Skip to main content

Table 2 G-CSF

From: Clozapine rechallenge and initiation despite neutropenia- a practical, step-by-step guide

Physiological role cytokine glycoprotein stimulating differentiation, release and survival of neutrophils and other granulocytes
Drug Filgrastim (recombinant G-CSF) has been available since the early 1990’s; originally to treat patients with chemotherapy-induced neutropenia
Current usage Severe chronic neutropenia, mobilisation of haematopoietic progenitors for stem cell transplantation [49,50,51], drug induced neutropenia [52].
G-CSF and clozapine rechallenge after CIN / CIA Multiple case reports [49, 53,54,55,56,57,58,59,60,61,62,63,64,65] reviewed by Lally et al [66, 67]; G-CSF successfully supported over 70% of initial CIN cases. Success was markedly reduced following CIA.
Common adverse effects and management Flu like symptoms, bone pain, headache, pyrexia and fatigue.
Rare adverse effects Splenic rupture, glomerulonephritis, alveolar haemorrhage, thrombocytopenia and capillary leak syndrome.
Side effect management and monitoring Analgesia, monitoring for splenomegaly [68] and bone mineral density assessment [69].
Long term safety Available from the 20,000 annual healthy volunteer peripheral blood donors. Initial concerns of increased leukaemia risk alleviated by long term follow up [70].
Dose, We took advice from haematology colleagues. G-CSF dosages ranged between single as required injections of 15million units to 30 million units twice weekly.
Administration Pre-loaded syringe for subcutaneous injection, volume < 1 ml
Storage Refrigerated
Cost UK approx. £50 ($65) per dose
Institutional / systemic factors High cost novel drug in psychiatric practice. Treating teams likely to be unfamiliar with usage and this may not be supported by all mental health organisations.