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Pegfilgrastim is used to prevent infection in people with low levels of white blood cells called neutrophils. It stimulates the bone marrow to make more neutrophils, which help fight infection in the body. A common side effect is pain in the bones, arms, and legs. Call your health care provider right away if you have pain in your left shoulder or left upper stomach area, trouble breathing, reduced need to pee, bruising or bleeding, or low blood pressure.

Uses

What is pegfilgrastim used for?

Pegfilgrastim is commonly used to help prevent infection in people who have low levels of white blood cells called neutrophils, which is known as neutropenia. Neutropenia can be caused by certain medical conditions and types of chemotherapy or radiation.

Pegfilgrastim may also be used for other conditions as determined by your health care provider.

How does pegfilgrastim work (mechanism of action)?

Pegfilgrastim increases neutrophil levels by stimulating the bone marrow to make more of them. Neutrophils help fight infection in the body.

How is pegfilgrastim supplied (dosage forms)?

Brands and other names

  • Fulphila
  • Fylnetra
  • Neulasta
  • Neulasta Onpro
  • Nyvepria
  • Stimufend
  • Udenyca
  • Udenyca Onbody
  • Ziextenzo

Dosage forms and strengths

  • 6 mg/0.6 mL single-dose prefilled syringe

How should I store pegfilgrastim?

Pegfilgrastim should be stored in a refrigerator, between 36 F and 46 F (2 C and 8 C). Do not freeze. If accidentally frozen, thaw in the refrigerator before using it. Throw away any pegfilgrastim that has been frozen more than one time. Store in a cool, dry place. Keep the medicine in its original container to protect it from light.

Side Effects

What are the most common side effects of pegfilgrastim?

The most common side effects of pegfilgrastim are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Bone pain
  • Pain in the arms or legs

There may be other side effects of pegfilgrastim that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pegfilgrastim?

While less common, the most serious side effects of pegfilgrastim are described below, along with what to do if they happen.

Severe Allergic Reactions. Pegfilgrastim may cause allergic reactions, which can be serious. These reactions can happen again within days of being treated for the first allergic reaction. Stop using pegfilgrastim and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Spleen Enlargement or Rupture. Pegfilgrastim can cause your spleen to get bigger or rupture. A ruptured spleen can cause death. Stop using pegfilgrastim and call your health care provider if you have pain in your left shoulder or left upper stomach area.

Acute Respiratory Distress Syndrome (ARDS). Pegfilgrastim can cause a serious lung problem called ARDS. Stop using pegfilgrastim and call your health care provider if you have trouble breathing, shortness of breath, or fast breathing with or without a fever.

Kidney Damage (Glomerulonephritis). Pegfilgrastim can cause a type of kidney damage called glomerulonephritis. Call your health care provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Difficulty catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

High White Blood Cells (Leukocytosis). Pegfilgrastim can cause the number of white blood cells in your body to be higher than normal, which is called leukocytosis. Your health care provider will check your white blood cells while you are using pegfilgrastim. 

Severely Low Platelet Levels. Pegfilgrastim can cause you to have a severely low level of platelets in your blood, also called thrombocytopenia. Platelets help form blood clots. Having a low level of platelets may increase your risk of bleeding. Tell your health care provider if you have any of the following symptoms of low platelet levels.

  • Easy bruising or bleeding
  • Bleeding that does not stop
  • Nosebleeds

Capillary Leak Syndrome (CLS). Pegfilgrastim may cause capillary leak syndrome (CLS), where protein and fluid leak out of your blood vessels into your body tissues. CLS can be serious or life-threatening. Tell your health care provider right away if you have any of the following symptoms of CLS.

  • Low blood pressure
  • Dizziness, feeling lightheaded, or fainting upon standing
  • Fluid retention
  • Weight gain
  • Shortness of breath

Inflammation of the Aorta (Aortitis). Pegfilgrastim may cause inflammation of your aorta, which is a large blood vessel that brings blood from your heart to the rest of your body. Call your health care provider if you have any of the following symptoms of aortitis.

  • Fever
  • Stomach or back pain
  • Tiredness

Warnings & Precautions

Who should not use pegfilgrastim?

Allergies to Ingredients. People who are allergic to any of the following should not use pegfilgrastim.

  • Filgrastim
  • Fulphila
  • Fylnetra
  • Neulasta
  • Neulasta Onpro
  • Nyvepria
  • Pegfilgrastim
  • Stimufend
  • Udenyca
  • Udenyca Onbody
  • Ziextenzo
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pegfilgrastim products they stock.

What should I know about pegfilgrastim before using it?

Do not use pegfilgrastim unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share pegfilgrastim with other people, even if they have the same condition as you. It may harm them.

Keep pegfilgrastim out of the reach of children. As this medicine should be kept in a refrigerator, take special precautions to keep it away from children who also use the refrigerator.

This medicine is injected under the skin. Make sure that you or a caregiver understands how to properly prepare and use pegfilgrastim. If you have any questions, talk to your health care provider.

Do not shake pegfilgrastim. Do not inject where your skin is thickened or bruised. Rotate injection sites.

Take the pegfilgrastim prefilled syringe out of the refrigerator for 30 minutes and allow it to reach room temperature before use. After you inject your dose, throw away any unused pegfilgrastim. Throw away any pegfilgrastim left out at room temperature for more than 48 hours.

You will need to have your blood tests checked while using pegfilgrastim. Keep all appointments to have your labs checked.

Pegfilgrastim may not work as well if you do not receive the full dose prescribed by your health care provider, which can increase your risk of infection. Call your health care provider right away if you are concerned you did not get your full dose of pegfilgrastim.

If you are using pegfilgrastim because you are getting chemotherapy, use pegfilgrastim at least 14 days before or 24 hours after chemotherapy.

What should I tell my health care provider before using pegfilgrastim?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if pegfilgrastim is right for you.

In particular, make sure that you discuss any of the following.

Breast or Lung Cancer. Pegfilgrastim may increase the risk of a type of cancer called acute myeloid leukemia (AML) or a condition called myelodysplastic syndrome (MDS) in certain people. If you have breast cancer or lung cancer and use pegfilgrastim with chemotherapy and/or radiation therapy, call your health care provider if you become more tired than usual, have easy bruising or bleeding, or get a fever.

Sickle Cell Disorder. Tell your health care provider if you have sickle cell disorder. Pegfilgrastim may cause sickle cell crisis in people who have this condition. Call your health care provider and stop using pegfilgrastim if you have symptoms such as pain or difficulty breathing.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Allergy to acrylic adhesives or latex
  • Kidney problems
  • Upcoming bone scan or test

Pregnancy. It is not known if or how pegfilgrastim could affect pregnancy or harm a fetus. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if pegfilgrastim passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should use pegfilgrastim while breastfeeding.

Interactions

Does pegfilgrastim interact with foods or drinks?

There are no known interactions between pegfilgrastim and foods or drinks.

There are no known interactions between pegfilgrastim and alcohol, but heavy drinking can slow your immune response and make it harder for your body to fight infection and cancer.

Does pegfilgrastim interact with other medicines (drug interactions)?

There are no known interactions between pegfilgrastim and other medicines. Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much pegfilgrastim?

If you or someone else has used too much pegfilgrastim, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of pegfilgrastim?

If you miss a dose, talk to your health care provider about when you should give your next dose.