Splenic rupture, including fatal cases, can occur following administration of human granulocyte colony-stimulating factors. In patients who report upper abdominal or shoulder pain after receiving tbo-filgrastim, discontinue tbo-filgrastim and evaluate for an enlarged spleen or splenic rupture.
Acute Respiratory Distress Syndrome (ARDS)
Acute respiratory distress syndrome (ARDS) can occur in patients receiving human granulocyte colony-stimulating factors. Evaluate patients who develop fever and lung infiltrates or respiratory distress after receiving tbo-filgrastim, for ARDS. Discontinue tbo-filgrastim in patients with ARDS.
Serious allergic reactions including anaphylaxis can occur in patients receiving human granulocyte colony-stimulating factors. Reactions can occur on initial exposure. The administration of antihistamines‚ steroids‚ bronchodilators‚ and/or epinephrine may reduce the severity of the reactions. Permanently discontinue tbofilgrastim in patients with serious allergic reactions. Do not administer tbo-filgrastim to patients with a history of serious allergic reactions to filgrastim or pegfilgrastim.
Use in Patients with Sickle Cell Disease
Severe and sometimes fatal sickle cell crises can occur in patients with sickle cell disease receiving human granulocyte colony-stimulating factors. Consider the potential risks and benefits prior to the administration of human granulocyte colony-stimulating factors in patients with sickle cell disease. Discontinue tbofilgrastim in patients undergoing a sickle cell crisis.
Potential for Tumor Growth Stimulatory Effects on Malignant Cells
The granulocyte colony stimulating factor (G-CSF) receptor through which tbo-filgrastim acts has been found on tumor cell lines. The possibility that tbo-filgrastim acts as a growth factor for any tumor type, including myeloid malignancies and myelodysplasia, diseases for which tbo-filgrastim is not approved, cannot be excluded.
Patient Counseling Information
Advise patients of the following risks and potential risks with leukocyte growth factors such as tbo-filgrastim:
- Bone pain is common. Analgesics such as acetaminophen or NSAIDS may be necessary.
- Rupture or enlargement of the spleen may occur, which may be signaled by abdominal pain, left upper quadrant pain, or left shoulder pain. Advise patients to report onset of pain in these areas to their doctor immediately.
- Dyspnea with or without fever, progressing to Acute Respiratory Distress Syndrome may occur. Advise patients to report dyspnea immediately to their doctor.
- Serious allergic reactions, including anaphylaxis, rash, and urticaria: Patients should report such reactions immediately.
- In patients with sickle cell disease, sickle cell crisis and death has occurred. Discuss the potential risks and benefits for patients with sickle cell disease prior to the administration of human granulocyte colony-stimulating factors.
- Tbo-filgrastim is used in circumstances where the risk of infection is increased. Patients should be alert for signs of infection such as fever, redness or swelling and should report these findings to their doctor immediately.
- Inform patients not to become pregnant while receiving tbo-filgrastim. If pregnancy occurs, advise patients of the possibility of fetal harm.
See FDA-Approved Patient Labeling (PATIENT INFORMATION)
Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenicity and genetic toxicology studies have not been conducted with tbo-filgrastim.
A fertility study was not conducted with tbo-filgrastim. Toxicology studies of up to 26 weeks in rats or monkeys did not reveal findings in male or female reproductive organs that would suggest impairment of fertility.
Use In Specific Populations
Pregnancy Category C
There are no adequate and well-controlled studies of tbo-filgrastim in pregnant women. In an embryofetal developmental study, treatment of pregnant rabbits with tbo-filgrastim resulted in adverse embryofetal findings, including increased spontaneous abortion and fetal malformations at a maternally toxic dose. Tbo-filgrastim should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
In the embryofetal developmental study, pregnant rabbits were administered subcutaneous doses of tbofilgrastim during the period of organogenesis at 1, 10 and 100 mcg/kg/day. Increased abortions were evident in rabbits treated with tbo-filgrastim at 100 mcg/kg/day. This dose was maternally toxic as demonstrated by reduced body weight. Other embryofetal findings at this dose level consisted of post-implantation loss‚ decreased in mean live litter size and fetal weight, and fetal malformations such as malformed hindlimbs and cleft palate. The dose of 100 mcg/kg/day corresponds to a systemic exposure (AUC0-24) of approximately 50-90 times the exposures observed in patients treated with the clinical tbofilgrastim dose of 5 mcg/kg/day.
It is not known whether tbo-filgrastim is secreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when tbo-filgrastim is administered to a nursing woman. Other recombinant G-CSF products are poorly secreted in breast milk and G-CSF is not orally absorbed by neonates.
The safety and effectiveness of tbo-filgrastim in pediatric patients have not been established.
Among 677 cancer patients enrolled in clinical trials of tbo-filgrastim, a total of 111 patients were 65 years of age and older. No overall differences in safety or effectiveness were observed between patients age 65 and older and younger patients.
The safety and efficacy of tbo-filgrastim have not been studied in patients with moderate or severe renal impairment. No dose adjustment is recommended for patients with mild renal impairment [Clinical Pharmacology (12.3)].
The safety and efficacy of tbo-filgrastim have not been studied in patients with hepatic impairment.
Last reviewed on RxList: 10/12/2012
This monograph has been modified to include the generic and brand name in many instances.
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