Drug interactions-

Nephrotoxic drugs- 
because plerixafor is primarily eliminated by the kidneys, coadministration of plerixafor
with drugs that reduce renal function or compete for active tubular secretion may increase
serum concentration of plerixafor or the coadministered drug

Peripheral Stem Collection and Transportation

Adverse reactions-

CNS-          dizziness  11%     fatigue  27%    headache 22%     insomnia 7%

GI-              diarrhea  37%        flatulance 7%  nausea   34%     vomiting  10%

Miscellaneous-     arthalgia   13%  injection site reactions  34% 

Special Precautions-

Leukemia- for the purpose of HSC mobilization , plerixafor may cause mobilization of leukemic cells and subsequent contamination of the apherisis product. Therfore, plexiafor is  not intended for HSC mobilzation and harvest with leukemia

Hematologic effects-
Leukocytosis- administration of plerixafor in conjunction with G-CSF  increases circulating
leukocytes as well as HSC population . Monitor white blood cells counts during plerixafor use.

Thrombocytopenia-  thrombocytopenia has been observed in patients receiving plerixafor.
Monitor platelet counts in all patients who receive plerixafor and undergo apheresis.

Tumor cell  mobilization- when plerixafor is used in combination with G-CSF for HSC  mobilaztion,tumor  cells may be released from marrow and subsequently collected in the leukapheresis product. The effect  of  potential reinfusion of tumor cells have not been well studied.

Renal function inpairment- in patients with moderate to severe renal impairment CrCl of 50mL/min or less ) reduce the dose of  plerixafor by one third to 0.16mg/kg

Pregnancy-  if this drug is used during pregnancy or if the patients becomes pregnant while taking the drug apraise the patient of the potential hazard to the fetus.

Lactation-  decide whether to discontinue breast feeding or the drug depending on the importance of the drug to the mother.

Children- the safety and effectiveness of the children have not been established in controlled clinical studies

Elderly- dosage adjustments in elderly with a CrCl of 50mL/ml or less is recommended

Monitoring- monitor white cell counts during plerixafor use. Excercise clinical judgement when adminstering plerixafor to patients with counts with peripheral blood neurophil counts
higher than 50.000/mcl

Indication-

Peripheral Stem Collection and Transportation

Dosage-
Maxomum dose 40mg/day
usual dosage -0.24mg/body weight by subcutaneous injection.
Begin treatment with plerixafor after the patient has received G-CSF once daily for 4 days.
Administer plerixafor approitately 11 hours prior to initiation of apheresis for up to 4 consecutive
 days.

1. Advice patients of the signs and symptoms of potential systemic reactions such as urticaria,
   periorbital  swelling, dyspnea, or hypoxia during and following plerixafor injection.

2.Instruct patients to inform a health care provider immediately if symptoms of vasovagal reactions
   such as ortostatic hypotension or syncope occur during or shortly after their plerixafor injection.

3. In patients experiencing itching, rash, or reacion at the site of injection , instruct them to notify
   a health care provider because these symptoms have been treated with nonprescription
   medications during clinical trials

4. Inform patients that plerixafor may cause GI disorders, including diarrhea, nausea, vomiting,
    flatulence and abdominal pain. Tell patients how to manage  specific GI disorders  and to
    inform  their healthcare provider events occur following perixafor injection.

5. Advice women with repoductive potential to use contraceptives methods during perixafor use. 

Pregnancy-
If the drug is used during pregnancy or if the patients becomes pregnant while taking
the drug apraise the patient of the potential hazard to the fetus.

Lactation- 
Decide whether to discontinue breast feeding or the drug depending on the importance
of the drug to the mother.

Children-
The safety and effectiveness of the children have not been established in controlled clinical
studies

Elderly-
Dosage adjustments in elderly with a CrCl of 50mL/ml or less is recommended