Neupogen (Filgrastim) Dosing for an 85 kg Male
For an 85 kg male, the recommended dose of Neupogen (filgrastim) is 425 mcg per day administered subcutaneously. 1, 2
Dosing Calculation and Administration
The standard recommended dose of filgrastim (Neupogen) for adults is 5 mcg/kg/day administered subcutaneously 1, 2. For an 85 kg patient:
- Calculation: 5 mcg/kg × 85 kg = 425 mcg/day
- Route: Subcutaneous injection (preferred over intravenous) 1, 2
- Duration: Continue until post-nadir ANC recovery to normal or near-normal levels by laboratory standards (typically ANC ≥ 2-3 × 10^9/L) 1
Timing of Administration
- Begin filgrastim 24-72 hours after completion of myelotoxic chemotherapy 1, 2
- Do not administer within 24 hours before or after cytotoxic chemotherapy as this may reduce efficacy and increase toxicity 2
- Continue until adequate neutrophil recovery is achieved 1
Vial Size Considerations
Guidelines support rounding the dose to the nearest vial size to maximize cost-benefit and patient convenience without clinical detriment 1. Neupogen is available in:
- 300 mcg/mL vials
- 480 mcg/1.6 mL vials
For an 85 kg patient requiring 425 mcg, rounding to a 480 mcg vial would be appropriate and consistent with guideline recommendations 1.
Special Clinical Scenarios
- For peripheral blood progenitor cell (PBPC) mobilization: A higher dose of 10 mcg/kg/day is recommended (850 mcg for an 85 kg patient) 1
- For high-dose chemotherapy with stem cell rescue: Begin between 24-120 hours after high-dose therapy 1
- For severe chronic neutropenia: Dosing may need to be adjusted to maintain blood neutrophil levels in the normal or low-normal range 2
Monitoring and Adverse Effects
Monitor for common adverse effects, which include:
- Bone pain (reported in 11% of patients vs 6% with placebo) 3
- Back pain (15% vs 8%) 3
- Arthralgia (9% vs 2%) 3
- Pain in extremity (7% vs 3%) 3
Important Cautions
- Do not use filgrastim concurrently with chemotherapy and radiation therapy, particularly involving the mediastinum 1
- For weekly chemotherapy regimens, pegfilgrastim is not recommended due to insufficient data 1, 2
- CSF dose escalation beyond the recommended dose is not advised outside of PBPC mobilization 1
Following these evidence-based guidelines will optimize neutrophil recovery while minimizing adverse effects in this 85 kg male patient.