Does neuprogen lower platelets

[alico222]

Hi,
I am looking into neuprogen , while I know it raises neutrophils, one of the listed side effects is lowering platelets... Does anyone have any info on this?

Don't want to avoid dose reductions of interferon by using neuprogen for low neutrophils , only to be dose reduced later for low platelets!!!
Thanks,
Alico

[orphanedhawk]

My experience is neupogen does not lower platelets, the treatment does that.
I looked over my labs and my platelet count dropped during tx and stayed within the same range for the few weeks while  I was on neupogen as the for the weeks when I was not.


The first time I did tx, I was on neupogen. A couple months after ending treatment I fell while getting into bed and broke my shoulder. I've had lots of worse falls in my life and never broke anything. I'm convinced the neupogen had something to do with it.
This time around, I took one shot of neup, it hurt so much, that I cried to the doc and he lowered the dosage by half. I landed up reducing the interferon partially so I didn't have to take that nasty stuff.

I'm not crazy about antibiotics but I'd go with taking them over neupogen.

[HectorSF]

Will is correct. At UCSF's liver transplant clinic (where I treated my hep C) all cirrhotics like myself (those that are more likely to have adverse events such as cytopenias) that treat their hepatitis C, are put on Cipro to prevent infection throughout their course of treatment. Infections of any type can be very problematic for cirrhotics.

I am not sure what my neutrophils level was during treatment, so I can't say for sure that if they "tanked" I wouldn't have been treated for it. But for prevention of infections UCSF's protocol is to put patients on Cipro.

Although I was "sick as a dog" on treatment I never had type of infection.

Cheers!
Hector

[willbb]

Smart doc friend......

[jules2551]

Just to chime in on the discussion...my Hepa Dr said he would let my ANC get down to .28 before he does any type of reduction or rescue meds.   He said this needs to be treated agressively right off the bat and as long as I can handle the sx, he is going for it.

[willbb]

..The docs all say  this is standard protocol
------------------------------------
Actually...let me correct that ..It seems you can see by my thread last Dec. and the comments that many of the knowlegable Hepas  "do not prescribe this .  Like Hectors nor mine . Mine teaches hepatology at a large transplant center and says in 15 years of clinical practice has never had a problem with a runaway bacterial infection from low ANC.

Best ..
Will

[willbb]

Yes..The docs all say  this is standard protocol.. It is not them that are taking one more very toxic med with no real study or clinical data  showing it to be of any benefit to HCV therapy patients.

Also they are not one of the approx 30 % that put up with the significant side of fairly significant "bone type" pain

However no doctor wants   "their " patient to be the  one patient that they lose to a runaway infection (even if it happened once in 8000 cases)

What is your ANC btw ,,if you don't mind me asking and what week are you in..

best..
Will

[Idyllic]

Wow Will that thread you initiated back in Dec of 2011 is a great one. I bookmarked it.  I have researched old threads related to Neupogen here on the forum and never came across that one. I doubt I will need Neupogen but as my ANC decreases as the months go by it is looking dicier than I would have thought. I am non-cirrhotic and so far the only reason my doc has provided for me possibly needing Neupogen is a variant of that it is standard practice and blah, blah, blah. I do not think I can tolerate being on one more heavy duty med if I truly do not need to be.

[alico222]

Thanks for replying in depth.
I am not on treatment at moment , having failed last time.
I am just worried neutrophils will drop again if I retreat.
Last time I was dose reduced interferon and I want to avoid it this time.
My off treatment ANC at moment is 1.00.
On treatment went to 0.5 in third week and was dose reduced.
Thought I may try to get neuprogen next time.. But did not want to then be faced with the worry of low platelets.
Thanks
Alico

[willbb]

oops    didn"t not mean to copy  the bottom half.. of that post        posting by phone   :)...

[willbb]

Hi..There is no concrete data that taking Neup will have an effect of lowering platlets.,however there is significant data that the use of Neup is for the most part unnecessary for patients receiving HCV therapy.(you may be interested in the discussion here I linked below.

Having said that many doctors will prescribe it if the ANC(neutrophils drop down to approx. .5 . even given the data that says HCV therap patients having problems with bacterial infection is extremely rare.

Also Neup is not FDA approved for HCV therap patients ,it is used mainly for cancer patients todoing chemo -therapy..


What is your ANC ..you have not mentioned this?

Here is the discussion a number of months ago ,with significant data included:

http://www.medhelp.org/posts/Hepatitis-C/Some-clarification-if-someone-knows-or-doctor-has-explained/show/1656098?personal_page_id=1837989

Also here is some facts on Neup side effects :

Best to you..

Will


Cancer Patients Receiving Myelosuppressive Chemotherapy
In clinical trials involving over 350 patients receiving Neupogen® following nonmyeloablative cytotoxic chemotherapy‚ most adverse experiences were the sequelae of the underlying malignancy or cytotoxic chemotherapy. In all phase 2 and 3 trials‚ medullary bone pain‚ reported in 24% of patients‚ was the only consistently observed adverse reaction attributed to Neupogen® therapy. This bone pain was generally reported to be of mild-to-moderate severity‚ and could be controlled in most patients with non-narcotic analgesics; infrequently‚ bone pain was severe enough to require narcotic analgesics. Bone pain was reported more frequently in patients treated with higher doses (20 to 100 mcg/kg/day) administered IV‚ and less frequently in patients treated with lower SC doses of Neupogen® (3 to 10 mcg/kg/day).

In the randomized‚ double-blind‚ placebo-controlled trial of Neupogen® therapy following combination chemotherapy in patients (n = 207) with small cell lung cancer‚ the following adverse events were reported during blinded cycles of study medication (placebo or Neupogen® at 4 to 8 mcg/kg/day). Events are reported as exposure-adjusted since patients remained on double-blind Neupogen® a median of 3 cycles versus 1 cycle for placebo.








% of Blinded Cycles With Events



Event

Neupogen®
N = 384 Patient
Cycles

Placebo
N = 257 Patient
Cycles



Nausea/Vomiting

57

64



Skeletal Pain

22

11



Alopecia

18

27



Diarrhea

14

23



Neutropenic Fever

13

35



Mucositis

12

20



Fever

12

11



Fatigue

11

16



Anorexia

9

11



Dyspnea

9

11



Headache

7

9



Cough

6

8



Skin Rash

6

9



Chest Pain

5

6



Generalized Weakness

4

7



Sore Throat

4

9



Stomatitis

5

10



Constipation

5

10



Pain (Unspecified)

2

7


In this study‚ there were no serious‚ life-threatening‚ or fatal adverse reactions attributed to Neupogen® therapy. Specifically‚ there were no reports of flu-like symptoms‚ pleuritis‚ pericarditis‚ or other major systemic reactions to Neupogen®.

:http://www.drugs.com/sfx/neupogen-side-effects.html