With a very quick positive response to therapy possible a significant increase in the number of neutrophils after administration of the initial doses of testosterone cypionate dosage . In drug treatment, need to perform regular full blood count (ANC, the number of red blood cells, platelets, etc.) daily for the first 2-3 days, then two times a week for the first 2 weeks, and every week or every other week in during maintenance therapy. During the maintenance therapy of 300 mg per day for alternating pattern may be significant fluctuations in the number of neutrophils. Given the fluctuations ANC values, to determine the true maximum reduction of ANC (nadir) blood sampling should be carried out before the appointment of the next dose of the drug.
Monotherapy drug does not prevent anemia and thrombocytopenia caused by myelosuppressive chemotherapy. Because of the potential application of higher doses of chemotherapy (eg full doses in accordance with the schemes) or more in a combination therapy, the patient may be at greater risk of thrombocytopenia and anemia. It is recommended to conduct regular blood tests and to determine platelet count and hematocrit.
In patients with infectious diseases and bone marrow infiltration of infectious agents (eg, complex Mycobacterium avium) or a tumor of bone marrow lesions (lymphoma) filgrastim therapy is carried out simultaneously with the therapy directed against these states. The effectiveness of in the treatment of neutropenia caused by bone marrow infiltration of infectious agents (osteomyelitis) or tumor lesion has not been established.
Other special precautions
Described isolated cases of splenic rupture in healthy donors and patients with cancer in patients receiving G-CSF (filgrastim) in some cases fatal. Given these data, it is recommended to closely monitor the size of the spleen by clinical examination (palpation) and instrumental methods (eg, ultrasound). It is necessary to carry out aiming diagnosis of suspected ruptured spleen or splenomegaly in the case of complaints of patients or healthy donors of pain in the upper left quadrant of the abdomen or upper shoulder area.
According to the literature, the presence of sickle-cell anemia, and high white blood cell count is a poor prognostic factor. These patients should be regularly carry out blood tests and take into account the possibility of splenomegaly and thrombosis. There are cases of sickle cell crises in patients receiving filgrastim, some – with fatal consequences. Therefore, in patients with sickle cell disease need to be careful in appointing (filgrastim), carefully evaluate the benefits and possible risks.
Patients with bone disease and osteoporosis receiving continuous treatment with testosterone cypionate dosage for more than 6 months, shows the control of the density of the bone substance.
Action patients with significantly reduced amount of unknown myeloid progenitor cells. Testosterone cypionate dosage increases the number of neutrophils by acting primarily on precursor cells of neutrophils.Therefore, in patients with a reduced content of progenitor cells (e.g., undergoing intensive chemotherapy or radiotherapy), the degree of increase in the number of neutrophils can be lower.
Action the reaction “graft versus host” is not set.
Contains sorbitol in a concentration of 50 mg / ml. It is unlikely that as a result of monotherapy in the body goes a sufficient amount of sorbitol to develop toxic reactions, however, patients with hereditary fructose intolerance should be careful.
At occurrence of symptoms such as cough, dyspnea, fever, and, in combination with radiological data using the presence of pulmonary infiltrates, and deterioration of pulmonary function, can include developing adult respiratory distress syndrome. In this case, drug therapy should be discontinued and appropriate treatment.
Instructions for use, handling and disposal
You should avoid vigorous shaking.
Before the introduction of the solution should be inspected for the presence of foreign visible particles. It allowed the introduction of the solution but without the presence of foreign visible particles.
Vials and syringe-tubes of the drug are intended for single use only.
Contact drugs to the environment should be minimized. Do not dispose of via wastewater or with household waste. If possible, a special system for the disposal of drugs should be used.
Overdose cases are not marked. In bone marrow transplantation studies in patients was administered at doses up to 138 mcg / kg per day without developing the toxic effects. After 1-2 days after discontinuation of the drug the number of circulating neutrophils is usually reduced by 50% and returns to normal 1-7 days.