Neulasta
Neulasta (pegfilgrastim) is an injectable medication that can lower your risk of infection when you have low white blood cells. It's usually used for people who've taken bone marrow-suppressing anticancer medications or have had exposure to radiation. It's similar to Neupogen (filgrastim), but lasts longer. There are many biosimilars to Neulasta (pegfilgrastim) available on the market, but they can't be switched without a new prescription.
What is Neulasta (pegfilgrastim)?
What is Neulasta (pegfilgrastim) used for?
- Infection prevention in people with certain cancers receiving anticancer medications that can cause low white blood cells (or febrile neutropenia)
- Increase survival in people exposed to bone marrow-suppressing radiation (Neulasta only)
How Neulasta (pegfilgrastim) works
Neulasta (pegfilgrastim) is a granulocyte colony-stimulating factor (G-CSF). It works like the G-CSF protein that you naturally have in your body. G-CSF stimulates (triggers) your bone marrow to make neutrophils, a type of white blood cell that helps your body fight infections.
Drug facts
Side effects of Neulasta (pegfilgrastim)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Bone pain (31%)
- Pain in arms and legs (9%)
Less Common Side Effects
- Injection site reaction
Neulasta (pegfilgrastim) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Shortness of breath or trouble breathing
- Ruptured spleen: pain in your left upper stomach or shoulder
- Serious allergic reaction: rash, trouble breathing, swelling of your tongue, lips, or throat
The following Neulasta (pegfilgrastim) side effects have also been reported
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:
Incidence not known
Black, tarry stools
bleeding gums
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
blisters in the skin
blood in the urine or stools
cloudy urine
decrease in how much or how often you urinate
difficulty with swallowing
dizziness
fainting or lightheadedness
fast heartbeat
flushing or redness of the skin
hives or welts, 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
lower back or side pain
painful or difficult urination
pinpoint red spots on the skin
sores on the skin
stomach pain
swelling of the hands, ankles, feet, or lower legs
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
unusually warm skin
Get emergency help immediately if any of the following symptoms of overdose occur:
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
Belching
change in sense of taste
cracked lips
hair loss or thinning of the hair
indigestion
joint pain
lack or loss of strength
loss of appetite
muscle soreness
swelling or inflammation of the mouth
trouble sleeping
vomiting
weakness, generalized
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.
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Pros and cons of Neulasta (pegfilgrastim)
Pros
- Long-lasting and only needs to be given once per chemotherapy cycle
- On-body injector (OBI) available for Neulasta that can help with administration after your chemotherapy treatment
- Available as a prefilled syringe for easier use
- No dose adjustments needed for people with kidney or liver problems
Cons
- Can cause bone pain
- Requires frequent blood work so your provider can make sure it's working and safe for you
- Not FDA approved for as many uses as filgrastim medications
- Brand only, so it can be expensive
Pharmacist tips for Neulasta (pegfilgrastim)
- If you'll be using Neulasta (pegfilgrastim) at home, your provider will show you or your caregiver how to inject the medication safely and correctly. If you have questions, refer to the instructions that come with your prescription or call your provider.
- Tell your provider if you or your caregiver has a latex or adhesive allergy. The prefilled syringe needle caps contain a latex product, and the Neulasta on-body injector (OBI) uses acrylic adhesive.
- Store Neulasta (pegfilgrastim) in the refrigerator (not in the freezer), protect it from light, and don't shake it. This helps prevent damage to the medication.
- When you're ready to use the medication, take it out of the refrigerator and let it come to room temperature for at least 30 minutes. This can make the injection more comfortable. Ask your provider how long you can leave the medication at room temperature before you have to throw it away; this is different for each pegfilgrastim product.
- Never reuse syringes or save leftover medication. This can lead to dangerous infections.
- After each use, throw away your syringe or the Neulasta OBI device into a sharps container. You can also use a sealable container made of puncture-resistant plastic. This helps prevent needlestick injuries to yourself or others.
For Neulasta Onpro (on-body injector)
- The on-body injector is usually placed on your skin by a healthcare provider right after your chemotherapy treatment. It's best to have a caregiver nearby the first time you use the OBI. They can help monitor you for allergic reactions and make sure the device is working properly.
- Review the instructions on how to check that the device is working properly. A green light on the device means that it's working. If the light turns red, contact your provider. There might be a problem with the device and you might need a replacement dose.
- Follow the instructions above to make sure the device doesn't fall off. If the device falls off, call your provider right away. Don't try to reapply the current device.
- Avoid traveling, driving, or operating heavy machinery 26 to 29 hours after your provider applies the OBI. This is when you'll receive the medication from the device and when you'll need to check that you've received the full dose.
- It's not recommended to bathe, use saunas, or expose the device to direct sunlight while you have the OBI on your skin, since it can affect the way the device works. Keep the OBI dry for about 3 hours before it delivers your dose so you can tell if the device is leaking. Call your provider if you notice any dripping from the device, since this could mean it's leaking and you might not get your full dose.
- Keep the OBI at least 4 inches away from electrical equipment like cell phones and microwaves. Avoid airport X-ray scans, ultrasounds, and other types of medical imaging scans while you're wearing the OBI. They can interfere with the way the OBI works.
Common questions about Neulasta (pegfilgrastim)
Chemotherapy medications can kill fast-growing cells, which is good for treating tumors. But it's possible that these medications can also kill the new, healthy white blood cells that Neulasta (pegfilgrastim) triggers your bone marrow to make if they're given too close together. Neulasta (pegfilgrastim) lasts a long time in your body. So to prevent any interactions, you shouldn't use Neulasta (pegfilgrastim) within 14 days of your next chemotherapy treatment. Similarly, Neulasta (pegfilgrastim) can only be used 24 hours after chemotherapy to prevent this interaction from happening. Receiving these medications at different times will help give Neulasta (pegfilgrastim) a chance to work better for you.
Unfortunately, it's not clear how long bone pain from Neulasta (pegfilgrastim) will last, and it also varies from person to person. One study found that on average, the pain was the most severe three days after Neulasta (pegfilgrastim) was given.
Common medications used to help relieve bone pain are nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Naprosyn) and antihistamines like loratadine (Claritin). Talk to your provider about your options before your first dose of Neulasta (pegfilgrastim). Some medications might work better for pain if they're given before your injection.
The Neulasta Onpro is an on-body injector (OBI) that's applied to your skin by your healthcare provider after you receive your chemotherapy. Your provider will make sure you receive the correct dose of Neulasta (pegfilgrastim) when they're preparing the device. About 27 hours after it's placed on your skin, Neulasta Pro automatically delivers your dose over 45 minutes. This allows you to stay at home to get your dose and helps take away any confusion around when you should inject your dose. The device isn't approved for people who've been exposed to bone marrow-suppressing radiation and hasn't been studied in children.
Fulphila, Nyvepria, Udenyca, Ziextenzo, Fylnetra, and Stimufend are known as biosimilars to Neulasta (pegfilgrastim). A biosimilar is a biologic medication with a comparable structure and works similarly to the original biologic that was first approved by the FDA. Biosimilars are sort of like generics, but they aren't identical to the original biologic. Biologics are made from living organisms (e.g., animal cells, bacteria), and because of the complex way they're made, exact copies of the original medication can't be made.
Fulphila, Nyvepria, Udenyca, Ziextenzo, Fylnetra, and Stimufend are biosimilars to Neulasta (pegfilgrastim). All seven brands are used to raise white blood cell counts to help reduce the risk of infection in people receiving certain cancer medications. They all have similar side effects. One difference is that only Neulasta is also approved to raise the chance of survival in people who've been exposed to certain doses of radiation, but not its biosimilars. Another difference is that Neulasta is available as an on-body injector that automatically delivers your dose at the right time. This makes it easy to take Neulasta (pegfilgrastim) at home.
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Risks and warnings for Neulasta (pegfilgrastim)
Neulasta (pegfilgrastim) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Large spleen
There have been rare cases of people having enlarged (larger than normal) spleens after using Neulasta (pegfilgrastim). In serious cases, the spleen can rupture (break open), which can be deadly. Contact your provider if you notice any pain in the upper left stomach area or in your shoulder.
Breathing problems
Neulasta (pegfilgrastim) can cause a serious breathing condition called acute respiratory distress syndrome (ARDS). It causes fluid to leak in your lungs, blocking the space in your lungs for oxygen. This prevents enough oxygen from getting into your blood and to your organs. Get medical help right away if you have shortness of breath, fast breathing, or fever.
Serious allergic reactions
- Risk factors: Allergy to Neulasta (pegfilgrastim) or similar medications | Allergy to acrylics or latex
Neulasta (pegfilgrastim) can cause serious allergic reactions, which can be life threatening if untreated. Don't take Neulasta (pegfilgrastim) if you've ever had an allergic reaction to it or a similar medication like Neupogen (filgrastim). In addition, the prefilled syringes contain latex and the on-body injector uses acrylic adhesive, so let your provider know if you have an acrylic or latex allergy. Make sure your healthcare team always has an up-to-date list of your allergies. Get medical help right away if you experience rash, shortness of breath, or swelling of your lips, tongue, or throat.
Sickle cell crisis in people with sickle cell anemia
- Risk factors: Sickle cell anemia
Sickle cell crisis (painful episode) can happen in people with sickle cell anemia while receiving Neulasta (pegfilgrastim). If this happens, your healthcare provider will stop the medication.
Kidney damage
Kidney damage can happen in people taking Neulasta (pegfilgrastim). If your provider suspects that you have kidney problems, you might need to get blood work done so they can check for signs of kidney damage. Then, they can decide if they need to lower your dose or pause the medication. The kidney damage will usually get better if it's the medication causing the problem.
Capillary leak syndrome
Colony-stimulating factor medications like Neulasta (pegfilgrastim) can cause capillary leak syndrome (CLS). CLS is a serious condition where fluid leaks out of your small blood vessels. Low blood pressure is a common sign, but certain lab results can also suggest CLS. Talk to your provider if you notice any early symptoms of CLS, including low blood pressure (e.g., dizziness, fainting), tiredness, stomach pain, extreme thirst, or sudden weight gain. Your provider will need to examine you further.
Cancer risk
Neulasta (pegfilgrastim) is a growth factor that primarily triggers the production of neutrophils in the body. But there's also a possibility for it to promote the growth of other types of tumors. Some people reported developing blood-related cancers and bone marrow problems when they used Neulasta (pegfilgrastim) as part of their treatment plan for breast or lung cancer along with chemotherapy or radiation. Your providers will check your labs closely and might stop Neulasta (pegfilgrastim) if the the benefits no longer outweigh the risks.
Blood vessel damage
Neulasta (pegfilgrastim) has been linked to a condition caused by inflammation of blood vessels called aortitis. This condition could happen as early as the first week after starting treatment. Let your provider know if you experience fever, stomach pain, back pain, or feel unwell so you can be checked out.
Neulasta (pegfilgrastim) dosage
Typical dosage for Neulasta (pegfilgrastim)
People receiving bone marrow-suppressing chemotherapy
- Adults and children weighing 99 lbs or more: The typical dose is 6 mg injected under the skin (subcutaneously) once per chemotherapy cycle. Please see the FAQ section for more details.
- Children who weigh less than 99 lbs: Dosing will depend on the child's weight.
People exposed to bone marrow-suppressing radiation (Neulasta only)
- Adults and children weighing 99 lbs or more The typical dose is 6 mg injected under the skin as soon as possible, followed by another 6 mg one week later.
- Children who weigh less than 99 lbs: Dosing will depend on the child's weight.
Interactions between Neulasta (pegfilgrastim) and other drugs
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.
How much does Neulasta (pegfilgrastim) cost?
$1,921.16
Neulasta (pegfilgrastim) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Neulasta (pegfilgrastim) will not be safe for you to take.
- Allergy to filgrastim products like Neupogen
What are alternatives to Neulasta (pegfilgrastim)?
Prevention of low neutrophil-related complications in:
Preparation for blood collection for your own stem cell transplant (Neupogen, Nivestym, and Zarxio only)
Increase survival in people exposed to bone marrow-suppressing radiation (Neupogen only)
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