Drugs to Be Used With a Filter for Preparation and/or Administration—2019

Abstract

This chart is an update to the 2012 article published in Hospital Pharmacy on injectable drugs to be used with a filter. To update the chart, drugs approved from December 2011 to April 2019 were reviewed to determine if they require filtration and drugs included in the 2012 table were reviewed for accuracy. Readers are urged to review national standards of practice for information about clinical situations that warrant the use of a filter for medication preparation or administration, independent of the drug being given, and the reader should consult the Food and Drug Administration (FDA)-approved prescribing information for the most up-to-date information.

Introduction

This chart is an update to the 2012 article published in Hospital Pharmacy on injectable drugs to be used with a filter.¹ To update the chart (see Table 1), drugs approved from December 2011 to April 2019 were reviewed to determine if they require filtration upon preparation or administration. Newly approved drugs were identified by consulting the Food and Drug Administration (FDA) Purple Book, the Drugs@FDA database, the FDA Novel Drug Approvals Web site (included the years 2015-2019), and the CenterWatch Web site.^154-157 Marketing status and filtration information for drugs included in the 2012 table were also reviewed for accuracy and updated as appropriate. Drugs are sorted and grouped in the chart by generic name.

Table 1.

Drugs to Be Used With a Filter for Preparation and/or Administration.^2-151

Drug	Filter size	Preparation	Administration	Comments
Abatacept (Orencia)	0.2 to 1.2 µm		X	Administer with a sterile nonpyrogenic, low protein–binding filter.6
Abciximab (Reopro)	0.2 or 5 µm (prior to bolus administration or upon continuous infusion preparation) 0.2 or 0.22 µm (upon continuous infusion administration)	X	X	Bolus injection: Filter prior to administration using a sterile, nonpyrogenic, low protein–binding syringe filter.7 Continuous infusion: Either use a sterile, nonpyrogenic, low protein–binding syringe filter during preparation or administer with an in-line, sterile, nonpyrogenic, low protein–binding filter.7
Ado-trastuzumab emtansine (Kadcyla)	0.2 or 0.22 µm		X	Administer with an in-line PES filter.8
Aflibercept (Eylea)	5 µm	X		Use the 19 gauge × 1.5 in filter needle provided by manufacturer during preparation; use a nonfilter needle for the intravitreal injection.9
Agalsidase beta (Fabrazyme)	0.2 µm		X	Administer with an in-line low protein–binding filter; do not use a filter during preparation.10
Albumina (eg, Albuked, Albuminar, Albuminex, AlbuRx, Albutein, Buminate, Flexbumin, Kedbumin, Plasbumin)	15 µm or smaller (Buminate only)		X (Buminate only)	Administer Buminate with a filter.11 No other albumin manufacturer recommends the use of a filter for preparation or administration.12-18
Alglucosidase alfa (Lumizyme)	0.2 µm		X	Administer with an in-line low protein–binding filter; do not use a filter during preparation.19
Alpha-1 proteinase inhibitor (eg, Aralast, Glassia, Prolastin-C, Zemaira)	Aralast: 20 µm	X		Aralast: Use the filter provided by the manufacturer during preparation.20
	Glassia: 5 µm (preparation and administration)	X	X	Glassia: Use the sterile filter needle provided by the manufacturer to transfer the solution to the infusion container.21 Administer with an in-line filter.
	Prolastin-C: 5 to 15 µm		X	Prolastin-C: Administer with an infusion filter.22
	Zemaira: 15 µmb (preparation) 5 µm (administration)	X	X	Zemaira: Use the filter vial transfer device provided by the manufacturer during preparation. Administer with an infusion filter.23
Amino acids, electrolytes, dextrose, and lipid injectable (Kabiven, Perikabiven)	1.2 µm		X	Administer with an in-line filter.24,25
Amiodaronec (Nexterone)	Not specified		X	Administer with an in-line filter.26,27 The manufacturer does not provide a filter size recommendation. One source suggests no loss of potency with the use of a 0.22-µm cellulose ester membrane filter.3
Amphotericin B lipid complexd (Abelcet)	5 µm	X		Use the filter needle provided by the manufacturer during preparation; do not use an in-line filter during administration.28
Amphotericin B liposomald (Ambisome)	5 µm (preparation) 1 µm or larger (administration)	X	X (optional)	Use the 5-µm filter provided by the manufacturer during preparation.29 An in-line membrane filter may be used for administration.
Andexanet alfa (Andexxa)	0.2 to 0.22 µm		X	Administer with a PES or equivalent low protein–binding in-line filter.30
Antihemophilic factor VIII (eg, Advate, Adynovate, Afstyla, Eloctate, Esperoct, Hemofil M, Jivi, Koate, Kogenate FS, Kovaltry, Monoclate-P, Novoeight, Nuwiq, Obizur, Recombinate, Xyntha)	150 µmb (Hemofil M only) 5 µm (Monoclate P only)	X		Use the filter needle (Hemofil M and Monoclate P) or vented filter spike (Monoclate P) provided by the manufacturer during preparation.31,32 For all other products, use the filter vial transfer device provided by the manufacturer during preparation.33-46
Antihemophilic factor VIII/von Willebrand Factor Complex (Alphanate, Humate P, Wilate)	15 µmb	X		Use the filter vial transfer device provided by the manufacturer.47-49 The manufacturer of Humate P states that another double-ended needle and vented filter spike can be used for reconstitution in place of the filter vial transfer device.48
Antithrombin III (Thrombate III, Atryn)	Atryn: 0.22 µm		X	Atryn: Administer with a 0.22-µm, in-line filter.50
	Thrombate III: 125 to 150 µmb	X		Thrombate III: Use the sterile filter needle provided by manufacturer during preparation.51
Antithymocyte globulin (Thymoglobulin)	0.22 µm		X	Administer with an in-line filter.52
Avelumab (Bavencio)	0.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.53
Belatacept (Nulojix)	0.2 to 1.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding filter.54
Belinostat (Beleodaq)	0.22 µm		X	Administer with an in-line filter.55
Bezlotoxumab (Zinplava)	0.2 to 5 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line or add-on filter.56
Blinatumomab (Blincyto)	0.2 µm		X	24- or 48-hour infusion: Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.57 7-day infusion: An in-line filter is not required.57
Botulism antitoxin heptavalent (BAT)	15 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.58
Botulism immune globulin IV (BabyBIG)	18 µm		X	Administer with an in-line or syringe-tip sterile, disposable filter.59
C1 esterase inhibitor (human) (Berinert, Cinryzee, Haegarda)	15 µmb (Berinert and Haegarda) 5 µmb (Cinryze)	X		Use the filter vial transfer device provided by the manufacturer.60-62 The manufacturers of Berinert and Haegarda state that another double-ended needle and vented filter spike can be used during preparation in place of the filter vial transfer device.60,61
Cabazitaxel (Jevtana)	0.2 or 0.22 µm		X	Administer with an in-line filter.63
Cemiplimab-rwlc (Libtayo)	0.2 to 5 µm		X	Administer with a sterile, in-line or add-on filter.64
Cerliponase alfa (Brineura)	0.2 µm		X	Administer with an in-line filter.65
Cetuximab (Erbitux)	0.22 µm		X	Administer with a low protein–binding in-line filter.66
Cladribine	0.22 µm	X		Single daily dose injection: Use a sterile disposable hydrophilic syringe filter during preparation.67 7-day infusion: Use a sterile disposable hydrophilic syringe filter during preparation for both cladribine and diluent solutions.67
Clofarabine (Clolar)	0.2 µm	X		Use a sterile syringe filter during preparation prior to dilution.68
Cytomegalovirus immune globulin IV (human) (Cytogam)	15 or 0.2 µm		X	Administer with an in-line filter.69
Daratumumab (Darzalex)	0.22 or 0.2 µm		X	Administer with an in-line, sterile, nonpyrogenic, low protein–binding PES filter.70
Defibrotide (Defitelio)	0.2 µm		X	Administer with an in-line filter.71
Durvalumab (Imfinzi)	0.2 or 0.22 µm		X	Administer with a sterile, low protein–binding in-line filter.72
Elosulfase alfa (Vimizim)	0.2 µm		X	Administer with a low protein–binding in-line filter.73
Elotuzumab (Empliciti)	0.2 to 1.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding filter.74
Emapalumab-lzsg (Gamifant)	0.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.75
Epoprostenol sodium (Flolan, Veletri)	0.22 µm		X	Administer with an in-line filter.76,77
Gallium dotatate GA-68 (Netspot)	0.22 µm	X		Use a sterile self-venting filter during preparation according to the GalliaPharm generator system–specific reconstitution instructions.78
Galsulfase (Naglazyme)	0.2 µm		X	Administer with a low protein–binding in-line filter; do not use a filter during preparation.79
Gemtuzumab ozogamicin (Mylotarg)	0.2 µm		X	Administer with an in-line PES filter.80
Golimumab (Simponi ariaf)	0.22 µm or smaller		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.81
Hemin (Panhematin)	0.45 µm or smaller		X	Administer with an in-line filter.82
Human plasma proteins (Octaplas)	Not specified		X	Administer with an in-line filter.83 The manufacturer does not provide a filter size recommendation, but following standard blood product filtering procedures can be considered since this is a plasma-based product.5
Ibritumomab tiuxetan (Zevalin)	0.22 µm		X	Administer with a low protein–binding in-line filter.84
Idursulfase (Elaprase)	0.2 µm		X	Administer with a low protein–binding in-line filter.85
Immune globulin IVa (eg, Bivigam, Carimune NF, Flebogamma DIF, Gammagard liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen)	15 µm (Gammagard S/D only)		X (Gammagard S/D only)	Administer Gammagard S/D with the infusion set provided by the manufacturer or another filter-containing administration set.86 All other products do not require filtration.87-97
Infliximab (Remicade), Infliximab-abda (Renflexis), Infliximab-dyyb (Inflectra)	1.2 µm or smaller		X	Administer with a sterile nonpyrogenic, low protein–binding in-line filter.98-100
Iobenguane I-131 (Azedra)	0.2 µm	X		Use a venting unit consisting of a needle, 0.2-µm sterile filter, and a charcoal filter during preparation.101
Ipilimumab (Yervoy)	0.2 to 1.2 µmb		X	Administer with a sterile nonpyrogenic, low protein–binding in-line filter.102
Isavuconazonium sulfate (Cresemba)	0.2 to 1.2 µm		X	Administer with an in-line filter.103
Ixabepilone (Ixempra kit)	0.2 to 1.2 µm		X	Administer with an in-line filter.104
Laronidase (Aldurazyme)	0.2 µm		X	Administer with a low protein–binding in-line filter; do not use a filter during preparation.105
Lipid emulsion (eg, Intralipid, Nutrilipid, Omegaven, Smoflipid)	1.2 µm		X	An air-eliminating in-line filter should be used when administering lipid emulsion, both alone and as part of an admixture.3,106-110
Lymphocyte immune globulin, antithymocyte globulin (Atgam)	0.2 to 1 µm		X	Administer with an in-line filter.111
Mannitol	The manufacturer does not provide a filter size recommendation; 0.2 to 5 µm has been suggested4,112		X	Administer with an in-line filter when infusing concentrated mannitol (20% or more) due to the potential for crystal formation113-116; one resource states to administer with an in-line filter for concentrations of 15% or more.2
Methacholine (Provocholine)	0.22 µm	X		Use a sterile, bacterial-retentive filter during preparation when transferring solution from each vial (at least 2 mL) to a nebulizer.117
Mogamulizumab-kpkc (Poteligeo)	0.22 µm		X	Administer with a sterile, low protein–binding in-line filter.118
Nivolumab (Opdivo)	0.2 to 1.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.119
Obiltoxaximab (Anthim)	0.22 µm		X	Administer with an in-line filter.120
Ocrelizumab (Ocrevus)	0.2 or 0.22 µm		X	Administer with an in-line filter.121
Paclitaxelg	0.22 µm or smaller		X	Administer conventional paclitaxel with an in-line filter122; a filter is not needed for the albumin-bound formulation (Abraxane).123
Panitumumab (Vectibix)	0.2 or 0.22 µm		X	Administer with a low protein–binding in-line filter.124
Patisiran (Onpattro)	0.45 µm (preparation) 1.2 µm (administration)	X	X	Use a sterile PES syringe filter during preparation.125 Administer with a PES in-line filter.
Pembrolizumab (Keytruda)	0.2 to 5 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line or add-on filter.126
Phenytoin sodium, parenteral	0.22 to 0.55 µm		X	Administer with an in-line filter.127
Posaconazole (Noxafil)	0.22 µm		X	Administer with a PES or PVDF in-line filter.128
Ramucirumab (Cyramza)	0.22 µm		X	Administer with a protein-sparing filter.129
Ranibizumab (Lucentis)	5 µm	X		Use a 19 gauge × 1.5 in filter needle during preparation; use a nonfilter needle for the intravitreal injection.130
Ravulizumab-cwvz (Ultomiris)	0.22 µm		X	Administer with a filter.131
Reslizumab (Cinqair)	0.2 µm		X	Administer with a low protein–binding in-line filter; Cinqair is compatible with PES, PVDF, nylon, and cellulose acetate in-line filters.132
Sebelipase alfa (Kanuma)	0.2 µm		X	Administer with a low protein–binding in-line filter.133
Siltuximab (Sylvant)	0.2 µm		X	Administer with an in-line PES filter.134
Tagraxofusp-erzs (Elzonris)	0.2 µm		X	Administer with a PES in-line filter; manufacturer recommends attaching the filter while preparing (priming) the infusion set.135
Taliglucerase alfa (Elelyso)	0.2 µm		X	Administer with a low protein–binding in-line filter.136
Technetium TC-99M sodium pertechnetate generator (RadioGenix System)	0.22 µm	X		Follow the Eluting RadioGenix System–specific reconstitution instructions provided in the package insert.137
Temsirolimus (Torisel)	5 µm or smaller (in-line filter) 0.2 to 5 µm (end-set filter)		X	Administer with an in-line PES filter or an end-set PES filter if an in-line filter is not available.138 Do not use both an in-line and an end-set filter.
Thiotepac (Tepadina)	0.2139 or 0.22140-142 µm		X	Administer with an in-line filter139; generic manufacturers recommend filtering with a polysulfone membrane or triton-free mixed ester of cellulose/PVC filter prior to administration140-142; solutions of generic thiotepa (10-300 mcg/mL) did not adsorb to cellulose nitrite, cellulose acetate ester, or Teflon filters.3
Trabectedin (Yondelis)	0.2 µm		X	Administer with a PES in-line filter.143
Treprostinil (Remodulin)	0.2 or 0.22 µm		X	Administer with an in-line filter.144
Ustekinumab (Stelara)	0.2 µm		X	Administer with a sterile, nonpyrogenic, low protein–binding in-line filter.145
Velaglucerase alfa (Vpriv)	0.2 µm		X	Administer with a low protein–binding in-line filter.146
Verteporfin (Visudyne)	1.2 µm		X	Administer with an in-line filter.147
Vestronidase alfa-vjbk (Mepsevii)	0.2 µm		X	Administer with a low protein–binding in-line filter.148
Vincristine sulfate liposome injection (Marqibo kit)h	0.2 µm	X		Use a sterile venting filter needle or other suitable device during preparation as recommended by the manufacturer; do not use an in-line filter for administration.149 Conventional (nonliposomal) vincristine does not require filtration.150
Ziv-aflibercept (Zaltrap)	0.2 or 0.22 µm3,151		X	Administer with a PES filter.151 Do not use filters made of PVDF or nylon.

Note. PES = polyethersulfone; IV = intravenous; PVDF = polyvinylidene fluoride; PVC = poly(vinyl chloride).

^aAll listed brand names have been checked, but only the specified brand name product(s) require filtration. The most up-to-date package insert should be periodically reviewed for the most current recommendations.

^bFilter size not specified in product labeling; size information was obtained via personal communication with manufacturer.

^cBoth the specified branded product and the conventional generic product require filtration.

^dOnly the specified amphotericin B products require filtration. An in-line filter (1 µm or larger) may be used during administration of amphotericin B desoxycholate.¹⁵²

^eSome lot numbers of Cinryze with expiration dates between June and August 2020 require the use of a supplemental filter prior to administration.¹⁵³ The supplemental filter is being supplied by the manufacturer with the product. The manufacturer can provide more information about these specific lot numbers.

^fA prefilled syringe formulation is also available under a different brand name.

^gThe currently marketed brand name product does not require filtration.

^hFiltration recommendations only apply to this specific formulation of liposomal vincristine.¹⁴⁹ Conventional vincristine does not require filtration.¹⁵⁰

The primary data source for each drug was the prescribing information. Three other sources were reviewed to confirm accuracy of the filtration information in the prescribing information.^2-4 Any pertinent information in addition to that found in the prescribing information was added to the comments field of the chart. Drugs that require filtration to remove glass particles from an ampule are not included because this is a well-known standard of practice.^5,158 In addition, medications for which filtration is optional, but not required, are not included in the chart. Drugs with manufacturer-supplied filter needles or filter devices are included in the chart. However, drugs with manufacturer-supplied, filter-containing vial adapters and/or vial transfer devices (eg, needleless vial transfer devices with built-in filters such as the Mix2Vial or Baxject reconstitution system) are only included in the chart if the product labeling states that a similar, commercially available device can be used instead of the manufacturer-supplied filter vial transfer device.

Readers are urged to review national standards of practice for information about clinical situations that warrant the use of a filter for medication preparation or administration, independent of the drug being given (eg, intraspinal injection, amino acid–containing parenteral nutrition solutions).⁵ Although every effort has been made to ensure the accuracy and completeness of the information presented in this chart, the reader is advised that the authors, Hospital Pharmacy, or SAGE cannot be held responsible for the currency of the information, for any errors or omissions, or for any consequences that may arise. The reader should consult the prescribing information for the most up-to-date information.