Zarxio Side Effects

Generic name: filgrastim

Medically reviewed by Drugs.com. Last updated on Apr 15, 2025.

Note: This document provides detailed information about Zarxio Side Effects associated with filgrastim. Some dosage forms listed on this page may not apply specifically to the brand name Zarxio.

Applies to filgrastim: injection solution.

Other dosage forms:

• solution

Precautions

It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Check with your doctor right away at the first sign of an infection, such as fever, chills, cough, sore throat, or unusual tiredness or weakness.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you or your child has a rash, itching skin, dizziness, lightheadedness, or fainting, swelling of the face, tongue, or throat, trouble breathing, or chest pain after you receive the medicine.

Check with your doctor right away if you or your child are having pain in the upper left part of your stomach or at the tip of the left shoulder. This could be a symptom of a serious side effect with the spleen.

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

This medicine may cause bleeding in the lungs. Check with your doctor right away if you or your child cough up blood or have blood in your sputum (spit).

This medicine may cause blood or bone marrow problems (eg, myelodysplastic syndrome, acute myeloid leukemia) in patients with breast or lung cancer. Check with your doctor right away if you have chest pain, chills, cough or hoarseness, fever, lower back or side pain, painful or difficult urination, sores, ulcers, or white spots on the lips or in the mouth, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness.

This medicine may cause kidney problems. Call your doctor right away if you or your child has swelling in your face or ankles, blood in the urine, or decrease in how much or how often you urinate.

This medicine may cause a condition called capillary leak syndrome. It can cause fluid to leak from the blood vessels into your body's tissues. Call your doctor right away if you have swelling or puffiness and are urinating less often, trouble breathing, feeling of fullness, dizziness, or feeling faint.

This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed more easily. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers. Check with your doctor right away if you or your child has black or tarry stools, bleeding gums, blood in the urine or stools, pinpoint red spots on the skin, or unusual bleeding or bruising after receiving this medicine.

This medicine may cause aortitis (inflammation of the aorta, the largest artery in the body). Check with your doctor right away if you have fever, stomach pain, unusual tiredness or weakness, or back pain.

The needle cover of the prefilled syringe contains dry natural rubber (a derivative of latex). This may cause an allergic reaction in people who are sensitive to latex. Tell your doctor if you or your child has a latex allergy before you start using this medicine.

Before you have any medical tests, tell the medical doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.

Serious side effects of Zarxio

Along with its needed effects, filgrastim (the active ingredient contained in Zarxio) 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 while taking filgrastim:

Other side effects of Zarxio

Some side effects of filgrastim 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:

For healthcare professionals

Applies to filgrastim: injectable solution.

Hematologic adverse events

• Very common (10% or more): Decreased platelet counts (up to 97%), increase in white blood cell counts between 10 x 10(9)/L and 70 x 10(9)/L (up to 88%), decreased hemoglobin (up to 65%), mild to moderate decreases in hemoglobin (up to 59%), leukocytosis (up to 41%), thrombocytopenia (up to 38%), transient thrombocytopenia (up to 35%), palpable splenomegaly (up to 30%), splenomegaly (up to 30%), anemia (up to 10%)
• Common (1% to 10%): Spleen disorder, splenic rupture/fatal splenic rupture
• Uncommon (0.1% to 1%): Sickle cell anemia with crisis/sickle cell crisis
• Rare (0.01% to 0.1%): Cytopenia
• Postmarketing reports: Sickle cell disorders^[Ref]

Musculoskeletal

• Very common (10% or more): Mild to moderate musculoskeletal symptoms (up to 44%), medullary bone pain (up to 38%), mild to moderate bone pain (up to 33%), bone pain (up to 30%), back pain (up to 15%), musculoskeletal pain (up to 14%), flank pain (up to 12%), myalgia (up to 12%)
• Common (1% to 10%): Arthralgia, extremity pain, muscle spasms, osteoporosis, severe musculoskeletal pain
• Uncommon (0.1% to 1%): Pseudogout/chondrocalcinosis pyrophosphate, rheumatoid arthritis exacerbation
• Rare (0.01% to 0.1%): Decreased bone density
• Frequency not reported: Musculoskeletal chest pain, neck pain^[Ref]

Other

• Very common (10% or more): Pyrexia (up to 48%), fatigue (up to 20%), pain (up to 12%)
• Common (1% to 10%): Asthenia, generalized weakness, malaise, mucosal inflammation, mucositis^[Ref]

Respiratory

• Very common (10% or more): Epistaxis (up to 15%), cough (up to 14%), dyspnea (up to 13%)
• Common (1% to 10%): Bronchitis, hemoptysis, sore throat, upper respiratory tract infection
• Uncommon (0.1% to 1%): Acute respiratory distress syndrome (ARDS), hypoxia, interstitial lung disease, pulmonary edema, pulmonary hemorrhage, pulmonary infiltrates/lung infiltration, respiratory failure
• Very rare (less than 0.01%): Pulmonary adverse events
• Frequency not reported: Interstitial pneumonia, serious pulmonary adverse events
• Postmarketing reports: Alveolar hemorrhage^[Ref]

Metabolic

• Very common (10% or more): Spontaneously reversible elevations in lactate dehydrogenase (up to 56%), spontaneously reversible elevations in uric acid (up to 56%)
• Common (1% to 10%): Anorexia, blood glucose decreased, blood lactate dehydrogenase increased, blood uric acid increased, decreased appetite, hyperuricemia
• Uncommon (0.1% to 1%): Fluid volume disturbances^[Ref]

Hepatic

• Very common (10% or more): Spontaneously reversible elevations in alkaline phosphatase (up to 56%), blood alkaline phosphatase increased (up to 11%)
• Common (1% to 10%): Gamma glutamyltransferase increased, hepatomegaly
• Uncommon (0.1% to 1%): AST increased^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (up to 43%), abdominal pain (up to 12%)
• Common (1% to 10%): Constipation, diarrhea, oral pain, oropharyngeal pain, pharyngolaryngeal pain, vomiting
• Frequency not reported: Stomatitis^[Ref]

Nervous system

• Very common (10% or more): Dizziness (up to 14%), headache (up to 10%)
• Common (1% to 10%): Hypoesthesia, paresthesia^[Ref]

Dermatologic

• Very common (10% or more): Rash/skin rash (up to 14%)
• Common (1% to 10%): Alopecia, cutaneous/leukocytoclastic vasculitis, erythema
• Uncommon (0.1% to 1%): Acute febrile neutrophilic dermatosis/Sweet's syndrome, maculopapular rash, pre-existing skin disorder exacerbation, psoriasis exacerbation
• Frequency not reported: Urticaria^[Ref]

Cardiovascular

• Very common (10% or more): Chest pain (up to 13%)
• Common (1% to 10%): Hypertension, hypotension, peripheral edema
• Uncommon (0.1% to 1%): Capillary leak syndrome, veno-occlusive disease
• Rare (0.01% to 0.1%): Aortitis, vascular disorder^[Ref]

Genitourinary

• Common (1% to 10%): Dysuria, hematuria, urinary tract infection
• Uncommon (0.1% to 1%): Proteinuria,
• Rare (0.01% to 0.1%): Urine abnormality^[Ref]

Local

• Common (1% to 10%): Injection site pain, injection site reaction, transfusion reaction^[Ref]

Immunologic

• Common (1% to 10%): Antibody formation, sepsis
• Uncommon (0.1% to 1%): Graft versus Host Disease (GvHD)/fatal GvHD^[Ref]

Hypersensitivity

• Common (1% to 10%): Drug hypersensitivity
• Uncommon (0.1% to 1%): Anaphylactic reaction, hypersensitivity/hypersensitivity reactions, severe allergic reaction
• Very rare (less than 0.01%): Allergic reaction
• Frequency not reported: Anaphylaxis, angioedema^[Ref]

Renal

• Common (1% to 10%): Glomerulonephritis^[Ref]

Psychiatric

• Common (1% to 10%): Insomnia^[Ref]

Oncologic

• Frequency not reported: cytogenetic abnormalities, transformation to myelodysplastic syndromes (MDS), transformation to acute myeloid leukemia (AML)^[Ref]

Transformation to MDS/AML and cytogenetic abnormalities appeared to be confined to patients with congenital neutropenia. The cumulative risk in this population in the eighth year of treatment was predicted to be 16.5%, or approximately 2% per year.^[Ref]

See also:

Frequently asked questions

• What are biosimilar drugs and how do they compare to biologics?
• What biosimilars have been approved in the United States?
• What is the difference between Nivestym and Neupogen?

Further information

Zarxio side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer