Mankhwala Neuromax: malangizo ntchito > Chithandizo ndi kupewa

Filgrastim ndi colombulant colanulocyte colony stimulating factor. Ndi mapuloteni kuchokera 175 ma amino acid. Sipadera ndi maselo. Escherichia colimu zida za G-CSF munthu. Ali ndi zofanana zochita monga G-CSFopangidwa mthupi la munthu. Imalimbikitsa maphunziro neutrophils Ndi kutuluka kwawo kuchokera kumongo. Kuchulukitsa neutrophils m'magazi amadziwika mkati mwa maola 24.

Zizindikiro zogwiritsidwa ntchito

neutropenia pambuyo chemotherapy,
kulimbikitsa CPMC opereka ndi odwala
neutropenia pambuyo zamanablo Chithandizo chisanachitike kufupika kwa mafupa,
idiopathic kapena kobadwa nako neutropenia Akuluakulu ndi ana,
wolimbikira neutropenia odwala HIV (ndi kulephera kwa njira zina zamankhwala).

Zotsatira za pharmacological

Neupomax ndi chowonjezera cha leukopoiesis. Neupomax imakhala ndi filgrastim, yomwe imapanganso zinthu zina m'magulu a anthu ochititsa chidwi a granulocyte (G-CSF). The yogwira thunthu ali ndi zochitika zofanana endo native G-CSF; kapangidwe kazinthu kamafilastastim kamasiyana ndi maselo amkati mwa N-terminal yowonjezera methionine yotsalira (filgrastim ndi puloteni yotsika-glycosylated). Gawo lomwe limagwiritsa ntchito mankhwalawa limapezeka pogwiritsa ntchito maumboni a DNA omwe amapangidwanso pama cell a Escherichia coli, mu ma genetic omwe amapanga jini omwe amaphatikizira mapuloteni a G-CSF.

Neupomax imawonjezera kupanga kwa neutrophils ndi ntchito yokhutiritsa, komanso kulowa kwake mu kama wamitsempha kuchokera m'maselo a m'mafupa. Neupomax imathandizira mu neutropenia yamayendedwe osiyanasiyana.

Pharmacodynamics wa mankhwala Neupomax

Intravenous komanso subcutaneous makonzedwe a filgrastim amatsogolera ku mzere wodalirika wama seramu ake. Kuchulukitsa kuchuluka kwa filgrastim kumafikira 150 ml / kg.

Kutalika kwa theka la moyo wa filgrastim ndi maola 3.5, pafupifupi chilolezo cha 0.6 ml / min / kg.

Filgrastim kwenikweni siyikumveka (mwa odwala omwe adapangidwa ndi kulowetsa mafupa othamanga, omwe adalandira infgrastim mosalekeza kwa masiku 28, panalibe zizindikiritso za mankhwalawo).

Njira yogwiritsira ntchito

Neupomax lakonzedwa kuti parenteral subcutaneous kapena mtsempha wama mtsempha. Njira yothetsera vutoli imaperekedwa tsiku ndi tsiku kapena m'njira zamkati mwa mitsempha (mpaka mphindi 30). Ngati ndi kotheka, Neupomax amaloledwa kutumizidwa m'njira yovomerezeka ya maola 24 mosalekeza. Njira yoyendetsera, komanso mlingo komanso nthawi yogwiritsira ntchito yankho la Neupomax, imatsimikiziridwa ndi katswiriyo, poganizira zomwe akuwonetsa ndi zomwe wodwalayo ali nazo. Kwa odwala ambiri, kayendetsedwe ka subcutaneous amasankhidwa.

Mothandizidwa ndi subcutaneally, tikulimbikitsidwa kuti musinthe jakisoni aliyense jekeseni (kusintha malo operekera jakisoni kumachepetsa chiopsezo cha kupweteka pambuyo pakukhazikitsa mankhwalawa.

Mlingo wa Neupomax pa cytotoxic chemotherapy

Mu reghemens yodziwika bwino, 5 μg / kg ya kulemera kwa wodwala nthawi zambiri amapatsidwa kamodzi patsiku. Mlingowu umaperekedwa tsiku lililonse mosaneneka kapena kudzera m'mitsempha (mpaka mphindi 30) ndikuwunikira chithunzi cha magazi. Mankhwalawa amagwiritsidwa ntchito poteteza kuchuluka kwa neutrophil.

Jekeseni woyamba wa filgrastim amachitika palibe kale kuposa maola 24 atamaliza kugwiritsa ntchito chemotherapy. Kutalika kwa kugwiritsa ntchito filgrastim mpaka masiku 14. Popeza mtundu wa chemotherapy womwe ukugwiritsidwa ntchito, utatha kuphatikiza komanso kupatsa mankhwala a pachimake myukomia, njira yogwiritsira ntchito njira ya Neupomax imatha kuchuluka mpaka masiku 38. Odwala ambiri, kuwonjezeka kwakanthawi kwa kuchuluka kwa ma neutrophils amalembedwa patsiku lachiwiri - lachitatu la filgrastim. Sitikulimbikitsidwa kuti tisiye mankhwala a filgrastim mpaka kuwerengera kwakanthawi a neutrophil atatha kuwongolera pazotsala zomwe zidakonzedweratu (ndi kusiya kwa chithandizo chamankhwala, mwayi wokhala ndi njira yokhazikika yamankhwala umachepa). Chithandizo cha Neupomax chimalephera ngati chiwerengero chonse cha neutrophils chikwera pamwamba 10,000 / μl.

Mlingo wa Neupomax mu myeloablative mankhwala omwe ali ndi kufalikira kwamkati

Mlingo woyambira wa filgrastim wa mankhwala a myeloablative akutsatiridwa ndi kupatsidwa zina (autologous or allogeneic) ofowoka kwa mafupa ndi 10 μg / kg ya wodwala. Mankhwala chikuyendetsedwera kudzera mu kulowetsedwa (kutalika kwa kukapanda kuleka ndi mphindi 30 kapena maola 24). Ndikothekanso kukhazikitsa kwa filgrastim mwa kulowetsedwa kwa maola 24.

Njira yoyambira ya Neupomax yothetsera imayendetsedwa asanadutse maola 24 pambuyo pa kumaliza kwa cytotoxic chemotherapy ndipo pasanathe maola 24 mutatha kufalikira.

Kutalika kwa kugwiritsa ntchito njira ya Neupomax mu myeloablative therapy sikupitilira masiku 28. Mlingo wa tsiku ndi tsiku wa filgrastim ukhoza kusinthidwa poganizira kuchuluka kwa neutrophils komanso kusintha kwa kuchuluka kwawo. Momwe ma neutrophil amawerengetsera kuposa 1000 / μl kwa masiku atatu otsatizana, kuchuluka kwa filgrastim kumachepetsedwa mpaka 5 μg / kg ya odwala patsiku. Ngati, mutatha kusintha kwa mlingo, gawo la neutrophil limaposa 1000 / μl kwa masiku atatu otsatizana, yankho la Neupomax litha. Ngati, mutasintha mlingo kapena kusiya yankho la Neupomax, kuchuluka kwa ma neutrophils amatsika mpaka osakwana 1000 / μl, muyenera kubwerera ku mlingo wam'mbuyo wa filgrastim.

Mlingo wa Neupomax pa kukokoloka kwa zotumphukira zamagazi zimayambira mwa odwala omwe ali ndi matenda oopsa

Pofuna kulimbikitsa maselo otumphukira wamagazi, odwala omwe ali ndi matenda oopsa amayenera kupatsidwa 10 μg / kg kwa thupi patsiku modutsa ndi bolus kapena subcutaneous kulowetsedwa (kwa maola 24) kwa masiku 6 otsatizana. Poyerekeza zakumbuyo kagwiritsidwe ntchito ka filgrastim, 2 leukapheresis imagwira mzere (nthawi zambiri patsiku la 5 ndi la 6 la mankhwala). Ngati leukapheresis yowonjezera ndiyofunikira, kayendetsedwe ka filgrastim iyenera kupitilizidwa mpaka njirayi yomaliza.

Mlingo wa Neupomax pambuyo pa chithandizo cha myelosuppression kuti muphatikize maselo amtsempha wamagazi

Pambuyo pochita chithandizo cha myelosuppressive, filgrastim imakonda kutumikiridwa pa mlingo wa 5 μg / kg wa wodwala mu mawonekedwe a kubaya kwa phazi. Chithandizo cha mankhwala a Neupomax chikuyamba tsiku litatha mlingo wotsiriza wa chemotherapy. Kutalika kwa kugwiritsa ntchito kwa filgrastim kumatsimikiziridwa ndi mulingo wa neutrophils komanso kusintha kwa kusintha kwa chiwerengero chawo, ndikulimbikitsidwa kupitilizabe kugwiritsa ntchito kukonzekera kwa Neupomax mpaka mfundo zabwinobwino za gawo la neutrophil zikapezeka. Leukapheresis imachitika pambuyo pakufika pamtundu wa neutrophil wopitilira 2000 / μl.

Mlingo wa Neupomax wolimbikitsa kusunthika kwa maselo a magazi mu zotumphukira mwa opereka athanzi kuti apatsidwe allogeneic

Opereka athanzi amalangizidwa kuti azigwiritsa ntchito minofu yafine pa 10 mgg / kg patsiku. Kutalika kwa maphunzirowa ndi masiku 4-5, pomwe ma leukapheresis amakuthandizani kuti mupeze 4 * 106 CD34 + cell / kg yolembetsa. Palibe zambiri pa chitetezo chogwiritsa ntchito filgrastim mwa opatsa athanzi osakwanitsa zaka 16 ndi zaka zopitilira 60.

Mlingo wa mankhwala Neupomax woopsa kwambiri neutropenia

Ndi kobadwa nako mawonekedwe a neutropenia, filgrastim imayikidwa pa mlingo wa 12 μg / kg wa wodwala patsiku, ndi idiopathic ndi nthawi neutropenia, filgrastim imayikidwa pa mlingo wa 5 μg / kg pa thupi patsiku. Zikatero, mankhwalawa Neupomax amaperekedwa mosavuta, tsiku lililonse amatha kugawidwa jakisoni zingapo kapena kutumikiridwa panthawi imodzi. Mankhwalawa amayenera kupitilizidwa mpaka chiwerengero chokhazikika cha neutrophil choposa 1500 / μl chikafika. Mutapeza nambala yofunikira ya neutrophils, ndikofunikira kusankha mtundu wocheperako wa filgrastim, womwe uonetsetsa kuti chiwerengero cha neutrophils chimasungidwa pamlingo wopatsidwa.

Poganizira momwe wodwalayo amayankhira mankhwala a filgrastim, pambuyo pa masabata 1-2 mlingo umatha kuchepetsedwa kapena kuwonjezeka nthawi 2. Kusintha kwina kwa mlingo kumachitika nthawi imodzi mu masabata 1-2. Mlingo woyenera kwambiri umawalola kuti mulingo wa neutrophils azisungidwa m'mbali mwa 1500-10000 / μl. M'matenda akulu, kuwonjezereka mwachangu kwa mlingo wa filgrastim ndikololedwa.

Kutetezeka kwa chithandizo chokhalitsa kwa nthawi yayitali ndi filgrastim mu Mlingo wa tsiku lililonse woposa 24 mcg / kg / tsiku kwa odwala omwe ali ndi mawonekedwe osatha a neutropenia sizinachitike.

Mlingo wa Neupomax wa neutropenia mwa odwala omwe ali ndi kachilombo ka HIV

Mlingo woyambira wa filgrastim kwa odwala omwe ali ndi kachilomboka komanso neutropenia ndi 1-4 μg / kg pa thupi patsiku. Mlingo uyenera kuyikidwa kuti mupeze mulingo wambiri wa neutrophils. Kutengera ndi kulekerera kwa filgrastim ndi mphamvu yowonjezera ya kuchuluka kwa ma neutrophils, mlingo wa yankho la Neupomax ukhoza kuchulukitsidwa. Osagwiritsa ntchito oposa 10 mcg / kg wa wodwala patsiku.

Mlingo wa mankhwala Neupomax m'magulu ena a odwala

Kwa ana ochepera zaka 16, filgrastim imafotokozedwa mu Mlingo woyenera kwa akuluakulu. Kuwerengera kwa kuchuluka kwa minofu ya mafgrastim mu ana ayenera kuchitika malinga ndi kulemera ndi kusuntha kwa mulingo wa neutrophils.

Okalamba odwala safuna kusintha kwa mlingo wa Neupomax.

Malangizo pakuchepetsa kwa Neupomax

Mothandizidwa ndi subcutaneally, Neupomax siimadziwitsidwa.

Pokonzekera njira yothetsera kulowetsedwa kwa kukapanda kuleka, njira yokha ya 5% ya dextrose ndiyofunika kugwiritsidwa ntchito. Sizoletsedwa kugwiritsa ntchito 0,9% sodium chloride (zothetsera sizigwirizana).

Tiyenera kukumbukira kuti mankhwalawa Neupomax pamwambo wa 2-15 μg / ml amatha kuyamwa ndi ma polima ndi galasi. Pofuna kupewa kuyamwa kwa filgrastim ndi makoma a vial, tikulimbikitsidwa kuti tiwonjezere anthu seramu albin pazothetsera (yomaliza ya albumin mu kulowetsedwa njira ayenera 2 mg / ml). Ngati kuchuluka komaliza kwa filgrastim kopitilira 15 μg / ml, kuwonjezera kwa albumin sikofunikira. Kuwonongeka kwa mankhwala Neupomax kwa ndende yosakwana 2 μg / ml ndi koletsedwa.

Malangizo apadera ogwiritsira ntchito mankhwala Neupomax

Filgrastim chithandizo chitha kuchitika kokha ndi katswiri yemwe akudziwa ntchito zopatsa mphamvu za koloni, ndipo malinga ndi kupezeka kwazofunikira zakuwunikira. Kulimbikitsa maselo ndi ma apheresis akuyenera kuchitika kokha m'malo azachipatala apadera.

Odwala omwe ali ndi vuto losatha la neutropenia ayenera kusamala mosiyanitsa asanayambitse mankhwala a filgrastim kuti asatenge matenda ena a hematological (kuphatikizapo kuchepa kwa magazi, matenda a myelogenous leukemia, myelodysplasia). Musanayambe chithandizo, ndikofunikira kuti mufufuze mafupa a cytogenetic ndi morphological.

Therapy ya Neupomax imatheka pokhapokha pounikira chithunzi chonse cha magazi otumphukira ndi kuwerengera koyenera kwa leukocyte formula ndi kuwerengera kwa ma cellel (kuwunika koyamba kuchitidwa musanagwiritse ntchito filgrastim, ndiye kuti kumachitika mobwerezabwereza katatu pa sabata ndi chemotherapy komanso katatu pa sabata. maselo amwazi). Ngati filgrastim imagwiritsidwa ntchito kulimbikitsa masentimita am'magazi, kukwera kwa maselo oyera a magazi kupitirira 100,000 / µl kapena kuchepa kwa chiwerengero cha maselo osakwana 100,000 / µl, Neupomax iyenera kuthetsedwa kapena kuti mlingo wa filgrastim uyenera kuchepetsedwa. Tiyenera kukumbukira kuti mankhwala a Neupomax samalepheretsa kuchepa kwa magazi m'thupi komanso thrombocytopenia yokhudzana ndi myelosuppressive chemotherapy.

Palibe umboni wazomwe zimachitika mu filgrastim pa kumtengowo motsutsana ndi zomwe akuchita.

Ndikofunikira kuyang'anitsitsa zonse zotsatira za kusanthula kwamkati panthawi ya mankhwala a Neupomax (kupatula proteinuria ndi hematuria).

Ndikulimbikitsidwa kuti muwoneke momwe ma ndulu amathandizira pakukula kwa mankhwalawa ndi Neupomax.

Ndikofunikira kuwongolera kuchuluka ndi kapangidwe ka minofu ya mafupa mwa odwala omwe ali ndi mafupa a mafupa kapena mafupa amthupi nthawi yayitali ndi Neupomax.

Zotsatira zoyipa

Poyerekeza ndi chithandizo cha mankhwala ndi mankhwala a Neupomax mwa odwala, kuoneka kwa zosafunika zoterezi ndizotheka:

Matenda a minofu: mafupa olowa, myalgia, kupweteka kwa mafupa, mafupa.
M`mimba thirakiti: hepatomegaly, matenda am'mimba, anorexia, kusanza, nseru.
Mitsempha yamagazi: leukocytosis, neutrophilia, thrombocytopenia, kuchepa magazi, kukulitsa ndi kupasuka kwa ndulu.
Njira yothandizira: kupuma pamavuto, kupindika.
CVS: kuthamanga kwa magazi, vasculitis.
Zotsatira zasayansi: kuchuluka (kosinthika) kwa uric acid, lactate dehydrogenase, gamma glutamylasease ndi alkaline phosphatase mu seramu, chosakhalitsa hypoglycemia (mutatha kudya).

Kuphatikiza apo, munthawi ya chithandizo ndi Neupomax yankho, kukula kwa proteinuria ndi hematuria, asthenia, kuchuluka kwa kutopa, petechiae, nosebleeds ndi erythema nodosum adalembedwa mwa odwala ena.

Mukamagwiritsa ntchito mankhwala a Neupomax, odwala amatha kuona mawonekedwe amtundu wa edema, urticaria, kulephera kupuma, ochepa hypotension, ndi tachycardia.

Kupanga kwa pachimake mawonekedwe a myeloid leukemia ndi myelodysplastic syndrome mwa odwala omwe ali ndi mawonekedwe a matenda a neutropenia adadziwika. Kulumikizana mwachindunji kwa matendawa ndi filgrastim therapy sikunatsimikizidwe, komabe, Neupomax iyenera kulembedwa kwa odwala omwe ali ndi vuto lalikulu la neutropenia kokha ndikuwunikira kwa marphological ndi cytogenetic pamafupa (kamodzi kamodzi miyezi 12). Ndikusintha kwa kusintha kwa cytogenetic m'mphepete mwa mafupa, zoopsa ndi zopindulitsa zomwe zingachitike pothandizidwa ndi filgrastim ziyenera kuyesedwa ndipo njira yolekerera mankhwala a Neupomax iyenera kuganiziridwanso.

Kukula kwa khansa ya m'magazi ndi MDS kumafuna kutsekedwa kwa Neupomax.

Neupomax siliwonjezera pafupipafupi komanso zovuta za zochitika zovuta za mankhwala a cytotoxic.

Filgrastim ikhoza kubweretsa kuwonjezeka kwakukulu kwa maselo odwala, omwe ayenera kuganizira panthawi ya odwala omwe ali ndi matenda odwala cell.

Contraindication

Neupomax sinafotokozeredwe odwala osalolera ku filgrastim kapena gawo lothandizira la yankho.

Neupomax sagwiritsira ntchito mankhwalawa odwala omwe ali ndi vuto lalikulu la syntgenital neutropenia (Costmann syndrome) ndi zovuta za cytogenetic.

Neupomax sangagwiritsidwe ntchito kuwonjezera milingo ya chemotherapeutic cytotoxic mankhwala pazomwe amavomerezedwa.

Muyenera kusamala mukamagwiritsa ntchito mankhwala a Neupomax mwa odwala omwe ali ndi vuto loyipa komanso lolimba la mtundu wa myeloid (kuphatikizapo pachimake myelogenous leukemia), komanso ndi matenda a cell.

Palibe deta pa chitetezo cha filgrastim mwa odwala omwe ali ndi autoimmune neutropenia.

Mimba

Chitetezo cha mankhwalawa ndi filgrastim ya amayi apakati sichikukhazikitsidwa. Ndikofunikira kuwunikira mozama kuopsa ndi maubwino musanapereke Neupomax kwa amayi panthawi yapakati.

Palibe deta pakulowera kwa Neupomax kupita mkaka wa m'mawere. Ndikofunikira kumaliza kuyamwitsa musanayambe chithandizo ndi Neupomax.

Kuyanjana kwa mankhwala osokoneza bongo

Chitetezo chogwiritsa ntchito filgrastim sichitsimikiziridwa kuti chimaphatikizidwa ndi mankhwala a myelosuppressive cytotoxic omwe amagwiritsidwa ntchito mu chemotherapy regimens (pamene mankhwalawa amaperekedwa tsiku lomwelo).

Pali umboni wowonjezera pakuvuta kwa neutropenia pomwe mukugwiritsa ntchito filgrastim ndi 5-fluorouracil.

Kugwiritsa ntchito kwa filgrastim pamodzi ndi zinthu zina za hematopoietic kukula, komanso ma cytokines, sikunaphunzire.

Ndikotheka kuwonjezera mphamvu ya filgrastim ikaphatikizidwa ndi kukonzekera kwa lifiyamu (kukonzekera kwa lifiyamu kumapangitsa kuti ma neutrophils amasulidwe).

Njira ya Neupomax siyigwirizana ndi 0,9% sodium chloride.

Malo osungira

Neupomax iyenera kusungidwa kuti isachitike ndi ana pa kutentha kwa madigiri 2-8 Celsius.

Sizoletsedwa kumasula yankho.

Moyo wa alumali ndi zaka 2.

Mutatsegula botolo, yankho silingasungidwe.

Granogen, Zarsio, Immugrast, Leukostim, Leucite, Myelastra, Neutrostim, Tevagrastim, Filgrastim, Filergim.

Fomu ya Mlingo:

yankho la mtsempha wa mtsempha wa magazi ndi ma transcutaneous.

1 ml yankho lili:

ntchito yogwira: filgrastim 300 mcg (30 miliyoni miliyoni)

obwera: glacial acetic acid, sodium hydroxide (sodium hydroxide), sorbitol (sorbitol), polysorbate 80, madzi a jekeseni.

Transparent kapena pang'ono opalescent, wopanda utoto kapena pang'ono utoto.

Mankhwala

Mankhwala.

The yogwira thunthu la mankhwala ndi filgrastim - mobwerezabwereza anthu granulocyte koloni zolimbikitsa chinthu (G-CSF). Filgrastim imakhala ndi zochita zofananira monga G-CSF yamunthu womaliza, ndipo imasiyana ndi yotsiriza chifukwa ndi puloteni wopanda glycosylated wotsalira wa N-terminal methionine. Filgrastim yomwe imapangidwa ndi ukadaulo wa DNA wopangidwanso imasiyanitsidwa ndi ma cell a bacteria Esherichiacoli, zida zamtunduwu zomwe zinayambitsa jini lomwe limalemba mapuloteni G-CSF.

Filgrastim imathandizira kupangika kwa ma neutrophils omwe amagwira ntchito ndi kutulutsidwa kwawo kulowa m'mafupa; amagwiritsidwa ntchito pochiza odwala omwe ali ndi neutropenia yamavuto osiyanasiyana.

Pharmacokinetics

Onse omwe ali ndi intravenous komanso subcutaneous makonzedwe a filgrastim, kutsata kokhazikika kwa kayendetsedwe kake ka seramu kumadalira. Kuchuluka kwa magawo m'magazi ndi pafupifupi 150 ml / kg.

Hafu ya moyo wa filgrastim kuchokera ku seramu ndi pafupifupi maola 3.5, ndipo chiwongolerocho chimakhala pafupifupi 0,6 ml / min / kg.

Kulowetsedwa kosatha kwa filgrastim kwa nthawi yayitali mpaka masiku 28 kwa odwala pambuyo pakutsanulira kwa mafupa osakanikirana sikumayendera limodzi ndi chizindikiro cha kukokomeza ndi kuchuluka kwa theka la moyo.

Zotsatira zoyipa

Kuchokera ku minculoskeletal system: kupweteka m'mafupa, minofu ndi mafupa, mafupa.

Kuchokera m'mimba: matenda a anorexia, kutsekula m'mimba, hepatomegaly, nseru ndi kusanza.

Thupi lawo siligwirizana: zotupa pakhungu, urticaria, kutupa kwa nkhope, kupindika, kufupika, kutsika magazi, tachycardia.

Kuchokera ku ziwalo za hemopoietic: neutrophilia ndi leukocytosis (monga chifukwa cha pharmacological zochita za filgrastim), magazi m'thupi, thrombocytopenia, kukulitsa ndi kupasuka kwa ndulu.

Kuchokera pakapumidwe: wamkulu kupuma mavuto matenda, mapapu kulowa.

Kuchokera pamtima: kutsitsa kapena kuchuluka kwa kuthamanga kwa magazi, vasculitis yapakhungu.

Kumbali ya zowonetsa zasayansi: kuchuluka kosinthika kwa zomwe lactate dehydrogenase, alkaline phosphatase, gamma-glutamyltransferase, uric acid, osakhalitsa a hypoglycemia atatha kudya, kawirikawiri: proteinuria, hematuria.

Zina: mutu, kutopa, kufooka, mphuno, petechiae, erythema nodosum.

Filgrastim sitiwonjezera zachilengedwe za cytotoxic therapy.

Kuchita ndi mankhwala ena

Chitetezo ndikuyenda bwino kwa kayendetsedwe ka filgrastim tsiku lomwelo monga mankhwala a myelosuppress antitumor sanakhazikitsidwe.

Pali malipoti osiyana azachuma aku neutropenia pomwe nthawi ya filgrastim ndi 5-fluorouracil.

Palibe umboni wa kuyanjana ndi zinthu zina za hematopoietic kukula kwa zinthu ndi ma cytokines.

Lithium, yomwe imalinganiza kumasulidwa kwa neutrophils, imatha kupititsa patsogolo zotsatira za filgrastim.

Mankhwala osagwirizana ndi 0,9% chloride solution.

Malangizo apadera

Chithandizo cha neypomaksom chikuyenera kuchitika pokhapokha kuyang'aniridwa ndi dokotala wodziwa kugwiritsa ntchito koloni zinthu zoyenera, ndi kuthekera koyenera kofotokozera. Njira zolimbikitsira ma cell ndi ma apheresis ziyenera kuchitika m'malo azachipatala apadera.

Chitetezo ndikuyenda bwino kwa filgrastim kwa odwala omwe ali ndi myelodysplastic syndrome komanso matenda a myelo native leukemia sanakhazikitsidwe, chifukwa chake sikulimbikitsidwa kuti mugwiritse ntchito filgrastim pamatendawa. Makamaka chidwi ayenera kulipira kuti kusiyanasiyana matenda pakati pachimake myelo native leukemia ndi kuphulika vuto la myelo native leukemia.

Neupomax asanaikidwe kwa odwala omwe ali ndi vuto lalikulu la neutropenia (TCH), kuwunika koyenera kuyenera kuchitika mosamala kupatula matenda ena amtundu monga aplastic anemia, myelodysplasia, ndi matenda a myelogenous leukemia (morphological ndi cytogenetic kusanthula kwa m'mafupa ayenera kuchitidwa asanalandire chithandizo).

Pogwiritsa ntchito filgrastim kwa odwala omwe ali ndi CTN, pakhala pali zochitika za chitukuko cha myelodysplastic syndrome ndi myeloid leukemia. Ngakhale kuti kulumikizana pakati pa kukhazikika kwa matendawa pogwiritsa ntchito filgrastim sikunakhazikitsidwe, mankhwalawa ayenera kugwiritsidwa ntchito ndi TCH mosamala motsogozedwa ndi morphological ndi cytogenetic kusanthula kwa m'mafupa (nthawi 1 m'miyezi 12). Zovuta za cytogenetic zimachitika m'mphepete mwa mafupa, chiopsezo ndi kupindulanso kwa chithandizo chamankhwala ndi filgrastim ziyenera kuwunikiridwa mosamala. Ndi chitukuko cha MDS kapena leukemia, Neupomax iyenera kusiyidwa.

Chithandizo cha Neupomax chikuyenera kuchitika pang'onopang'ono poyeretsa kuchuluka kwa magazi ndi kuchuluka kwa leukocyte ndi kuwerenga kwa maselo a mapiritsi (musanayambe chithandizo.) Kawiri pa sabata ndi muyezo wa chemotherapy komanso osachepera katatu pa sabata ndikulimbikitsidwa kwa PSCC kapena popanda kufalikira kwa mafupa. Mukamagwiritsa ntchito Neupomax kuphatikiza PSCC, mankhwalawa amathetsedwa ngati kuchuluka kwa leukocytes kupitirira 100,000 / μl. Ndi chiwalo cholimba chokhala ndi zinthu zosakwana 100,000 / μl, timalimbikitsidwa kusiya kwakanthawi mankhwala a filgrastim kapena kuchepetsa mlingo wake.

Filgrastim siiletsa thrombocytopenia ndi magazi m'thupi chifukwa cha myelosuppressive chemotherapy.

Mukamalandira chithandizo ndi Neupomax, urinalysis iyenera kuchitidwa pafupipafupi (kupatula hematuria ndi proteinuria) ndipo kukula kwa ndulu kuyenera kuyang'aniridwa.

Filgrastim iyenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi matenda odwala maselo mogwirizana ndi kukula kwa chiwonetsero cha kuchuluka kwa maselo odwala.

Chitetezo ndi kufunika kwa mankhwalawa kwa akhanda komanso odwala omwe ali ndi autoimmune neutropenia sanakhazikitsidwe.

Odwala omwe ali ndi mafupa othandizira komanso mafupa am'mimba omwe amalandira chithandizo mosalekeza ndi Neupomax kwa miyezi yopitilira 6 akuwonetsedwa kuwongolera mafupa.

Zotsatira za filgrastim pazomenyera motsutsana ndi kuchititsa kwake sizinakhazikitsidwe.

Kutulutsa Fomu.

Njira yothetsera kulowetsedwa kwamkati ndi makulidwe, 300 μg (ma miliyoni 30) mu 1 ml. Pa 1.0 ml (300 mcg, mayunitsi 30 miliyoni) kapena 1.6 ml (480 mcg, mayunitsi 48 miliyoni) m'mabotolo agalasi, osindikizidwa ndi oyimitsa kuchokera osakaniza ndi mphira ndi zigawo za aluminium.

Mabotolo asanu, odzaza ndi ma CD opangira filimu ya PVC limodzi ndi malangizo ogwiritsira ntchito, amaikidwa pakatoni.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

P / c kapena mwa mawonekedwe ofupikira amkati (mkati mwa mphindi 30), tsiku lililonse mpaka chiwerengero cha neutrophils chikufika pazomwe zimafunikira (nadir) ndikubwerera pamlingo woyenera. Mankhwala amadziwitsidwa mu 5% dextrose solution.

Makonda / njira ya kaperekedwe ka mankhwala. Kusankhidwa kwa kayendetsedwe ka kayendetsedwe kake kumatengera mtundu wamatendawo.

Ma regimoto a cytotoxic odziwika bwino: mayunitsi 0,5 miliyoni (5 mcg) / kg kamodzi patsiku. Mlingo woyamba wa mankhwalawa umaperekedwa pasanathe maola 24 pambuyo pa cytotoxic chemotherapy. Kutalika kwa mankhwala mpaka masiku 14. Pambuyo pakuthandizira komanso kuphatikiza mankhwala othandizira pachimake myelogenous leukemia, kutalika kwa mankhwalawa kumatha kuchuluka mpaka masiku 38, kutengera mtundu, mlingo, ndi cytotoxic chemotherapy regimen yomwe imagwiritsidwa ntchito. Kukula kwakanthawi kwa kuchuluka kwa neutrophils nthawi zambiri kumawonedwa pakatha masiku 1-2 chiyambireni chithandizo. Kuti mukwaniritse zochizira zokhazikika, ndikofunikira kupitiliza chithandizo mpaka chiwerengero cha neutrophils chikadutsa pazomwe zimafunikira ndikufika pazofunikira. Sitikulimbikitsidwa kuletsa mankhwalawa nthawi isanakwane mpaka chiwerengero cha neutrophils chikudutsa pazomwe zikuyembekezeka. Chithandizo chimayimitsidwa ngati chiwerengero chonse cha neutrophils pambuyo pa nadir chafika pa 1 chikwi / µl.

Pambuyo pa mankhwala a myelo-ablative, otsatiridwa ndi kupindika kapena kufupika kwa m'mafupa: kuwonongeka kwa sc kapena iv (20 ml ya 5% dextrose solution). Mlingo woyambirira ndi magawo 1 miliyoni a mankhwalawa (10 mcg) / kg patsiku mu / kukapumira kapena kwa mphindi 30 kapena maola 24 kapena kulowetsedwa kosalekeza kwa maola 24. Mlingo woyamba wa mankhwalawa uyenera kuperekedwa mosapitirira maola 24 Pambuyo cytotoxic chemotherapy, ndi kufalikira kwa mafupa - osapitirira maola 24 mutatha kulowetsedwa kwa mafupa. Kutalika kwa mankhwala sikupitilira masiku 28. Pambuyo pakuchepa kwambiri kwa chiwerengero cha neutrophils (nadir), mlingo wa tsiku ndi tsiku umasinthidwa kutengera mphamvu ya chiwerengero cha neutrophils. Ngati kuchuluka kwa ma neutrophils aposa 1 chikwi / μl kwa masiku atatu otsatizana, mlingo umachepetsedwa mpaka 0,5 miliyoni / kg / tsiku, ndiye kuti ngati chiwerengero chonse cha neutrophils chikuposa 1 chikwi / forl kwa masiku atatu otsatizana, mankhwalawo amachotsedwa. Ngati munthawi ya chithandizo manambala onse a neutrophils amatsika zosakwana 1 chikwi / μl, mlingo umakulanso molingana ndi dongosolo lomwe wapatsidwa.

Kusunthika kwa zotumphukira za tsinde lamitsempha yamagazi (PSCC) pambuyo pa myelosuppressive chithandizo chotsatira kutsitsidwa kwa magazi a PSCC osakanikirana kapena popanda kufalikira kwa mafupa kapena odwala omwe ali ndi matenda a myeloablative akutsatiridwa ndi kuikidwa kwa PSCC: ma miliyoni 1 (10 mcg) / kg patsiku mosalekeza 24-maola s / c kulowetsedwa kapena s / jakisoni 1 nthawi imodzi kwa masiku 6 otsatizana. Ndikulimbikitsidwa kuchita leukapheresis 3 mzere pa 5, 6 ndi 7 masiku.

Kusunthidwa kwa PSCA pambuyo pa kulolerana kwa myelosuppress: mayunitsi a 0,5 miliyoni (5 μg) / kg patsiku ndi jakisoni wa tsiku ndi tsiku, kuyambira tsiku la 1 atamaliza chemotherapy mpaka chiwerengero cha neutrophils chikadutsa pazomwe zimafunikira ndikufika pazachilendo mfundo. Leukapheresis iyenera kuchitidwa panthawi yomwe kuchuluka kwathunthu kwa ma neutrophils akukwera kuchokera pansi pa 500 mpaka 5,000 / μl. Kwa odwala omwe sanalandire chemotreapia, gawo limodzi la leukapheresis ndilokwanira. Nthawi zina, zimalimbikitsidwa kuchita magawo owonjezera a leukapheresis.

Kulimbikitsa kwa PSCC mwaopereka amoyo wathanzi pakuika ma allogeneic: s / c 1 miliyoni 1 (10 μg) / kg / tsiku kwa masiku 4-5 kumapereka chiwerengero cha CD34 + 4 miliyoni / kg.

Aakulu neutropenia: tsiku lililonse, kamodzi kapena zingapo jakisoni wa mankhwala. Ndi kobadwa nako neutropenia, mlingo woyambirira ndi mayunitsi 1.2 miliyoni (12 μg) / kg / tsiku, ndi idiopathic kapena nthawi neutropenia - mayunitsi 0,5 miliyoni (5 μg) / kg / tsiku mpaka chiwonetsero chokhazikika cha chiwerengero cha neutrophils chimaposa 1500 / μl. Pambuyo achire zotsatira zake, njira yocheperako yotsimikiza imatsimikizika kuti ichitike, ndipo kukonzekera kwatsiku ndi tsiku kumafunikira. Pambuyo pa chithandizo cha milungu iwiri kapena itatu, kumwa koyamba kumatha kuwonjezeredwa kapena kuchepetsedwa ndi 50%, kutengera momwe wodwalayo amayankhira chithandizo. Pambuyo pake, masabata onse a 1-2, mutha kusintha kusintha kwa mankhwalawa kuti musunge ma neutrophils osiyananso ndi 1.5-10,000 / μl. M'matenda akulu, regimen yomwe ikuwonjezeka mwachangu muyezo wa mankhwala ingagwiritsidwe ntchito. Mu 97% ya odwala omwe adatsimikiza kulandira chithandizo, achire wokwanira adawonedwa ndi Mlingo mpaka 24 mcg / kg / tsiku. Mlingo watsiku ndi tsiku sayenera kupitilira 24 mcg / kg / tsiku.

Neutropenia mu kachilombo ka HIV: mlingo woyambirira ndi mayunitsi 0,0,4 miliyoni (1-4 μg) / kg / tsiku kamodzi, s / c kuti achulukitse kuchuluka kwa neutrophils. Pazipita tsiku mlingo 10 mgg / kg. Matenda a chiwerengero cha neutrophils nthawi zambiri amapezeka pambuyo masiku awiri. Mukakwaniritsa achire, njira yokonza ndi 300 mcg / tsiku 2-3 kawiri pa sabata molingana ndi chiwembu. Pambuyo pake, kusintha kwa mankhwalawa komanso kuyamwa kwakanthawi kantchito kungafunike kuti chiwerengero cha neutrophils chopitilira 2,000 / μl chikhale.

Kwa odwala okalamba, kusintha kwa mankhwala sikofunikira.

Malangizo a kuchuluka kwa mankhwalawa kwa ana ndi chimodzimodzi kwa akuluakulu omwe amalandiridwa ndi myelosuppressive chemotherapy.

Ngati mankhwalawa amathandizidwa kuti azikhala osachepera 1.5 miliyoni (15 μg) / ml, ndiye kuti seramu albumin iyenera kuwonjezeredwa ku yankho kuti gawo lomaliza la albumin ndi 2 mg / ml (mwachitsanzo, ndi yankho lomaliza la 20 ml, kuchuluka kwa mankhwalawa ndi ochepera 30 miliyoni ED (300 μg) iyenera kuperekedwa ndi 0,2 ml ya yankho la 20% ya albin ya anthu). Simungathe kuchepetsa mankhwalawo mpaka pomalizitsa magawo ochepera a miliyoni miliyoni (2 μg) / ml.

Neupomax, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Nthawi zambiri, mankhwalawa amaperekedwa tsiku lililonse mosagwirizana, nthawi zina - kulowetsedwa (kupasuka kokha mu 5% yankho dextrose) Kusankhidwa kwa kayendetsedwe ka mankhwala ndi mlingo wa Neupomax zimatengera nyengo yamankhwala. Malangizo a kuchipatala ndi ovuta, amasiyana matenda osiyanasiyana. Nawa ena a iwo.

Maphunzirowa atatha chemotherapy sankha 5 mcg / kg kamodzi patsiku s / c, tsiku lililonse mpaka mlingo wabwinobwino ubwezeretsedwe neutrophils. Mlingo woyamba umaperekedwa tsiku limodzi kumapeto chemotherapy. Kutalika kwa chithandizo mpaka milungu iwiri. Pambuyo mankhwala olowa pachimake myeloid leukemia Kutalika kwa mankhwala kungakhale mpaka masiku 38. Kuchulukana neutrophils Zimadziwika pambuyo pa masiku 1-2, komabe, kuti mukwaniritse zotsatira zokhazikika, chithandizo sichiyenera kusokonezedwa.

Mankhwala a Myeloablative musanachitike kufalikira

Chithandizo chimayamba ndi 10 mcg / kg patsiku, omwe amaperekedwa kudzera m'mitsempha. Kutalika kwa chithandizo mpaka masiku 28.

Kulimbikitsa CPMC opereka - 10 mcg / kg 1 nthawi patsiku, subcutaneally mpaka masiku 5 ndikuwongolera kwina leukapheresis.

Kulimbikitsa CPMC odwala akudwala chemotherapy - 5 mcg / kg kamodzi patsiku, subcutaneously, tsiku lililonse mpaka matenda neutrophils. Leukapheresis amachitika pamene neutrophils akwaniritsa mfundo> 2000 / μl.

Neutropenia odwala HIV - 1-4 mcg / kg 1 nthawi patsiku, pang'onopang'ono kusintha momwe muliri neutrophils. Kenako yikani mankhwala okonza - 3 mcg / kg tsiku lililonse.

Pharmacokinetics

Ndi pa / mu ndi s / kukhazikitsidwa kwa Neupomax, kudalira kwathunthu kwa seramu ndende ya filgrastim pamankhwala kumadziwika.

Kuchuluka kwa magawidwe kumasiya pafupifupi 150 ml / kg. Chilolezo chokwera pafupifupi 0.6 ml / min / kg.

The seramu theka moyo ndi pafupifupi 3.5 maola.

Ndi kulowetsedwa kosalekeza kwa Neupomax kwakanthawi mpaka masiku 28, odwala omwe adapangidwa ndi kufalikira kwa mafupa sanadziwe kuwonjezeka kwa theka la moyo komanso kusangalatsa kwa chinthu chogwira ntchito.

Malangizo ogwiritsira ntchito Neupomax: njira ndi mlingo

Neupomax imayang'aniridwa sc m'njira ya jakisoni kapena iv m'njira yafupikitsa mphindi 30 infusions. Komanso, ngati ndi kotheka, sc kapena intravenous makonzedwe a infusions a maola 24 ndikotheka. Dokotala amasankha njira yolondola yotsatirira malingana ndi momwe wodwalayo alili, koma njira yokhazikikayi ya kaperekedwe ka mankhwalawo imawerengedwa kuti ndiyabwino kwambiri.

Tsiku ndi tsiku, tsamba la jakisoni limalimbikitsidwa kuti lisinthidwe, izi zimapewa kupweteka pakukhazikitsa yankho.

Malangizo pokonza njira:

Ndi subcutaneous makonzedwe, Neupomax sanatchulidwe. Ngati ndi kotheka, kulowetsedwa ngati zosungunulira pogwiritsa ntchito yankho la dextrose 5%.
Chifukwa chosagwirizana ndi mankhwala, ndizoletsedwa kugwiritsa ntchito njira ya 0.9% sodium chloride ya dilution.
Wofinya Neupomax woipa wa 2-15 μg / ml akhoza kutsatsa ndi pulasitiki ndi galasi. Pofuna kupewa kuyamwa, ndikofunikira kuwonjezera seramu ya albin yankho, njira yake imawerengeredwa kuti ndende yomaliza ndi 2 mg / ml.
Albumin sayenera kuwonjezeredwa ndi kuchepetsedwa Neupomax pazowonjezera pamtunda wa 15 μg / ml.
Neupomax kuchepetsedwa muzitsulo zosakwana 2 μg / ml sayenera kugwiritsidwa ntchito.

Ndondomeko za Cytotoxic Chemotherapy

Mlingo woyenera ndi 5 mg pa kilogalamu ya thupi kamodzi patsiku kapena iv m'njira yovutitsa kwa mphindi 30.

Mlingo woyamba umaperekedwa pasanadutse maola 24 pambuyo pa kutha kwa cytotoxic chemotherapy.

Neupomax imagwiritsidwa ntchito tsiku ndi tsiku mpaka, pambuyo pakuchepa kwakukulu kwa kuchuluka kwa ma neutrophils, chiwerengero chawo chimabwezeretsedwa kukhala chabwinobwino, koma osapitilira masiku 14. Pambuyo pofika pazomwe zimachitika, Neupomax imathetsedwa.

Kutalika kwa mankhwalawa kungathe kuwonjezeka mpaka masiku 38 kwa odwala omwe amalandila kuphatikiza ndi kupatsidwa mankhwala ogwirizana ndi pachimake myelo native leukemia. Pankhaniyi, gwiritsani ntchito mtundu wa chemotherapy regimen, mtundu wake ndi mlingo.

Kukula kwakanthawi kwa kuchuluka kwa ma neutrophils nthawi zambiri kumawonedwa patatha masiku 1-2 atayamba kugwiritsa ntchito filgrastim. Kuti mukwaniritse bwino mankhwala, chithandizo sichiyenera kusokonezedwa mpaka malingaliro abwinobwino a neutrophil afika pakuchepa kwakukulu kwa chiwerengero chawo. Zotheka kuti chiwerengero chonse cha neutrophils choposa 10,000 / μl, Neupomax sichitha.

Matenda owopsa a neutropenia (TCH)

Mulingo woyamba wa tsiku ndi tsiku ndi: kobadwa nako neutropenia - 12 mcg / kg, wokhala ndi idiopathic kapena nthawi zina neutropenia - 5 mcg / kg. Mankhwalawa amatumizidwa kamodzi kapena masiku angapo, mpaka chiwerengero cha neutrophils chokhazikika pamwamba pa 1500 / /l. Atakwaniritsa kufunika kwake kuti isungidwe, Neupomax imagwiritsidwa ntchito muyezo wokonza womwe umapangidwa payekhapayekha. Pambuyo pa milungu iwiri ya chithandizo, kutengera momwe wodwalayo amayankhira, mlingo woyambayo umachulukitsidwa kapena kuchepera.

M'tsogolomo, pakatha masabata awiri aliwonse, ngati kuli kotheka, kusintha kwamtundu umodzi kumachitika kuti kumakuthandizani kuti mukhalebe ndi ma neutrophils osiyanasiyana kuyambira 1500 / μl mpaka 10,000 / μl.

Odwala omwe ali ndi matenda oopsa amatha kuthandizidwa malinga ndi regimen yomwe ikusonyeza kuwonjezeka kwa mlingo wambiri.

Kutetezedwa kwa nthawi yayitali kugwiritsa ntchito filgrastim mu Mlingo wa tsiku ndi tsiku woposa 24 mcg / kg kwa odwala omwe ali ndi TCH sichinakhazikitsidwe.

Mankhwala a Myeloablative otsatiridwa ndi kupindika kapena kufalikira kwa mafupa

Chithandizo chimayamba ndi tsiku la 10 mgg / kg. Neupomax imayang'aniridwa kudzera mu mawonekedwe a kulowetsedwa kwakanthawi kwa mphindi 30, kulowetsedwa kwa maola 24 kapena kulowerera.

Mlingo woyamba ungathe kutumikiridwa pasanadutse maola 24 pambuyo pa kutha kwa maphunziro a cytotoxic chemotherapy, chifukwa cha kufalikira kwa mafupa - osapitirira maola 24. Kutalika kwa kugwiritsa ntchito Neupomax sikuyenera kupitirira masiku 28.

Mlingo wa tsiku ndi tsiku umatha kusinthidwa malinga ndi kuchuluka kwa ma neutrophils. Ngati kwa masiku atatu otsatizana chiwerengero chonse cha neutrophils chimaposa 1000 / μl, mlingo wa tsiku ndi tsiku umachepetsedwa kukhala 5 μg / kg, pamene masiku atatu otsatira mukamagwiritsa ntchito Neupomax muyezo uwu wa manambala onse a neutrophils sagwera pansi pa 1000 / μl, mankhwalawo amachotsedwa. Ngati kuchepa kwa chiwerengero cha neutrophils pansipa 1000 / μl, ndiye kuti mankhwalawa amawonjezedwanso koyambirira.

Kusunthika kwa Maselo Oteteza Mitsempha Yotentha Kwambiri (PSCC) mu Odwala omwe ali ndi Matenda a Tumor

Mlingo woyenera ndi 10 mcg / kg 1 nthawi patsiku ngati jekeseni kapena kulowetsedwa kwa maola 24. Mankhwalawa amagwiritsidwa ntchito tsiku lililonse kwa masiku 6. Komanso, tsiku lachisanu ndi chisanu ndi chimodzi, leukapheresis nthawi zambiri amayamba. Ngati leukapheresis yowonjezera kapena yowonjezera yawonetsedwa, kuyambitsa kwa Neupomax kumapitilira mpaka kumapeto kwa ndondomeko yomaliza.

Kusunthidwa kwa PSCC pambuyo pa myelosuppressive chemotherapy

Neupomax imayendetsedwa ngati mawonekedwe a jakisoni watsiku ndi tsiku.

Mlingo wovomerezeka tsiku lililonse ndi 5 mcg / kg. Mlingo woyamba umaperekedwa tsiku litatha kutha kwa chemotherapy, chithandizo chimapitilizidwa mpaka chiwerengero cha neutrophil chikafika.

Leukapheresis imatheka pokhapokha chiwerengero cha neutrophils chikapitilira chizindikiro cha 2000 / μl.

HIV Neutropenia

Mankhwala kutumikiridwa sc. Chithandizo chimayamba ndi mlingo wa tsiku ndi tsiku wa 1-4 μg / kg ndipo umapitilira mpaka chiwerengero cha neutrophils chikhale chofanana. Nthawi zina, ndizotheka kuwonjezera mlingo wa tsiku ndi tsiku, koma osapitirira 10 μg / kg.

Mukakwaniritsa njira yothandizira, mankhwalawa a Neupomax amachepetsedwa kukhala mlingo wokonzanso, womwe nthawi zambiri amakhala 300 mcg tsiku lina lililonse.

M'tsogolomu, adokotala amasintha mtundu wa dosing payokha kwa wodwala aliyense kuti mlingo ukhale wa neutrophils pamwambapa 2000 / µl.

Mimba komanso kuyamwa

Chitetezo cha filgrastim pakugwiritsa ntchito panthawi yomwe ali ndi pakati sichinakhazikitsidwe, chifukwa chake, mankhwalawa amatha kuikidwa pokhapokha ngati phindu lomwe likuyembekezeredwa limakhala lalikulu kuposa zoopsa zomwe zingachitike.

Kutha kwa filgrastim kulowa mkaka wa m'mawere sikunakhazikitsidwe, chifukwa chake, kupangidwira kwa Neupomax sikulimbikitsidwa panthawi ya mkaka wa m`mawere.

Ndemanga pa Neypomaks

Malinga ndi ndemanga ya Neupomax, mankhwalawa amalembedwa osati chifukwa cha neutropenia yokha yomwe imakhudzana ndi chemotherapy, komanso kuchepa kwambiri kwa chiwerengero cha neutrophils m'magazi chifukwa cha matenda ena ambiri omwe ali ndi autoimmune komanso oncological. Komanso, kugwiritsa ntchito filgrastim ndikofunikira pakulimbana ndi kachilombo ka HIV komanso hepatitis C mwa odwala omwe amalandila mankhwala oletsa kubereka, omwe ali ndi matenda a nyamakazi.

Mosasamala kanthu za chizindikirocho, mukamagwiritsa ntchito Neupomax, kuchuluka kwachulukidwe ka neutrophils ndi leukocytes kunadziwika, kuyankha kwa kukondoweza kunachitika patatha masiku pafupifupi 9. Komabe, odwala omwe amalandila mankhwala oletsa kubereka, filgrastim iyenera kugwiritsidwa ntchito kwa nthawi yayitali.

Pali zodandaula za kupatula kwa mavuto, monga kuzizira, kupweteka kwapafupa ndi mafupa, malungo, kamwa yowuma, ndi mutu.

Chifukwa chake, Neupomax imagwiritsidwa ntchito nthawi zambiri ndipo imagwira ntchito kwambiri pakuchiza komanso kupewa neutropenia.