Filgrastim is indicated for the following conditions-

• Decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with non-myeloid malignancies receiving myelosuppressive anti cancer drugs associated with a significant incidence of severe neutropenia with fever
• Reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML) 
• Reduce the duration of neutropenia and neutropenia-related clinical sequelae‚ e.g.‚ febrile neutropenia, in patients with non-myeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation (BMT) 
• Mobilize autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis 
• Reduce the incidence and duration of sequelae of severe neutropenia (e.g.‚ fever‚ infections‚ oropharyngeal ulcers) in symptomatic patients with congenital neutropenia‚ cyclic neutropenia‚ or idiopathic neutropenia
• Increase survival in patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Syndrome of Acute Radiation Syndrome) 

Patients with cancer receiving myelosuppressive chemotherapy or induction and/or consolidation chemotherapy for AML:

• Recommended starting dose is 5 mcg/kg/day subcutaneous injection, short intravenous infusion (15 to 30 minutes), or continuous intravenous infusion.

Patients with cancer undergoing bone marrow transplantation 

• 10 mcg/kg/day given as an intravenous infusion no longer than 24 hours. 

Patients undergoing autologous peripheral blood progenitor cell collection and therapy 

• 10 mcg/kg/day subcutaneous injection
• Administer for at least 4 days before first leukapheresis procedure and continue until last leukapheresis 

Patients with congenital neutropenia

• Recommended starting dose is 6 mcg/kg subcutaneous injection twice daily 

Patients with cyclic or idiopathic neutropenia

• Recommended starting dose is 5 mcg/kg subcutaneous injection daily

Patients acutely exposed to myelosuppressive doses of radiation 

• 10 mcg/kg/day subcutaneous injection

Side effects associated with filgrastim include-

• fever
• pain
• rash
• cough
• dyspnea 
• diarrhea
• bone pain
• epistaxis

Fever	Pain	Rash
Coughing	Epistaxis	Diarrhea

• Filgrastim can increase the risk of spleen enlargement or rupture, which can be life-threatening in some cases. Patients should be monitored closely for signs of splenomegaly or splenic rupture, such as left upper quadrant pain, left shoulder pain, or a palpable mass.
• Acute respiratory distress syndrome (ARDS): Evaluate patients who develop fever and lung infiltrates or respiratory distress for ARDS. Discontinue Figrastim in patients with ARDS.
• Serious allergic reactions, including anaphylaxis: Permanently discontinue Filgrastim in patients with serious allergic reactions. 
• Fatal sickle cell crises have occurred.
• Filgrastim can also cause capillary leak syndrome, a condition characterized by the leakage of fluid and protein from blood vessels into surrounding tissues, leading to edema and hypotension. Patients should be monitored for signs of capillary leak syndrome, such as hypotension, hypoalbuminemia, and edema. Filgrastim should be discontinued if capillary leak syndrome occurs.