Tbo-Filgrastim (Subcutaneous)

Tbo-filgrastim is a medication used to treat severe neutropenia, or low white blood cells, that is caused by some cancer medicines.

Overview

Tbo-filgrastim is an injectable medication used to treat severe neutropenia, or low white blood cells, that is caused by some cancer medicines. It reduces the duration or severity of neutropenia in patients who have received any form of myelosuppressive antineoplastics that may cause this low white blood cell count.

This drug is a synthetic form of a substance that is usually produced by the body called a 'colony stimulating factor'. By mimicking the way this substance works, Tbo-filgrastim can help the bone marrow to create new white blood cells in order to combat and reduce neutropenia.

Myelosuppressive antineoplastics, a form of cancer medicine that fights cancer cells, is known to also affect these white blood cells, whose role in the body is to fight infection. Tbo-filgrastim is prescribed with or following this medication in a solution form to prevent or reduce the risk of infection during treatment.

Conditions Treated

  • Neutropenia caused by certain cancer medications

Type of Medicine

  • Colony Stimulating Factor
  • Solution (pre-filled syringe)

Side Effects

Alongside the effects Tbo-filgrastim is designed to produce, this medication may cause other side effects. Although not all, if any, of these effects, might occur, if they do become prevalent it is critical for the patient to seek appropriate medical attention as soon as possible, based on the severity of the effects experienced.

If any of the following side effects appear, consult with a medical professional as soon as possible:

  • Bloody or cloudy urine
  • Bone pain
  • Chest pain or tightness
  • Chills
  • Cough
  • Difficulty with swallowing
  • Dizziness
  • Eye pain
  • Fast heartbeat
  • Fever
  • General feeling of illness
  • Headache
  • Hives, itching, or skin rash
  • Pain in the upper left part of the stomach or at the tip of the left shoulder
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Sore throat
  • Trouble breathing
  • Unusual tiredness
  • Unusual weakness
  • Weight gain

During a course of treatment with Tbo-filgrastim, some side effects may happen often as a result of the treatment. These usually do not require medical attention when they initially occur. They may also go away as your body adapts to the drug or can continue consistently during your treatment cycle.

If any of these side effects appear to increase in severity over time, continue for longer than expected or are particularly uncomfortable, inform a medical professional at your own convenience.

The following side effects may occur when taking Altretamine, but usually, do not require medical attention:

  • Warmth at the injection site
  •  Ulceration
  •  Tingling
  •  Tenderness
  •  Swelling
  •  Stinging
  •  Soreness
  •  Scarring
  •  Redness
  •  Rash
  •  Pain
  •  Numbness
  •  Lumps
  •  Itching
  •  Inflammation
  •  Hives, infection
  •  Feeling of pressure
  •  Discoloration of the skin
  •  Coldness
  •  Burning
  •  Blistering
  •  Bleeding

For any serious side effects experienced, or any signs of an allergic reaction to the medication such as hives, difficulty breathing, and swelling of your face, lips, tongue, or throat, aim to receive emergency medical attention as soon as possible.

Dosage

A typical adult dosage of Tbo-filgrastim, when used for neutropenia associated with chemotherapy, is 5 mcg/kg/day. This is administered as a single daily subcutaneous bolus injection.

It is advised that the patient should avoid administration during the period 24 hours before and 24 hours after the administration of chemotherapy that is of a cytotoxic type. In addition, a medical professional should monitor the complete blood count (CBC) of the patient both prior to chemotherapy as well as twice per week until recovery.

Interaction

Many drugs may interact with other medications within the human body, both those currently being used and those used recently. This can lead to varying effects of medications and even additional potential negative side effects that can cause the drug to become ineffective or even cause harm to the patient.

Patients and physicians should keep an up-to-date list of all medications and diagnostic drugs currently in use in order to prevent issues with negative drug interaction, and in order to build a fully realized picture of the patient's medical history and any current or past reactions to drugs that may influence the medical professional's decision to prescribe Tbo-filgrastim as a viable medication.

It's key that the patient's medical team is completely aware of every medication within their system and routine, from long-term medication to over the counter tablets, and makes a medical professional aware of their current/recent drug usage to ensure treatment that is most effective and is less likely to risk causing harm. These medications may cause potential moderate interaction with Tbo-filgrastim:

  • Abemaciclib
  • Abraxane (paclitaxel protein-bound)
  • Actimmune (interferon gamma-1b)
  • Adcetris (brentuximab)
  • Adriamycin (doxorubicin)
  • Adriamycin pfs (doxorubicin)
  • Adriamycin rdf (doxorubicin)
  • Adrucil (fluorouracil)
  • Aldesleukin
  • Alemtuzumab
  • Alimta (pemetrexed)
  • Aliqopa (copanlisib)
  • Alkeran (melphalan)
  • Altretamine
  • Arranon (nelarabine)
  • Arsenic trioxide
  • Arzerra (ofatumumab)
  • Asparaginase escherichia coli
  • Avastin (bevacizumab)
  • Azacitidine
  • Beleodaq (belinostat)
  • Belinostat
  • Bendamustine
  • Bendeka (bendamustine)
  • Besponsa (inotuzumab ozogamicin)
  • Bevacizumab
  • Bexarotene
  • Bexxar (iodine i 131 tositumomab)
  • Bexxar dosimetric (tositumomab)
  • Bexxartherapeutic (tositumomab)
  • Bicnu (carmustine)
  • Blenoxane (bleomycin)
  • Bleo 15k (bleomycin)
  • Bleomycin
  • Blinatumomab
  • Blincyto (blinatumomab)
  • Bortezomib
  • Bosulif (bosutinib)
  • Bosutinib
  • Brentuximab
  • Busulfan
  • Busulfex (busulfan)
  • Cabazitaxel
  • Campath (alemtuzumab)
  • Camptosar (irinotecan)
  • Capecitabine
  • Carboplatin
  • Carboplatin novaplus (carboplatin)
  • Carfilzomib
  • Carmustine
  • Ccnsb capsules (lomustine)
  • Ceenu (lomustine)
  • Cerubidine (daunorubicin)
  • Chlorambucil
  • Cisplatin
  • Cladribine
  • Cladribine novaplus (cladribine)
  • Clofarabine
  • Clolar (clofarabine)
  • Copanlisib
  • Cosmegen (dactinomycin)
  • Cyclophosphamide
  • Cytarabine
  • Cytarabine liposomal / daunorubicin liposomal
  • Cytosar (cytarabine)
  • Cytosar-u (cytarabine)
  • Cytoxan (cyclophosphamide)
  • Cytoxan lyophilized (cyclophosphamide)
  • Dacarbazine
  • Dacogen (decitabine)
  • Dactinomycin
  • Daratumumab
  • Darzalex (daratumumab)
  • Dasatinib
  • Daunorubicin
  • Daunorubicin liposomal
  • Daunoxome (daunorubicin liposomal)
  • Decitabine
  • Docefrez (docetaxel)
  • Docetaxel
  • Doxil (doxorubicin liposomal)
  • Doxorubicin
  • Doxorubicin liposomal
  • Droxia (hydroxyurea)
  • Dtic-dome (dacarbazine)
  • Ellence (epirubicin)
  • Eloxatin (oxaliplatin)
  • Elspar (asparaginase escherichia coli)
  • Epirubicin
  • Ergamisol (levamisole)
  • Eribulin
  • Eskalith (lithium)
  • Eskalith-cr (lithium)
  • Etopophos (etoposide)
  • Etoposide
  • Evomela (melphalan)
  • Farydak (panobinostat)
  • Floxuridine
  • Fludara (fludarabine)
  • Fludarabine
  • Fludeoxyglucose f18
  • Fluorouracil
  • Folex pfs (methotrexate)
  • Folotyn (pralatrexate)
  • Fudr (floxuridine)
  • Gazyva (obinutuzumab)
  • Gemcitabine
  • Gemtuzumab
  • Gemzar (gemcitabine)
  • Gleevec (imatinib)
  • Gleostine (lomustine)
  • Gliadel (carmustine)
  • Halaven (eribulin)
  • Herceptin (trastuzumab)
  • Hexalen (altretamine)
  • Hyaluronidase / rituximab
  • Hycamtin (topotecan)
  • Hydrea (hydroxyurea)
  • Hydroxyurea
  • Ibrance (palbociclib)
  • Ibritumomab
  • Ibrutinib
  • Iclusig (ponatinib)
  • Idamycin (idarubicin)
  • Idamycin pfs (idarubicin)
  • Idarubicin
  • Idelalisib
  • Ifex (ifosfamide)
  • Ifex / mesnex (ifosfamide / mesna)
  • Ifosfamide
  • Ifosfamide / mesna
  • Imatinib
  • Imbruvica (ibrutinib)
  • In-111 zevalin (ibritumomab)
  • Infergen (interferon alfacon-1)
  • Inotuzumab ozogamicin
  • Interferon alfa-2a
  • Interferon alfa-2b
  • Interferon alfa-2b / ribavirin
  • Interferon alfa-n1
  • Interferon alfacon-1
  • Interferon gamma-1b
  • Intron a (interferon alfa-2b)
  • Iodine i 131 tositumomab
  • Irinotecan
  • Irinotecan liposomal
  • Istodax (romidepsin)
  • Ixabepilone
  • Ixazomib
  • Ixempra (ixabepilone)
  • Jakafi (ruxolitinib)
  • Jevtana (cabazitaxel)
  • Kymriah (tisagenlecleucel)
  • Kyprolis (carfilzomib)
  • Lemtrada (alemtuzumab)
  • Lenalidomide
  • Leukeran (chlorambucil)
  • Leustatin (cladribine)
  • Levamisole
  • Lipodox (doxorubicin liposomal)
  • Lipodox 50 (doxorubicin liposomal)
  • Lithium
  • Lithium carbonate er (lithium)
  • Lithobid (lithium)
  • Lithonate (lithium)
  • Lithotabs (lithium)
  • Lomustine
  • Lonsurf (tipiracil / trifluridine)
  • Lynparza (olaparib)
  • Marqibo (vincristine liposome)
  • Matulane (procarbazine)
  • Mechlorethamine
  • Melphalan
  • Mercaptopurine
  • Meta trace fdg (fludeoxyglucose f18)
  • Methotrexate
  • Methotrexate lpf sodium (methotrexate)
  • Midostaurin
  • Mithracin (plicamycin)
  • Mitomycin
  • Mitoxantrone
  • Mustargen (mechlorethamine)
  • Mutamycin (mitomycin)
  • Mvasi (bevacizumab)
  • Myleran (busulfan)
  • Mylocel (hydroxyurea)
  • Mylotarg (gemtuzumab)
  • Navelbine (vinorelbine)
  • Nelarabine
  • Neosar (cyclophosphamide)
  • Neutrexin (trimetrexate)
  • Nilotinib
  • Ninlaro (ixazomib)
  • Nipent (pentostatin)
  • Niraparib
  • Novantrone (mitoxantrone)
  • Obinutuzumab
  • Ofatumumab
  • Oforta (fludarabine)
  • Olaparib
  • Omacetaxine
  • Oncaspar (pegaspargase)
  • Oncovin (vincristine)
  • Onivyde (irinotecan liposomal)
  • Onxol (paclitaxel)
  • Osimertinib
  • Otrexup (methotrexate)
  • Oxaliplatin
  • Paclitaxel
  • Paclitaxel protein-bound
  • Palbociclib
  • Panobinostat
  • Paraplatin (carboplatin)
  • Pazopanib
  • Pegaspargase
  • Pegasys (peginterferon alfa-2a)
  • Peginterferon alfa-2a
  • Peginterferon alfa-2b
  • Pegintron (peginterferon alfa-2b)
  • Pemetrexed
  • Pentostatin
  • Pharmorubicin pfs (epirubicin)
  • Pharmorubicin rdf (epirubicin)
  • Platinol (cisplatin)
  • Platinol-aq (cisplatin)
  • Plicamycin
  • Pomalidomide
  • Pomalyst (pomalidomide)
  • Ponatinib
  • Pralatrexate
  • Procarbazine
  • Proleukin (aldesleukin)
  • Purinethol (mercaptopurine)
  • Purixan (mercaptopurine)
  • Rasuvo (methotrexate)
  • Rebetron (interferon alfa-2b / ribavirin)
  • Revlimid (lenalidomide)
  • Rheumatrex dose pack (methotrexate)
  • Rituxan (rituximab)
  • Rituxan hycela (hyaluronidase / rituximab)
  • Rituximab
  • Roferon-a (interferon alfa-2a)
  • Romidepsin
  • Ruxolitinib
  • Rydapt (midostaurin)
  • Sprycel (dasatinib)
  • Streptozocin
  • Sylatron (peginterferon alfa-2b)
  • Synribo (omacetaxine)
  • Tabloid (thioguanine)
  • Tagrisso (osimertinib)
  • Tarabine pfs (cytarabine)
  • Targretin (bexarotene)
  • Tasigna (nilotinib)
  • Taxol (paclitaxel)
  • Taxotere (docetaxel)
  • Temodar (temozolomide)
  • Temozolomide
  • Teniposide
  • Tepadina (thiotepa)
  • Thalidomide
  • Thalomid (thalidomide)
  • Thioguanine
  • Thioplex (thiotepa)
  • Thiotepa
  • Tipiracil / trifluridine
  • Tisagenlecleucel
  • Toposar (etoposide)
  • Topotecan
  • Tositumomab
  • Trabectedin
  • Trastuzumab
  • Treanda (bendamustine)
  • Trexall (methotrexate)
  • Trimetrexate
  • Trisenox (arsenic trioxide)
  • Uracil mustard
  • Velban (vinblastine)
  • Velcade (bortezomib)
  • Venclexta (venetoclax)
  • Venetoclax
  • Vepesid (etoposide)
  • Verzenio (abemaciclib)
  • Vidaza (azacitidine)
  • Vinblastine
  • Vincasar pfs (vincristine)
  • Vincristine
  • Vincristine liposome
  • Vinorelbine
  • Votrient (pazopanib)
  • Vumon (teniposide)
  • Vyxeos (cytarabine liposomal / daunorubicin liposomal)
  • Xatmep (methotrexate)
  • Xeloda (capecitabine)
  • Y-90 zevalin (ibritumomab)
  • Yondelis (trabectedin)
  • Zanosar (streptozocin)
  • Zejula (niraparib)
  • Zevalin (ibritumomab)
  • Zydelig (idelalisib)

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical conditions or issues, both current or previous, may influence how Tbo-filgrastim functions, which can result in varying side effects, exacerbated illness or other ill effects. A medical professional should be consulted if the patient has suffered from any of the following:

  • Sickle cell disease (red blood cell disease)
  • Tumor Growth as a result of Tbo-filgrastim
  • Glomerulonephritis
  • Kidney Disease

You should also inform a doctor prior to taking this medication if you have any upcoming diagnostic tests, including a bone scan, that may be affected by this medication.

Warnings

If the patient experiences any symptoms of infection when under treatment with Tbo-filgrastim, it is advisable to contact a medical professional immediately. These symptoms may include:

  • Fever
  • Chills
  • Cough
  • Sore throat
  • Unusual tiredness or weakness

If the patient experiences any pain in the upper left area of the stomach or at the tip of the left shoulder, it is important that they seek medical advice as soon as possible. These symptoms could be an indicator of a serious condition within the spleen caused or exacerbated by Tbo-filgrastim.

Additionally, if the patient experiences any of the following symptoms, these may be caused by a serious lung condition known as Acute Respiratory Distress Syndrome, and medical attention should be sought immediately:

  • Fever
  • Chest pain or tightness
  • Trouble breathing

If the patient experiences any of the following symptoms while Tbo-filgrastim is being used as treatment, they may be suffering from Capillary Leak Syndrome and should seek medical help as soon as possible:

  • Fever
  • Cloudy urine
  • Decrease or increase in the amount of urine
  • Fainting or lightheadedness
  • Nausea
  • Stomach pain
  • Swelling of hands, ankles, feet, or lower legs

The pregnancy risk of Tbo-filgrastim is category C, suggesting that this medication may cause risk to unborn infants. These risks and benefits should be discussed with a relevant medical professional before deciding to undertake treatment

Storage

This medication should be stored in the refrigerator, but not frozen. It should also be protected from light.

Each injection should be given 30 minutes to reach room temperature prior to injecting a dose, but should not be maintained at room temperature for more than five days. If the syringe is not used during this time, it can be returned to the refrigerator.

Granix (the US brand name for Tbo-filgrastim) is available on prescription based on the recommendation of a suitable medical professional and should be stored out of reach of children and pets at all times.

Summary

Tbo-filgrastim is a prescription-only medication used in the treatment of severe neutropenia, that can be and often is caused by some cancer medicines in the myelosuppressive antineoplastics family. The low white blood cell count that this medication causes can result in higher risk of infection, which Tbo-filgrastim helps to prevent and reduce.

This medication is developed to mimic 'colony stimulating factor', a substance produced by a healthy body that helps the body to create white blood cells through the bone marrow. Due to the nature of the medication, and how it works, bone pain is a common side effect of Tbo-filgrastim.

Tbo-filgrastim is an effective method to increase white blood cells that are reduced by chemotherapy treatments, and are available in pre-filled syringes for home-based treatment.

Resources
Last Reviewed:
December 24, 2017
Last Updated:
April 27, 2018
Content Source: