Pegfilgrastim, Injection peg-fil-GRAS-tim

What are other names for this medicine?

Type of medicine: granulocyte colony stimulating factor; G-CSF

Generic and brand names: pegfilgrastim, injection; Neulasta

What is this medicine used for?

This medicine is given by injection (shot) to treat neutropenia (a condition where the body makes too few white blood cells). Neutropenia can be caused by drugs used to treat cancer.

This medicine may also be used for other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine or to latex
• bone marrow problems
• sickle cell anemia

Also tell your provider if you have recently had any kind of infection or if you are taking radiation therapy or chemotherapy.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant while receiving this medicine. It is not known whether this medicine will harm an unborn baby. Do not breast-feed without your healthcare provider's approval.

How do I use it?

This medicine comes in the form of a liquid in vials or in prefilled syringes. Your healthcare provider will determine the exact dosage. Check the label on the medicine for directions about your specific dose. If your healthcare provider is giving you the shots, keep all your appointments.

This medicine is usually given by subcutaneous injection (shot just under the skin).

Sometimes you can give yourself these shots or have someone at home give them to you. The shots are usually given just under the skin. Use this medicine exactly as your healthcare provider prescribes. Be sure you know how and when to have shots and how much medicine to use. Use sterile, disposable syringes and needles. Use each syringe and needle only once and dispose of them safely, following your healthcare provider's instructions.

Carefully read and follow the directions that come in the package of medicine for preparing and giving the shots. Do not shake the medicine. Do not use the medicine if it is discolored or has particles in it.

Wash your hands before using this medicine. Follow these steps to give yourself the shots:

1. Your healthcare provider will tell you where you can give yourself the shots (abdomen, thigh, upper arm, or other sites). If you are giving the shot in your abdomen, choose a site at least 2 inches away from the belly button. Each time you have a shot, choose a different spot for the shot to lessen irritation.
2. Use an alcohol swab to clean the skin where you will give yourself the shot.
3. Gently pinch up the skin and insert the needle into the skin at a 45° angle. After you insert the needle completely, release your grasp of the skin.
4. Inject all of the solution by gently and steadily pushing down the plunger.
5. After you have given yourself the shot, withdraw the needle and syringe and press an alcohol swab on the spot where the shot was given.
6. Discard the syringe, needle, and drug vial. Use the syringes and needles ONLY ONCE. Throw them away after use. Put used needles in rigid puncture-resistant containers with lids or caps, such as heavy plastic bleach bottles with screw caps. DO NOT throw needles directly into garbage cans or dumpsters.
7. Use only one dose from each vial of medicine. Do not reenter the vial with the needle. Discard unused portions remaining in the vial after the dose has been withdrawn.
8. When you repeat the procedure, use a new syringe and vial. If you are not sure of how to give yourself the shots, ask your healthcare provider or pharmacist for help.

What if I miss a dose?

Contact your healthcare provider if you miss a dose.

What if I overdose?

Symptoms of an acute overdose have not been reported.

What should I watch out for?

You will need to have blood tests regularly to see how this medicine affects you. Keep all appointments for these tests.

This medicine may cause bone or muscle pain. Talk to your healthcare provider about which pain reliever you should use.

This medicine may increase the risk of certain cancers. Talk with your provider about this.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Pain in the upper abdomen or left shoulder, severe bone pain, severe vomiting or diarrhea, continuing fever, fatigue, chest pain, irritation of the mouth, swelling in hands or feet.

Other: Nausea; loss of hair; diarrhea; vomiting; constipation; loss of appetite; muscle or bone pain; weakness; trouble sleeping; dizziness; flushing; headache; bruising; nosebleeds; hair loss; redness, pain or swelling at the injection site.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• lithium (Lithobid)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Keep this medicine in the refrigerator. Do not let it freeze. If accidentally frozen, allow the medicine to thaw in the refrigerator before using. Discard any medicine that is frozen a second time. Do not leave the medicine in direct sunlight.

Before injection, you may keep the medicine at room temperature for up to 48 hours, protected from light. Discard any medicine left at room temperature over 48 hours.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicines in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.