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

28 February 2019
Volume 28 · Issue 4


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).

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