How does this medication work? What will it do for me?
Pegfilgrastim belongs to the family of medications known as granulocyte colony stimulating factors (G-CSF). Pegfilgrastim helps the bone marrow produce white blood cells which help the body fight infection.
Pegfilgrastim is used to treat neutropenia (low counts of a certain type of white blood cell known as neutrophils) for people who have certain types of cancer and are receiving a type of chemotherapy that slows down white blood cell production.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Neulasta® is available in a single-use syringe that contains 6 mg of pegfilgrastim.
Each 0.6 mL single-use syringe of sterile clear colourless preservative-free liquid for subcutaneous administration contains pegfilgrastim 6 mg (based on protein mass only). Nonmedicinal ingredients: polysorbate 20, sodium acetate, sorbitol, and water for injection, USP; pH: 4.0.
How should I use this medication?
The recommended adult dose of pegfilgrastim is 6 mg given by subcutaneous (under the skin) injection after each cycle of chemotherapy. Pegfilgrastim should not be given less than 14 days before chemotherapy and not until 24 hours after chemotherapy.
Pegfilgrastim is usually given under medical supervision. If you are giving pegfilgrastim to yourself, your doctor or health care professional will instruct you on how to use pegfilgrastim properly. It is important to use this medication exactly as prescribed by your doctor.
If you miss a dose of pegfilgrastim, call your doctor.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Do not shake this medication vigorously. This medication should be stored in the refrigerator and protected from light. Freezing should be avoided, but if the medication is accidentally frozen, allow it to thaw in the refrigerator before being given. If the medication is accidentally frozen 2 times or is left at room temperature for more than 72 hours, it should be discarded.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to pegfilgrastim, to filgrastim, or any of the ingredients of the medication
- are allergic to products made using the E. coli bacteria
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- bone pain
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- chest pain
Stop taking the medication and seek immediate medical attention if any of the following occur:
- a severe allergic reaction (e.g., hives, shortness of breath, wheezing, swelling of the face or throat, fast heart rate, dizziness)
- signs of a ruptured spleen (e.g., upper left abdominal pain or pain at the tip of the shoulder pain)
- signs of acute respiratory distress syndrome (e.g., fever, shortness of breath, cough, or lung congestion)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
April 10, 2014
Health Canada has issued new restrictions concerning the use of Neulasta (pegfilgrastim). To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Cytotoxic chemotherapy: The safety of using pegfilgrastim at the same time as cytotoxic chemotherapy (a type of chemotherapy that kills cells, especially cancer cells) has not been established. Pegfilgrastim should not be used within 14 days before or 24 hours after chemotherapy. In addition, it is not known whether is is safe and effective to use pegfilgrastim after certain chemotherapy medications (e.g., mitomycin C, 5-flurouracil, and nitrosoureas such as carmustine and lomustine).
Lung problems: Pegfilgrastim may cause adult respiratory distress syndrome (ARDS), a serious lung condition, when people with neutropenia have sepsis (bacterial infection in the blood). If ARDS occurs, this medication should be stopped until the ARDS resolves.
Radiation: It is nnot known whether it is safe and effective to use pegfilgrastim with radiation therapy. Pegfilgrastim should not be used during radiation therapy.
Sickle cell disease: Pegfilgrastim may cause sickle cell crisis when used by people who have sickle cell disease. You and your doctor should carefully consider the benefits and risks of using pegfilgrastim in these circumstances.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, stop taking it immediately and call your doctor.
Breast-feeding: It is not known whether pegfilgrastim passes into breast milk. Pegfilgrastim is not recommended by breast-feeding mothers.
Children: The safety and effectiveness of pegfilgrastim have not been established for children.
What other drugs could interact with this medication?
There may be an interaction between pegfilgrastim and any of the following:
- mitomycin C
- other cytokine medications (e.g., growth factors)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.