Molgramostim - Indications, Dosage, Side Effects and Precautions

• Molgramostim is an immunomodulator used to stimulate the production of neutropenia due to chemotherapy.

Molgramostim is an immune stimulator which is prescribed to correct neutropenia -the condition that causes low levels of neutrophils - following a high dose chemotherapy regimen or bone marrow transplantation.

It is a granulocyte macrophage colony-stimulating factor (GM-CSF), a human protein which is also recommended for the treatment of ganciclovir induced neutropenia.

It is also used in acute respiratory distress syndrome, a life threatening condition because of the difficulty in breathing.

This drug is not approved in most places, including the US. The UK has granted orphan drug status for the treatment of acute respiratory distress syndrome. 

Molgramostin is contraindicated, should be avoided or used with caution in the following conditions:

• Allergy to the drug
• Patient undergoing chemotherapy or radiotherapy for bone marrow malignancies
• Heart failure and cardiac arrhythmia
• Pre-existing asthma or other lung disease
• Fluid retention

The recommended adult doses for its indications are as follows:

Treatment of chemotherapy induced neutropenia:
• The initial dosage is 5-10 mcg/kg for 7-10 days as a subcutaneous injection. The maximum dosage is 10mcg/kg/day.

Treatment of complications in bone marrow transplantation:
• Initially 10mcg/kg/day as an intravenous infusion for 4 to 6 hours on the first day of bone marrow transplantation.
• The maximum dosage is 10mcg/kg/day.
• The treatment to be continued for about 1 month.

Ganciclovir induced neutropenia:
• A dosage of 5mcg/kg daily as a subcutaneous injection.
• The maximum dosage is 10mcg/kg daily.
• After obtaining the polymorphonuclear cell (PMN) counts after the fifth dose, the dosage can be adjusted.

• Molgramostim is available as sub-cutaneous injection as well as an intravenous infusion. It is used as an inhalation for acute respiratory distress syndrome.
• The vial containing the medication should be allowed to reach the room temperature by keeping out from the cold storage 30 minutes before injecting.

• The treatment to be stopped if patients develop pulmonary infiltrates.
• Dosage adjustment is required in liver and kidney impairment.

•  Gastrointestinal Tract: Diarrhea, nausea, loss of appetite, stomach upset
•  Cardio vascular system: Pleural and pericardiac effusion (fluid accumulation around the lung and the heart), cardiac arrhythmia (abnormal heart rhythm), transient hypotension (low blood pressure)
•  Respiratory: Breathing difficulty
•  Musculoskeletal: Muscle or bone pain, muscle aching or weakness
•  Skin: Rashes, swelling, redness or pain at the injection site
•  Others: Chills, fever, headache, swelling of the feet, sudden weight gain, dizziness, severe allergic reaction

• A complete blood cell count has to be monitored during molgramostim therapy.

Bleomycin: Molgramstim may increase the risk of bleomycin induced pulmonary toxicity.
Anti-cancer drugs: Do not administer molgramostim within 24 hours of myelosuppressive (bone marrow suppressive) cytotoxic anti-cancer drugs as there may be a high risk of bone marrow suppression.

• Store at between 2 - 8°C.
• Not to be frozen.
• To be protected from light.