Editing Filgrastim (section)

{{Short description|Medication}}
{{distinguish|granulocyte-macrophage colony-stimulating factor|epoetin alfa}}
{{Use dmy dates|date=February 2022}}
{{cs1 config |name-list-style=vanc |display-authors=6}}
{{drugbox
| image              = filgrastim.jpg
| width              = 184
| alt                = 
| caption            = 
| type               = 

<!-- Clinical data -->
| pronounce          = 
| tradename          = Neupogen, others
| Drugs.com          = {{drugs.com|monograph|filgrastim}}
| MedlinePlus        = a692033
| DailyMedID         = Filgrastim
| pregnancy_AU       = B3
| pregnancy_AU_comment = <ref name="Drugs.com Pregnancy">{{cite web | title=Filgrastim Use During Pregnancy | website=Drugs.com | date=13 September 2018 | url=https://www.drugs.com/pregnancy/filgrastim.html | access-date=17 December 2019 | archive-date=18 December 2019 | archive-url=https://web.archive.org/web/20191218054847/https://www.drugs.com/pregnancy/filgrastim.html | url-status=live }}</ref>
| pregnancy_category = 
| routes_of_administration = [[Intraveneous]], [[Subcutaneous injection|subcutaneous]]
| class              = Hematopoietic agents, [[colony-stimulating factor]]s
| ATC_prefix         = L03
| ATC_suffix         = AA02
| ATC_supplemental   = 
| biosimilars        = filgrastim-aafi,<ref name="Nivestym Drug Approval Package" /> filgrastim-ayow,<ref name="Releuko FDA label" /> filgrastim-sndz, filgrastim-txid<ref name="Nypozi FDA label" /> Accofil,<ref name="Accofil EPAR" /> Biograstim,<ref name="Biograstim EPAR" /> Fraven, Grastofil,<ref name="Grastofil EPAR" /> Nivestim,<ref name="Nivestim EPAR" /> Nivestym,<ref name="Nivestym SBD" /> Nypozi,<ref name="Nypozi FDA label" /><ref name="Nypozi SBD" /> Ratiograstim,<ref name="Ratiograstim EPAR" /> Releuko,<ref name="Releuko FDA label">{{cite web | title=Releuko- filgrastim injection, solution | website=DailyMed | date=11 March 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=74e1ec6e-1630-4654-895c-2bd355f939e7 | access-date=16 March 2022 | archive-date=17 March 2022 | archive-url=https://web.archive.org/web/20220317050614/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=74e1ec6e-1630-4654-895c-2bd355f939e7 | url-status=live }}</ref> Tevagrastim, Zarxio,<ref name="FDA_Zarxio_2015" /> Zarzio,<ref name="Zarzio EPAR" /> Zefylti<ref name="Zefylti EPAR" /><ref name="Zefylti PI" />

<!-- Legal status -->
| legal_AU           = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->
| legal_AU_comment   = 
| legal_BR           = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F-->
| legal_BR_comment   = 
| legal_CA = Rx-only
| legal_CA_comment = /&nbsp;Schedule D<ref>{{cite web | title=Health product highlights 2021: Annexes of products approved in 2021 | website=[[Health Canada]] | date=3 August 2022 | url=https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/health-product-highlights-2021/appendices.html | access-date=25 March 2024}}</ref>
| legal_DE           = <!-- Anlage I, II, III or Unscheduled-->
| legal_DE_comment   = 
| legal_NZ           = <!-- Class A, B, C -->
| legal_NZ_comment   = 
| legal_UK           = POM
| legal_UK_comment   = <ref name="Neupogen SmPC">{{cite web | title=Neupogen 30 MU (0.3 mg/ml) solution for injection - Summary of Product Characteristics (SmPC) | website=(emc) | date=7 May 2021 | url=https://www.medicines.org.uk/emc/product/3000/smpc | access-date=1 March 2022 | archive-date=1 March 2022 | archive-url=https://web.archive.org/web/20220301025307/https://www.medicines.org.uk/emc/product/3000/smpc | url-status=live }}</ref><ref name="Zarzio SmPC">{{cite web | title=Zarzio 30 MU/0.5 ml solution for injection or infusion in pre-filled syringe - Summary of Product Characteristics (SmPC) | website=(emc) | date=4 July 2019 | url=https://www.medicines.org.uk/emc/product/6672/smpc | access-date=20 December 2019 | archive-date=20 December 2019 | archive-url=https://web.archive.org/web/20191220191620/https://www.medicines.org.uk/emc/product/6672/smpc | url-status=live }}</ref><ref>{{cite web | title=Nivestim 12 MU/ 0.2 ml solution for injection/infusion - Summary of Product Characteristics (SmPC) | website=(emc) | date=18 December 2019 | url=https://www.medicines.org.uk/emc/product/575/smpc | access-date=20 December 2019 | archive-date=20 December 2019 | archive-url=https://web.archive.org/web/20191220191621/https://www.medicines.org.uk/emc/product/575/smpc | url-status=live }}</ref>
| legal_US           = Rx-only
| legal_US_comment   = <ref name="Neupogen FDA label" />
| legal_EU           = Rx-only
| legal_EU_comment   = <ref name="Nivestim EPAR" />
| legal_UN           = <!-- N I, II, III, IV / P I, II, III, IV-->
| legal_UN_comment   = 
| legal_status       = <!--For countries not listed above-->

<!-- Pharmacokinetic data -->
| bioavailability    = 
| protein_bound      = 
| metabolism         = 
| metabolites        = 
| onset              = 
| elimination_half-life = 
| duration_of_action = 
| excretion          = 

<!-- Identifiers -->
| CAS_number         = 121181-53-1
| CAS_supplemental   = 
| PubChem            = 
| IUPHAR_ligand      = 6968
| DrugBank           = DB00099
| ChemSpiderID       = none
| UNII_Ref           = {{fdacite|correct|FDA}}
| UNII               = PVI5M0M1GW
| KEGG               = D03235
| ChEBI              = 
| ChEMBL             = 1201567
| NIAID_ChemDB       = 
| PDB_ligand         = 
| synonyms           = XM02 

<!-- Chemical and physical data -->
| IUPAC_name         = Human granulocyte colony stimulating factor
| C                  = 845
| H                  = 1343
| N                  = 223
| O                  = 243
| S                  = 9
| SMILES             = 
| StdInChI           = 
| StdInChI_comment   = 
| StdInChIKey        = 
| density            = 
| density_notes      = 
| melting_point      = 
| melting_high       = 
| melting_notes      = 
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| solubility         = 
| sol_units          = 
| specific_rotation  = 
}}

<!-- Definition and medical uses -->
'''Filgrastim''', sold under the brand name '''Neupogen''' among others, is a [[medication]] used to treat [[neutropenia|low neutrophil count]].<ref name=AHFS2016/> Low neutrophil counts may occur with [[HIV/AIDS]], following [[chemotherapy]] or [[radiation poisoning]], or be of an unknown cause.<ref name=AHFS2016/> It may also be used to increase white blood cells for gathering during [[leukapheresis]].<ref name=AHFS2016/> It is given either by [[intravenous|injection into a vein]] or [[Subcutaneous injection|under the skin]].<ref name=AHFS2016/> Filgrastim is a leukocyte growth factor.<ref name="Neupogen FDA label" />

<!-- Side effects and mechanism -->
Common side effects include fever, cough, chest pain, joint pain, vomiting, and hair loss.<ref name=AHFS2016/> Severe side effects include [[splenic rupture]] and [[allergic reactions]].<ref name=AHFS2016/> It is unclear if use in [[pregnancy]] is safe for the baby.<ref name=AHFS2016/> Filgrastim is a recombinant form of the naturally occurring [[granulocyte colony-stimulating factor]] (G-CSF).<ref name=AHFS2016/> It works by stimulating the body to increase [[neutrophil]] production.<ref name=AHFS2016/>

<!-- History, society and culture -->
Filgrastim was approved for medical use in the United States in 1991.<ref name=AHFS2016>{{cite web|title=Filgrastim|url=https://www.drugs.com/monograph/filgrastim.html |publisher=The American Society of Health-System Pharmacists|access-date=8 December 2016|url-status=live|archive-url=https://web.archive.org/web/20170510112413/https://www.drugs.com/monograph/filgrastim.html |archive-date=10 May 2017}}</ref> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }}</ref><ref name="WHO22nd">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }}</ref> Filgrastim [[biosimilar]] medications are available.<ref name=AHFS2016/>