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Indication

Neulasta® (pegfilgrastim) is a prescription medication used to reduce the risk of infection (initially marked by fever) in patients with some tumors receiving strong chemotherapy that decreases the number of infection-fighting white blood cells.

Important Safety Information

Who should not take Neulasta®?
Do not take Neulasta® if you have had an allergic reaction to Neulasta® or to NEUPOGEN® (Filgrastim).

What should I tell my health care provider before taking Neulasta®?
If you have a sickle cell disorder, make sure your doctor knows about it before using Neulasta®.

What are possible serious side effects of Neulasta®?
  • Spleen Rupture. Your spleen may become enlarged and can rupture while taking Neulasta®. A ruptured spleen can cause death. The spleen is located in the upper left section of your stomach area. Call your doctor right away if you have pain in the left upper stomach area or left shoulder tip area. This pain could mean your spleen is enlarged or ruptured.
  • A serious lung problem called acute respiratory distress syndrome (ARDS). Call your doctor or seek emergency care right away if you have shortness of breath, trouble breathing, or a fast rate of breathing.
  • Serious Allergic Reactions. Neulasta® can cause serious allergic reactions. These reactions can cause shortness of breath, wheezing, dizziness, swelling around the mouth or eyes, fast pulse, sweating, and hives. If you start to have any of these symptoms, call your doctor or seek emergency care right away. If you have an allergic reaction during the injection of Neulasta®, stop the injection. Call your doctor right away.
  • Sickle Cell Crises. You may have a serious sickle cell crisis if you have a sickle cell disorder and take Neulasta®. Serious and sometimes fatal sickle cell crises can occur in patients with sickle cell disorders receiving Filgrastim, a medicine similar to Neulasta®. Call your doctor right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.

What are the most common side effects of Neulasta®?
The most common side effect you may experience is aching in the bones and muscles. If this happens, it can usually be relieved with a nonaspirin pain reliever, such as acetaminophen.

What important information do I need to know about receiving Neulasta®?
  • Occasionally pain and redness may occur at the injection site. If there is a lump, swelling, or bruising at the injection site that does not go away, talk to the doctor.
  • Neulasta® should only be injected on the day the doctor has determined and should not be injected until approximately 24 hours after receiving chemotherapy.
  • The needle cover on the single-use prefilled syringe contains dry natural rubber (latex), which should not be handled by persons sensitive to this substance.

If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For more information, please see the Neulasta® Patient Product Information and Prescribing Information.

Measuring White Blood Cells

It’s important for your doctor to monitor your white blood cell counts, because low white blood cell counts can put you at greater risk for certain types of infection Infection—An invasion of microorganisms such as bacteria or viruses that have the ability to multiply and cause disease..1

Complete blood count

To monitor whether you are at an increased risk of infection due to chemotherapyChemotherapy—The use of drugs to destroy cancer cells. A person on chemotherapy may take one drug or a combination of drugs. Most often these drugs are given by vein using intravenous (IV) infusion. Some can be taken by mouth or given as a shot., your doctor will routinely use a test called a complete blood count (CBC)Complete blood count (CBC)—The CBC is a test that determines the number of red blood cells, white blood cells, and platelets in the blood. A CBC is useful to determine if a patient has an infection..2 A CBC measures levels of the three main types of blood cells, which are all made in the bone marrow.

White blood cells

White blood cells

White blood cells protect your body against foreign invaders such as bacteriaBacteria—The smallest forms of life. Bacteria are the most common causes of infections in people with cancer. Some examples of bacterial infection include food poisoning, pneumonia and strep throat.. There are several types of white blood cells in the body. NeutrophilsNeutrophil—The most common type of white blood cell. Neutrophils help the body fight infection. A low white blood cell count usually indicates that the neutrophil count is low. It is easier to get an infection and harder to recover from an infection when the number of neutrophils in the bloodstream is low., a specific type of white blood cell, help protect against and fight certain types of infectionInfection—An invasion of microorganisms such as bacteria or viruses that have the ability to multiply and cause disease..2 The number of neutrophils circulating in your body is referred to as your absolute neutrophil count (ANC)Absolute neutrophil count (ANC)—ANC refers to the number of neutrophils present in the blood. Neutrophils are particularly important because they defend our bodies against certain types of infection., which provides a measure of your body’s ability to fight infection. If your ANC falls below normal, you may have a condition called neutropenia.1


Red blood cells

Red blood cells

Your body needs oxygen to release energy and keep your organs and tissues healthy. Red blood cells carry oxygen throughout your body using a substance called hemoglobin (hee-mo-glow-bin), also known as Hb. When carrying oxygen, hemoglobinHemoglobin (Hb)—The part of the red blood cell that carries oxygen. A person with a low hemoglobin level may have anemia. Hemoglobin is sometimes written as Hb or Hgb on CBC reports. is the protein that makes your blood red. It also contains iron, which holds the oxygen that is delivered to organs and tissues throughout your body by the red blood cells.3 A blood test called a hematocritHematocrit (Hct)—A blood test that measures the number of red blood cells in the bloodstream. The lower the hematocrit, the lower the number of red blood cells in the blood. A person with a low hematocrit may have anemia. Hematocrit is sometimes written as Hct on CBC reports. (hee-mat-oh-crit), or Hct, measures the number of red blood cells in the bloodstream.4 If your Hb or Hct level is too low, you may have anemiaAnemia—Anemia is a lower-than-normal number of red cells in the blood. Red blood cells are important because they carry oxygen from the lungs to all other cells in the body. Shortness of breath, fatigue, and weakness are signs of anemia. (ah-nee-mee-ah), which can make you feel tired.2


Platelets

Platelets

PlateletsPlatelets—A type of cell made in the bone marrow. The main function of platelets is to aid in clotting the blood following an injury. help your body stop bleeding by forming clots. People with a low platelet count, a condition called thrombocytopeniaThrombocytopenia—A condition resulting from an abnormally low number of platelets (thrombocytes) circulating in the blood. Bleeding and/or bruising may occur if the platelet count is especially low. (throm-bo-sy-toh-pee-nee-ah), may experience excessive bleeding or bruising.2


Doctors often measure your CBC regularly before and during your chemo to assess your risk of infection.

Below is a sample chart of normal ranges to help you track your own blood counts. Note that different labs may use different ranges.

UNDERSTANDING YOUR BLOOD COUNTS
Normal Ranges*: Male Normal Ranges*: Female
White Blood Cells (WBCs) 5.0–10.0 x 109/L 5.0–10.0 x 109/L
Red Blood Cells (RBCs) 4.7–6.1 x 1012/L 4.2–5.4 x 1012/L
Neutrophils 2.5–8.0 x 109/L 2.5–8.0 x 109/L
Hemoglobin (Hb or Hgb) 14–18 g/dL 12–16 g/dL
Hematocrit (Hct) 0.42-0.52 0.37-0.47
Platelets (Pls) 150–400 x 109/L 150–400 x 109/L

L= liter
g/dL = grams per deciliter
*A CBC may include additional blood cell counts not included in this table. Normal ranges may vary by lab, race, and age.

Your doctor may measure your CBC regularly to assess your risk of infection.

LEARN ABOUT HELPING TO PROTECT AGAINST INFECTION »

Indication

Neulasta® (pegfilgrastim) is a prescription medication used to reduce the risk of infection (initially marked by fever) in patients with some tumors receiving strong chemotherapy that decreases the number of infection-fighting white blood cells.

Important Safety Information

Who should not take Neulasta® (pegfilgrastim)?
Do not take Neulasta® (pegfilgrastim) if you have had an allergic reaction to Neulasta® (pegfilgrastim) or to NEUPOGEN® (Filgrastim).

What should I tell my health care provider before taking Neulasta® (pegfilgrastim)?
If you have a sickle cell disorder, make sure your doctor knows about it before using Neulasta® (pegfilgrastim).

What are possible serious side effects of Neulasta® (pegfilgrastim)?
  • Spleen Rupture. Your spleen may become enlarged and can rupture while taking Neulasta® (pegfilgrastim). A ruptured spleen can cause death. The spleen is located in the upper left section of your stomach area. Call your doctor right away if you have pain in the left upper stomach area or left shoulder tip area. This pain could mean your spleen is enlarged or ruptured.
  • A serious lung problem called acute respiratory distress syndrome (ARDS). Call your doctor or seek emergency care right away if you have shortness of breath, trouble breathing, or a fast rate of breathing.
  • Serious Allergic Reactions. Neulasta® (pegfilgrastim) can cause serious allergic reactions. These reactions can cause shortness of breath, wheezing, dizziness, swelling around the mouth or eyes, fast pulse, sweating, and hives. If you start to have any of these symptoms, call your doctor or seek emergency care right away. If you have an allergic reaction during the injection of Neulasta® (pegfilgrastim), stop the injection. Call your doctor right away.
  • Sickle Cell Crises. You may have a serious sickle cell crisis if you have a sickle cell disorder and take Neulasta® (pegfilgrastim). Serious and sometimes fatal sickle cell crises can occur in patients with sickle cell disorders receiving Filgrastim, a medicine similar to Neulasta® (pegfilgrastim). Call your doctor right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.

What are the most common side effects of Neulasta® (pegfilgrastim)?
The most common side effect you may experience is aching in the bones and muscles. If this happens, it can usually be relieved with a nonaspirin pain reliever, such as acetaminophen.

What important information do I need to know about receiving Neulasta® (pegfilgrastim)?
  • Occasionally pain and redness may occur at the injection site. If there is a lump, swelling, or bruising at the injection site that does not go away, talk to the doctor.
  • Neulasta® (pegfilgrastim) should only be injected on the day the doctor has determined and should not be injected until approximately 24 hours after receiving chemotherapy.
  • The needle cover on the single-use prefilled syringe contains dry natural rubber (latex), which should not be handled by persons sensitive to this substance.

If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For more information, please see the Neulasta® Patient Product Information and Prescribing Information.

* Individual cancer patients depicted on this website are compensated spokespeople for Amgen, Inc.

References:

  1. Wujcik D. Infection. In: Groenwald SL, Goodman M, Frogge MH, Yarbro CH, eds. Cancer Symptom Management. Boston, Mass: Jones &
    Bartlett Publishers; 1996:289-304.
  2. Chemotherapy and you. National Cancer Institute website. Update May 2007. NIH Publication No. 07-7156. Available at: http://www.cancer.gov/cancertopics/chemotherapy-and-you.pdf. Accessed March 2, 2011.
  3. Dictionary of cancer terms—definition of hemoglobin. National Cancer Institute website. http://nci.nih.gov/dictionary?CdrID=45108.
    Accessed March 2, 2011.
  4. Chemotherapy principles: an in-depth discussion. American Cancer Society website. Updated September 28, 2010. http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Chemotherapy/ChemotherapyPrinciplesAnIn-depthDiscussionoftheTechniquesanditsRoleinTreatment/chemotherapy-principles-chemo-side-effects-bone-marrow-suppression. Accessed March 2, 2011.
  5. Pagana KD, Pagana TJ. Mosby's Manual of Diagnostic and Laboratory Tests. St Louis, Mo: Mosby; 1998.