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pegfilgrastim (Subcutaneous route)

peg-fil-GRA-stim

Commonly used brand name(s)

In the U.S.

  • Neulasta

Available Dosage Forms:

  • Solution

Therapeutic Class: Hematopoietic

Pharmacologic Class: Colony Stimulating Factor

Uses For pegfilgrastim

Pegfilgrastim injection is used to treat neutropenia (low white blood cells) that is caused by cancer medicines. It is a synthetic (man-made) form of a substance that is naturally produced in your body called a colony stimulating factor. Pegfilgrastim helps the bone marrow to make new white blood cells.

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When certain cancer medicines are used to fight cancer cells, they also affect the white blood cells that fight infections. Pegfilgrastim is used to reduce the risk of infection while you are being treated with cancer medicines.

pegfilgrastim is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, pegfilgrastim is used in certain patients with the following medical conditions:

  • Harvesting of peripheral blood stem cells, prior to autologous stem-cell transplantation.

Before Using pegfilgrastim

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For pegfilgrastim, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to pegfilgrastim or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of pegfilgrastim injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pegfilgrastim in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of pegfilgrastim. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bone marrow cancer or other bone marrow problems or
  • Lung disease or breathing problems or
  • Sickle cell disease (red blood cell disease)—Use with caution. May make these conditions worse.
  • Sepsis (serious infection)—There have been reports of acute respiratory distress syndrome (ARDS) in patients who had a serious infection and were receiving a similar medicine called filgrastim.

Proper Use of pegfilgrastim

A nurse or other trained health professional may give you pegfilgrastim. pegfilgrastim is given as a shot under your skin.

You may be taught how to give pegfilgrastim at home. Make sure you understand all of the instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.

pegfilgrastim may be given in 2 ways: a single prefilled syringe for manual use or for use with the On-body Injector for Neulasta® use.

pegfilgrastim comes with patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions about:

  • How to prepare the injection.
  • The proper use of disposable syringes.
  • How to give the injection.
  • How long the injection can be stored at home.

If you have any questions about any of this, check with your doctor.

Allow the medicine to warm at room temperature before you inject it. If the medicine in the prefilled syringe has changed color, looks cloudy, or if you see particles in it, do not use it.

The needle cover of the prefilled syringe contains dry natural rubber (a derivative of latex), which may cause an allergic reaction in people who are sensitive to latex. Tell your doctor if you have a latex allergy before you start using pegfilgrastim.

Dosing

The dose of pegfilgrastim will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of pegfilgrastim. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injectable dosage form:
    • To increase white blood cell count:
      • Adults—6 milligrams (mg) as a single injection one time every cancer treatment cycle.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

pegfilgrastim needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store in the refrigerator. Do not freeze.

Leave the medicine in the carton until you are ready to use it. If you accidentally freeze the medicine, let it thaw out in the refrigerator before you use it. If you accidentally freeze the medicine a second time, do not use it. You may let the medicine warm up to room temperature before you use it. Keep it away from heat or direct light. The medicine can stay out of the refrigerator for up to 48 hours. Discard any medicine that has been out of the refrigerator for more than 48 hours.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Precautions While Using pegfilgrastim

It is very important that your doctor check your progress at regular visits to make sure that pegfilgrastim is working properly. Blood tests may be needed to check for unwanted effects.

If you have left upper stomach pain or shoulder tip pain, contact your doctor right away. This could be a symptom of a serious side effect with the spleen.

Check with your doctor right away at the first sign of any infection such as fever, chills, cough, sore throat, or redness, swelling, or pain around a cut or sore.

Check with your doctor right away if you develop a fever, chest pain or tightness, fast breathing, or trouble breathing. These could be symptoms of a serious lung condition called acute respiratory distress syndrome (ARDS).

pegfilgrastim may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, swelling of the face, tongue, or throat, trouble breathing, or chest pain after you receive the medicine.

You should not use pegfilgrastim for 14 days before and up to 24 hours after you receive cancer medicines.

If you are receiving pegfilgrastim via the On-body Injector for Neulasta®:

  • Tell your doctor if you have an allergy to acrylic adhesives.
  • Do not drive, use machines, or travel during hours 26-29 following the application of On-body Injector. You must have a caregiver nearby for your first dose.

Make sure any doctor or dentist who treats you knows that you are using pegfilgrastim. pegfilgrastim may affect the results of certain medical tests (eg, bone tests).

pegfilgrastim Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Chills
  • cough
  • fever
  • sore throat
  • ulcers, sores, or white spots in the mouth
Rare
  • Bluish lips or skin
  • pain, left upper abdomen or shoulder
  • tightness in the chest
  • troubled breathing
Incidence not known
  • Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
  • difficulty with swallowing
  • dizziness
  • fast heartbeat
  • flushing or redness of the skin
  • hives or welts or skin rash
  • itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • sores on the skin
  • unusual tiredness or weakness
  • unusually warm skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • bone pain
  • change in sense of taste
  • constipation
  • cracked lips
  • diarrhea
  • hair loss or thinning of the hair
  • headache
  • heartburn
  • indigestion
  • joint pain
  • lack or loss of strength
  • loss of appetite
  • muscle soreness
  • nausea
  • stomach discomfort, upset, or pain
  • swelling of the hands, ankles, feet, or lower legs
  • swelling or inflammation of the mouth
  • trouble sleeping
  • vomiting
  • weakness, generalized
  • weight loss
Incidence not known
  • Body produces substance that can bind to drug making it less effective or cause side effects

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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