Pegfilgrastim is a leukocyte growth factor indicated to-

• Decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia. 
•  Increase survival in patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Subsyndrome of Acute Radiation Syndrome)

Neutropenia

Patients with cancer receiving myelosuppressive chemotherapy 

• 6 mg administered subcutaneously once per chemotherapy cycle.
• Do not administer between 14 days before and 24 hours after administration of cytotoxic chemotherapy. 
• Use weight based dosing for pediatric patients weighing less than 45 kg.
  • 10 - 20 kg: Dose:1.5 mg Volume: 0.15 mL 
  • 21 - 30 kg: Dose: 2.5 mg Volume: 0.25 mL
  • 31 - 44 kg: Dose: 4 mg Volume: 0.4 mL

Patients acutely exposed to myelosuppressive doses of radiation

• Two doses, 6 mg each, administered subcutaneously one week apart. Administer the first dose as soon as possible after suspected or confirmed exposure to myelosuppressive doses of radiation, and a second dose one week after. 
• Use weight based dosing for pediatric patients weighing less than 45 kg.
  • 10 - 20 kg: Dose:1.5 mg Volume: 0.15 mL 
  • 21 - 30 kg: Dose: 2.5 mg Volume: 0.25 mL
  • 31 - 44 kg: Dose: 4 mg Volume: 0.4 mL

For pediatric patients weighing less than 10 kg, administer 0.1 mg/kg (0.01 mL/kg) of Neulasta

Side effects associated with pegfilgrastim include-

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

Fever	Pain	Rash
Coughing	Epistaxis	Diarrhea

• Pegfilgrastim 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 Pegfilgrastim in patients with serious allergic reactions. 
• Fatal sickle cell crises have occurred.
• Pegfilgrastim 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. Pegfilgrastim should be discontinued if capillary leak syndrome occurs.