References

Bondarenko IM, Bias P, Buchner A. Incidence of bone pain in patients with breast cancer treated with lipegfilgrastim or pegfilgrastim: an integrated analysis from phase II and III studies. Support Care Cancer. 2016; 24:(1)267-73 https://doi.org/10.1007/s00520-015-2777-7

Bujalska-Zadrożny M, Tatarkiewicz J, Kulik K, Filip M, Naruszewicz M. Magnesium enhances opioid-induced analgesia—what we have learnt in the past decades?. Eur J Pharm Sci.. 2017; 99:113-27 https://doi.org/10.1016/j.ejps.2016.11.020

Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994; 23:(2)129-38

Dabbagh A, Elyasi H, Razavi SS, Fathi M, Rajaei S. Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Scand.. 2009; 53:(8)1088-91 https://doi.org/10.1111/j.1399-6576.2009.02025.x

ECOG-ACRIN Cancer Research Group. ECOG performance status. 2019. https://ecog-acrin.org/resources/ecog-performance-status (accessed 11 February 2019)

Gavioli E, Abrams M. Prevention of granulocyte-colony stimulating factor (G-CSF) induced bone pain using double histamine blockade. Support Care Cancer. 2017; 25:(3)817-22 https://doi.org/10.1007/s00520-016-3465-y

Evaluation of reported bone pain in cancer patients receiving chemotherapy in pegfilgrastim clinical trials: a retrospective analysis. 2010. https://doi.org/10.1016/S1548-5315(11)70402-8

Kirshner JJ, McDonald MC, Kruter F NOLAN: a randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim. Support Care Cancer. 2018; 26:(4)1323-34 https://doi.org/10.1007/s00520-017-3959-2

Moore K, Haroz R. When hydromorphone is not working, try loratadine: an emergency department case of loratadine as abortive therapy for severe pegfilgrastim-induced bone pain. J Emerg Med. 2017; 52:(2)e29-e31 https://doi.org/10.1016/j.jemermed.2016.08.018

Moore DC, Pellegrino AE. Pegfilgrastim-induced bone pain: a review on incidence, risk factors, and evidence-based management. Ann Pharmacother. 2017; 51:(9)797-803 https://doi.org/10.1177/1060028017706373

Moukharskaya J, Abrams DM, Ashikaga T Randomized phase II study of loratadine for the prevention of bone pain caused by pegfilgrastim. Support Care Cancer. 2016; 24:(7)3085-93 https://doi.org/10.1007/s00520-016-3119-0

Casale TB, Blaiss MS, Gelfand E First do no harm: managing antihistamine impairment in patients with allergic rhinitis. J Allergy Clin Immunol.. 2003; 111:(5)S835-42 https://doi.org/10.1067/mai.2003.1550

Özkaraman A, Argon G, Usta Yesilbalkan O Effects of granulocyte colony-stimulating factor administration time on pain. Bratisl Med J.. 2017; 118:(07)399-404 https://doi.org/10.4149/BLL_2017_078

Pawloski PA, Larsen M, Thoresen A, Giordana MD. Pegfilgrastim use and bone pain: a cohort study of community-based cancer patients. J Oncol Pharm Pract.. 2016; 22:(3)423-429 https://doi.org/10.1177/1078155215585188

Romeo C, Li Q, Copeland L. Severe pegfilgrastim-induced bone pain completely alleviated with loratadine: a case report. J Oncol Pharm Pract.. 2015; 21:(4)301-4 https://doi.org/10.1177/1078155214527858

Shipton EA, Shipton EE. Vitamin D and pain: vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. Pain Res Treat. 2015; 2015:1-12 https://doi.org/10.1155/2015/904967

Wintermeyer E, Ihle C, Ehnert S Crucial role of vitamin D in the musculoskeletal system. Nutrients. 2016; 8:(6) https://doi.org/10.3390/nu8060319

Williamson MA, Snyder LM, Wallach JB. Wallach's interpretation of diagnostic tests, 9th edn. Philadelphia (PA): Lippincott Williams & Wilkins; 2011

Xu H, Gong Q, Vogl FD, Reiner M, Page JH. Risk factors for bone pain among patients with cancer receiving myelosuppressive chemotherapy and pegfilgrastim. Support Care Cancer. 2016; 24:(2)723-30 https://doi.org/10.1007/s00520-015-2834-2

Oral loratadine in the management of G-CSF-induced bone pain: a pilot study

28 February 2019
Pain Relief
02 February 2019
Volume 28 · Issue 4

Abstract

This pilot study aimed to ascertain if bone pain induced by granulocyte-colony stimulating factors (G-CSFs) can be alleviated or eliminated by oral antihistamine loratadine. Twelve patients with cancer receiving chemotherapy were included in the study. Daily pain increased between before treatment started and after cycle 1 in all patients. All 12 participants were started on loratadine on cycle 2; three patients were taking pain medications in addition to this as needed, which were ibruprofen (n=1) or tramadol (n=2). Pain decreased towards the later cycles after patients were started on loratadine in cycle 2, with the exception of one patient who also took tramadol as needed in cycle 3. Oral loratadine was found to be associated with pain reduction in patients with cancer receiving G-CSFs.

Pegfilgrastim (Neulasta) is a recombinant human granulocyte-colony stimulating factor (G-CSF) agent used for primary or secondary prophylaxis of febr ile neutropenia in patients receiving myelosuppressive chemotherapy. It is administered as a single 6 mg subcutaneous injection 24–72 hours after completion of a chemotherapy cycle. Pain is a common side effect and, although G-CSF-associated bone pain is usually mild to moderate, severe pain can occur (Gregory et al, 2010; Bondarenko et al, 2016; Xu et al, 2016). The exact mechanisms of bone pain related to G-CSF have yet to be elucidated, but a younger age and a history of bone pain have been identified as risk factors (Xu et al, 2016). In addition, it is reported that administering G-CSF at 14:00 (as opposed to 10:00) results in significantly less pain for patients (Özkaraman et al, 2017).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

Cancer
G-CSF
Histamine
Chemotherapy
Pain
Loratadine
Pegfilgrastim