 This is a federally controlled substance (Schedule CII). 1

Major Contraindications

  • Known hypersensitivity to amphetamine products 1
  • Current use or use within 14 days of monoamine oxidase inhibitors (MAOIs) 1

Serious Cardiovascular Risks

  • Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, or other serious cardiac disease 1
  • Sudden death has occurred in patients with heart defects or serious heart disease 1
  • Monitor blood pressure and heart rate regularly during treatment 1

Psychiatric Risks

  • Screen patients for risk factors for manic episodes before initiating treatment 1
  • Monitor for new psychotic or manic symptoms; consider discontinuation if these occur 1
  • Assess family history of suicide, bipolar illness, or depression 1

Pediatric Considerations

Xelstrym is not recommended in children under 6 years of age because they experience higher plasma exposure and higher incidence of adverse reactions (particularly weight loss) compared to older children at the same dosage. 1

Growth Suppression

Closely monitor height and weight in pediatric patients. Those not growing or gaining weight as expected may need treatment interruption. 1

Other Important Warnings

  • Peripheral vasculopathy including Raynaud's phenomenon—monitor for digital changes 1
  • Contact sensitization—discontinue if suspected 1
  • Application site reactions—rotate sites daily to minimize 1
  • External heat exposure—avoid during wear as it increases absorption rate and extent 1
  • Serotonin syndrome—increased risk with serotonergic agents (SSRIs, SNRIs, triptans) 1

Renal Impairment Adjustments

  • Severe renal impairment: Maximum dose 13.5 mg/9 hours 1
  • End-stage renal disease (ESRD): Maximum dose 9 mg/9 hours 1

Pregnancy and Breastfeeding

Storage and Disposal

Keep in a safe place to prevent theft. Never share with others—selling or giving away is illegal and may cause harm or death. 1

References

3
Guideline

myeloid growth factors.

Journal of the National Comprehensive Cancer Network : JNCCN, 2013

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.