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Neupogen

filgrastim

Used for Neutropenia

Neupogen (filgrastim) is an injectable medication that can lower your risk of an infection when you have a low white blood cell count. It's usually used in people being treated for cancer, but can also be used in other situations. There are currently three biosimilars to Neupogen (filgrastim) available on the market, but they can't be swapped for one another without a new prescription.

Reviewed by:

Kristianne Hannemann, PharmD

Cydnee Ng, PharmD

Last reviewed on July 7, 2022

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Interactions Contraindications Alternatives Latest news Images Prices Medicare

What is Neupogen (filgrastim)?

What is Neupogen (filgrastim) used for?

Prevention of low neutrophil-related complications in:

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)

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)

How Neupogen (filgrastim) works

Neupogen (filgrastim) 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.

Are you looking for information on Granix (tbo-filgrastim) or Neulasta (pegfilgrastim) instead?

Drug Facts

Common BrandsNeupogen, Nivestym, Releuko, Zarxio

Drug ClassColony-stimulating factor

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

More on Neupogen (filgrastim) essentials

Filgrastim: Biosimilars: healthcare worker holding injection 1158460912

Filgrastim Biosimilars: What to Know About Zarxio and Other Neupogen Alternatives

Written by Rachel Feaster, PharmD, BCOP, BCPS

What are the side effects of Neupogen (filgrastim)?

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

Fever (48%)
Nausea (43%)
Low platelets (38%)
Feeling weak or tired (20%)
Dizziness (14%)
Cough (14%)
Rash (14%)
Shortness of breath (13%)
Chest pain (13%)

Side effects and percentages are listed for Neupogen (filgrastim) in people with cancer receiving bone marrow-suppressing chemotherapy. They might differ with other uses of Neupogen (filgrastim).

Other Side Effects

Bone or joint pain
General pain

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
Kidney damage: swelling of face or ankles, dark colored urine, blood in urine, urinating less
Low platelet count: easy bruising, longer bleeding time, blood in urine or stools
Serious allergic reaction: rash, face swelling, shortness of breath, fast heart rate

Source: DailyMed

The following 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:

More common

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

blood in the urine or stools

bloody nose

chills

cough

coughing up blood

diarrhea

difficult or labored breathing

difficulty with swallowing

dizziness

facial swelling

feeling of fullness

fever

headache

increased menstrual flow or vaginal bleeding

lower back or side pain

nausea

nosebleeds

pain in the back, ribs, arms, or legs

pain spreading to the left shoulder

painful or difficult urination

pale skin

paralysis

pinpoint red or purple spots on the skin

prolonged bleeding from cuts

red or black, tarry stools

red or dark brown urine

skin rash

sore throat

sores, ulcers, or white spots on the lips, tongue, or inside the mouth

stomach pain

tightness in the chest

trouble breathing

unusual bleeding or bruising

unusual tiredness or weakness

vomiting

Less common

Blurred vision

chest pain

nervousness

pounding in the ears

slow or fast heartbeat

Incidence not known

Blisters on the skin

blue lips, fingernails, or skin

difficult or fast breathing

sores on the skin

swollen glands

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

Bone, joint, or muscle pain

hair loss or thinning of the hair

loss of appetite

weight loss

Less common

Cracked lips

difficulty having a bowel movement

swelling or inflammation of the mouth

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.

Pros and cons of Neupogen (filgrastim)

Pros

Dose can be adjusted based on your neutrophil count for some conditions

Can start to see the benefits after a few days

May be administered at home by yourself or by a caregiver after a provider gives you instructions (for injections under the skin)

Available as a prefilled syringe for easier administration

Cons

Needs to be injected every day

Can cause low platelets and bone pain

Requires frequent blood tests to see how well the medication is working and to monitor side effects

Not interchangeable with other biosimilar products, so need to get a new prescription to change brands

Pharmacist tips for Neupogen (filgrastim)

If you or a caregiver will be injecting the medication at home, make sure you understand all the steps before leaving the hospital, clinic, or pharmacy. Contact your provider or pharmacist if you ever have problems administering the right amount of medication. They can review how to give the medication safely and correctly with you or your caregiver.

Store Neupogen (filgrastim) in the refrigerator (not in the freezer) when you're not using it. Protect it from light, and don't shake it.

When you're ready to give yourself an injection, take the vial or syringe 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. Don't let it stay out for more than 24 hours.

Always check that the medication is colorless and clear of all particles before using. Contact your provider or pharmacy about getting a replacement medication if you see something floating in the liquid.

Don't give Neupogen (filgrastim) within 24 hours of certain chemotherapy medications. This is because it's possible that chemotherapy medications can affect how well Neupogen (filgrastim) works when given during this time. Make sure you know your chemotherapy schedule and when you should give yourself Neupogen (filgrastim).

When switching between prefilled syringes and vials, the volume (amount) you use might be different even if your dose hasn't changed. Ask your pharmacist or provider if you have any questions.

Never reuse needles, syringes, or ununsed portions of your single-dose vials. Reusing these items can lead to dangerous infections.

After each dose, throw away your needle or syringe in a sharps container. If you don't have a sharps container, you can use a container that is made of heavy-duty plastic, leak-resistant, and closes with a tight-fitting lid. Never put needles or syringes in your household trash to avoid injury to yourself or others.

If you miss or forget your dose, contact your provider for further instructions.

Frequently asked questions about Neupogen (filgrastim)

Is Neupogen (filgrastim) a blood product?

No, Neupogen (filgrastim) isn't a blood product, because it's not made from human blood. While it may look and act like a protein we have in our bodies, the G-CSF in the medication is actually made by bacteria called Escherichia coli (E. coli).

Where do you inject Neupogen (filgrastim)?

If you're injecting Neupogen (filgrastim) under the skin, it can be injected into the outer area of your upper arm, belly (2 inches away from your belly button), thigh, or upper outer buttocks. Make sure to inject the medication into your fatty tissue (not your muscle) so it works properly. Ask your provider if you have any questions during or after training. Also, be sure to check out the instructions for use that come with your prescription for more details on how to inject Neupogen (filgrastim) safely.

What are the biosimilars to Neupogen (filgrastim)?

Nivestym, Releuko, and Zarxio are known as biosimilars to Neupogen (filgrastim). 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.

What is the difference between Neupogen (filgrastim), Nivestym, Releuko, and Zarxio?

Nivestym, Releuko, and Zarxio are biosimilars to Neupogen (filgrastim). All four brands are used to raise white blood cell counts to help reduce the risk of infection, and they all have similar side effects. One difference is that Neupogen, Nivestym, and Zarxio can be used to collect blood stem cells for transplant, but Releuko isn't approved for this use. Another difference is that Neupogen is approved to raise the chance of survival in people who've been exposed to certain doses of radiation, but not its biosimilars.

Why is Neupogen (filgrastim) given 24 hours after chemotherapy?

Neupogen (filgrastim) and other similar medications are started 24 hours after chemotherapy to prevent interactions between the two medications. Chemotherapy is helpful for treating tumors since it blocks new cells from being made and the tumor from growing. But it's also possible for chemotherapy to stop Neupogen (filgrastim) from making new, healthy white blood cells in your bone marrow. Neupogen (filgrastim) shouldn't be used in the 24 hours before through 24 hours after chemotherapy to give it the best chance to work well for you.

How long does Neupogen (filgrastim) last in the refrigerator?

Neupogen (filgrastim) can last in the refrigerator up until its expiration date. Sometimes, the expiration date is easier to see on the box than each individual vial or syringe, so you might want to keep the original box until all the medication has been used. Once Neupogen (filgrastim) has been taken out of the refrigerator, it's good for 24 hours.

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What are the risks and warnings for Neupogen (filgrastim)?

Neupogen (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.

Large spleen

There have been rare cases of people having enlarged (larger than normal) spleens while taking Neupogen (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

Neupogen (filgrastim) 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 Neupogen (filgrastim) or similar medications

Neupogen (filgrastim) can cause serious allergic reactions, which can be life-threatening if untreated. Don't take Neupogen (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. 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 Neupogen (filgrastim). If this happens, your healthcare provider will stop the medication.

Kidney damage

Kidney damage can happen in people taking Neupogen (filgrastim). 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 Neupogen (filgrastim) 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.

Blood vessel damage

Risk factors: Severe, chronic (long-term) neutropenia | Taking Neupogen (filgrastim) for a long time

Some people using filgrastim products have reported skin lesions caused by inflammation and tissue damage of blood vessels. This condition is called cutaneous vasculitis. Most cases were moderate to severe and occurred in people taking the medication for a long time. Let your provider know if you notice itchy, red spots or bumps on your skin, feel unwell, or muscle or joint pain. Your provider might pause your treatment until your symptoms of cutaneous vasculitis goes away.

In addition, other people receiving filgrastim products have reported developing another 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.

Cancer risk

Neupogen (filgrastim) 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 tumors. Some people using Neupogen (filgrastim) for severe chronic neutropenia reported developing blood-related cancers. Others reported developing these cancers when they used Neupogen (filgrastim) 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 Neupogen (filgrastim) if the risks become greater than the benefits.

Neupogen (filgrastim) dosage forms

Typical dosing for Neupogen (filgrastim)

Your dose depends on your weight, your blood cell counts, and the condition you're taking the medication for.

In general, the typical starting dose is 5 mcg/kg to 10 mcg/kg of body weight per day. It's given once or twice per day, depending on why you're taking it. Neupogen (filgrastim) is given as an injection under the skin (subcutaneously) or an injection through the veins (intravenously, IV).

Interactions between Neupogen (filgrastim) and other drugs

Neupogen (filgrastim) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Neupogen (filgrastim). Please note that only the generic name of each medication is listed below.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Vincristine
Vincristine Sulfate Liposome

Neupogen (filgrastim) 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 Neupogen (filgrastim) will not be safe for you to take.

Allergy to pegfilgrastim products like Neulasta

What are alternatives to Neupogen (filgrastim)?

There are a number of medications that your doctor can prescribe in place of Neupogen (filgrastim). Compare a few possible alternatives below.

Neupogen (filgrastim)

Used for:

Prevention of low neutrophil-related complications in:

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)

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)

View Prices

Granix (tbo-filgrastim)

Used for:

Help raise white blood cell (WBC) count during chemotherapy treatment

$1288.27 Lowest GoodRx priceView Prices

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)

$6321.81 Lowest GoodRx priceView Prices