VALLEY BAPTIST MEDICAL CENTER

FILGRASTIM PROTOCOL

PROTOCOL

A. All orders for filgrastim (Neupogen) for adult patients will be subject to this protocol, unless
the physician has noted on the order to exclude patient from this protocol.

B. All ordered dosages for filgrastim will be reviewed by a pharmacist.

C. The pharmacist will review all ordered dosages for filgrastim and, if necessary, adjust the
dose of filgrastim based on patient’s most current weight at the recommended daily dosage of
5 mcg/kg.

D. The pharmacy will prepare all dosages of filgrastim in unit dose syringes at 1500.

E. The standard administration time for filgrastim at VBMC will be at 1700.

F. The standard route of administration at VBMC will be subcutaneous.

G. If not already ordered by the physician, the pharmacist will order a CBC with differential
every other day starting on Day 3 of filgrastim therapy until ANC > 1,500 cells/mm3 or
WBC > 2,500 cells/mm3 (in the absence of a differential) has been documented; thereafter,
CBC with differential may be ordered daily. The CBC with differential may be ordered daily
following documentation of an ANC > 1,500 cells/mm3 or WBC > 2,500 cells/mm3
(regardless of the day of therapy).

H. The pharmacist will monitor the absolute neutrophil count (ANC) and discontinue filgrastim
based on the following criteria: ANC > 1,500 cells/mm3 for 2 consecutive days OR a single
determination of WBC > 2,500 cells/mm3 (in the absence of a differential or isolated
neutropenia) [ANC = (% segs + % bands) × WBC]

I. Orders for labs or for the discontinuation of filgrastim as per protocol will be written by the
pharmacist in the patient’s medical chart.

References
1. Ozer H, et al. 2000 Update of recommendations for the use of hematopoietic colony-stimulating
factors: evidence-based, clinical practice guidelines. J Clin Oncol 2000; 18:3558-85.
2. Bernstein BJ, Blanchard LM. Economic and clinical impact of a pharmacy-based filgrastim protocol
in oncology patients. Am J Health-Syst Pharm 1999;56:1330-3.

rev 4/05