Granix
Granix (tbo-filgrastim) is used to raise (low white blood cell (WBC) count) caused by anticancer medications. It's very similar to the medication Neupogen (filgrastim), but not quite the same. Granix (tbo-filgrastim) is injected under the skin daily until WBC levels are within normal range, for up to 2 weeks at a time. The most common side effect of medications like Granix (tbo-filgrastim) is bone pain. Currently there's no generic version available, only brand name.
What is Granix (tbo-filgrastim)?
What is Granix (tbo-filgrastim) used for?
Help raise white blood cell (WBC) count during chemotherapy treatment
How Granix (tbo-filgrastim) works
Granix (tbo-filgrastim) is a granulocyte colony-stimulating factor (G-CSF). It works like the naturally occurring G-CSF protein in your body to stimulate (trigger) bone marrow to make neutrophils, which is a type of white blood cell that helps your body fight infection.
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What are the side effects of Granix (tbo-filgrastim)?
Common Side Effects
- Bone pain (3%)
Other Side Effects
- Muscle pain
- Headache
- Vomiting
- Rash
Serious Side Effects
- Ruptured spleen: pain in your left upper stomach or shoulder
- Serious lung problem: shortness of breath, fast rate of breathing or trouble breathing
- Serious allergic reaction: rash, face swelling, shortness of breath, fast heart rate
- Kidney damage: swelling of face or ankles, dark colored urine, blood in urine, urinating less
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Capillary leak syndrome—stomach or muscle pain, unusual weakness or fatigue, feeling faint or lightheaded, decrease in the amount of urine, swelling of the ankles, hands, or feet, trouble breathing
- High white blood cell level—fever, fatigue, trouble breathing, night sweats, change in vision, weight loss
- Inflammation of the aorta—fever, fatigue, back, chest, or stomach pain, severe headache
- Kidney injury (glomerulonephritis)—decrease in the amount of urine, red or dark brown urine, foamy or bubbly urine, swelling of the ankles, hands, or feet
- Shortness of breath or trouble breathing
- Spleen injury—pain in upper left stomach or shoulder
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Bone pain
- Diarrhea
- Fever
- Headache
- Muscle pain
- Vomiting
Pros and cons of Granix (tbo-filgrastim)
Pros
Can be used at home if your provider says it's ok to do so
Available in a convenient prefilled syringe
The prefilled syringe doesn't contain any latex (Neupogen (filgrastim) and Neulasta (pegfilgrastim) do)
Can be used in children age 1 month or older
Cons
Needs daily injections, unlike a similar medication called Neulasta (pegfilgrastim), which is injected once every chemotherapy cycle
Only FDA-approved for use in people receiving bone marrow-suppressing anticancer medications, unlike Neupogen (filgrastim) and Zarxio (filgrastim-sndz) which can be used in other situations
Injections can be uncomfortable
Pharmacist tips for Granix (tbo-filgrastim)
Store Granix (tbo-filgrastim) in the refrigerator (not in the freezer). Protect the medication from light and don't shake it.
If you're giving yourself injections at home, your provider should train you on how to do it properly and safely. Be sure to read the Instructions for Use, and contact your provider if you have any questions.
When you're ready for an injection, take the medication out of the refrigerator, and let the medication warm up to room temperature (but don't leave it in direct sunlight). This can take about 30 minutes. The medication can be left at room temperature for 5 days; anything longer should be thrown away.
Always check that the medication is colorless and clear of all particles (solid chunks). Contact your provider or pharmacy about getting a replacement medication if this isn't the case.
Granix (tbo-filgrastim) can be injected into your stomach, thigh, upper outer buttocks, or upper back portion of the upper arms. Rotate the injection sites every day to give your skin time to heal. Avoid injecting the medication in areas that are tender, red, bruised, hard, or scarred.
Throw away your any injection supplies or unused medication after each use in a sharps container. Reusing injection supplies or leftover medication can lead to serious infections.
Granix (tbo-filgrastim) shouldn't be given within 24 hours of your chemotherapy medication. Make sure you know your chemotherapy schedule and know when you should administer Granix (tbo-filgrastim).
Frequently asked questions about Granix (tbo-filgrastim)
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What are the risks and warnings for Granix (tbo-filgrastim)?
Granix (tbo-filgrastim) 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.
Risk of spleen rupture
There have been rare cases of people having enlarged (larger than normal) spleens while taking Granix (tbo-filgrastim). 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
Granix (tbo-filgrastim) can cause a serious breathing condition, where fluid builds up in your lungs, called acute respiratory distress syndrome (ARDS). Get medical help right away if you have a fever and trouble breathing.
Sickle cell crisis in people with sickle cell anemia
Risk factors: Sickle cell anemia
Sickle cell crisis (painful episode) has occurred in people with sickle cell anemia while receiving Granix (tbo-filgrastim). If this happens, If this happens, your healthcare provider will stop the medication.
Kidney damage
Kidney damage can happen in people people taking Granix (tbo-filgrastim). Your provider will monitor your labs and can lower your dose or pause the medication if they suspect kidney problems. The kidney damage will usually get better if it's the medication causing the problem. Let your provider know if you notice blood in your urine, which can be a sign of kidney problems.
Capillary leak syndrome (CLS)
G-CSF medications like Granix (tbo-filgrastim) can cause capillary leak syndrome (CLS). CLS is a serious condition where blood leaks out of your small blood vessels. Low blood pressure is a common sign, but CLS can also be seen in certain lab tests. Talk to your provider if you experience dizziness, light headedness, or swelling in your hands and feet
Cancer risk
Granix (tbo-filgrastim) is a growth factor, which means there's a possibility for it to make other types of tumors (myeloid cell lines) grow. Talk with your provider if you have questions about Granix (tbo-filgrastim) and the risk of cancer growth.
Serious allergic reactions
Risk factors: Allergy to Granix (tbo-filgrastim) or similar medications
Granix (tbo-filgrastim) can cause serious allergic reactions, which can be life threatening if not treated. Don't take Granix (tbo-filgrastim) if you've ever had an allergic reaction to it or a similar medication like Neulasta (pegfilgrastim). Make sure your healthcare team always has an up to date list of your allergies.
Blood vessel damage
Some people receiving filgrastim products like Granix (tbo-filgrastim) have reported developing 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.
Granix (tbo-filgrastim) dosage forms
Typical dosing for Granix (tbo-filgrastim)
Granix (tbo-filgrastim) is usually started at least 24 hours after chemotherapy. The typical dose is 5 mcg/kg of body weight per day given as a subcutaneous (under the skin) injection until your WBC count is within normal range. The maximum duration of treatment is 2 weeks.
How much does Granix (tbo-filgrastim) cost?
What are alternatives to Granix (tbo-filgrastim)?
Help raise white blood cell (WBC) count during chemotherapy treatment
People getting bone marrow-suppressing chemotherapy
People with acute myeloid leukemia (AML) after induction or consolidation chemotherapy
People with cancer who received bone marrow transplants
People with severe, long-term neutropenia (low neutrophils)
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)
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References
Best studies we foundAmerican Cancer Society. (2023). Low white blood cell counts (neutropenia).
Burris, H. A., et al. (2010). Pegfilgrastim on the same day versus next day of chemotherapy in patients with breast cancer, non-small-cell lung cancer, ovarian cancer, and non-Hodgkin's lymphoma: Results of four multicenter, double-blind, randomized phase II studies. Journal of Oncology Practice.
Cephalon, Inc. (2023). GRANIX® (tbo-filgrastim) injection, for subcutaneous use [package insert].
Cephalon, LLC. (2023). Granix- tbo-filgrastim injection, solution [package insert]. DailyMed.
Chen, A. J., et al. (2020). Provider differences in biosimilar uptake in the filgrastim market. The American Journal of Managed Care.
National Cancer Institute. (n.d.). Neutrophil.
National Center for Advancing Translational Sciences. (2023). Systemic capillary leak syndrome.
National Heart, Lung, and Blood Institute. (2022). What is acute respiratory distress syndrome?
Punnapuzha, S., et al. (2023). Febrile neutropenia. StatPearls.
Teva Pharmaceutical Industries Ltd. (2014). FDA approves Teva’s GRANIX® (tbo-filgrastim) injection for self-administration.
Vasculitis Foundation. (n.d.). Aortitis.
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