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Neulasta

Last reviewed on RxList: 4/10/2020
Neulasta Side Effects Center

What Is Neulasta?

Neulasta (pegfilgrastim) is a colony-stimulating factor, a man-made form of a protein that stimulates the growth of white blood cells, used to decrease the incidence of infection, by treating neutropenia, a lack of certain white blood cells caused by receiving cancer chemotherapy.

What Are Side Effects of Neulasta?

Common side effects of Neulasta include:

  • bone pain,
  • pain in your arms or legs, or
  • injection site reactions (bruising, swelling, pain, redness, or a hard lump).

Get medical help right away if you have rare but very serious side effects of Neulasta including:

  • breathing problems (e.g., trouble breathing, shortness of breath, fast breathing).

Dosage for Neulasta

The recommended dosage of Neulasta is a single subcutaneous (under the skin) injection of 6 mg administered once per chemotherapy cycle.

What Drugs, Substances, or Supplements Interact with Neulasta?

Neulasta may interact with lithium (Eskalith, Lithobid, and others). There may be other drugs that can interact with Neulasta.

Neulasta During Pregnancy and Breastfeeding

Tell your doctor about all prescription and over-the-counter medications and supplements you use. Neulasta should be used only when prescribed during pregnancy. It is not known whether this drug passes into breast milk. Consult your doctor before breastfeeding.

Additional Information

Our Neulasta (pegfilgrastim) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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Neulasta Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives, skin rash, sweating; dizziness, warmth or tingly feeling; wheezing, difficulty breathing; swelling of your face, lips, tongue, or throat.

Capillary leak syndrome is a rare but serious side effect of pegfilgrastim. Call your doctor right away if you have signs of this condition, which may include: decreased urination, tiredness, dizziness or light-headed feeling, trouble breathing, and sudden swelling, puffiness, or feeling of fullness.

Call your doctor at once if you have:

  • fever, tiredness, stomach pain, back pain;
  • sudden or severe pain in your left upper stomach spreading up to your shoulder;
  • easy bruising, unusual bleeding, purple or red spots under your skin;
  • rapid breathing, feeling short of breath, pain while breathing;
  • bruising, swelling, or a hard lump where the medicine was injected; or
  • kidney problems--little or no urination, pink or dark urine, swelling in your face or lower legs.

Common side effects may include:

  • bone pain; or
  • pain in your arms or legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Neulasta (Pegfilgrastim)

Neulasta Professional Information

SIDE EFFECTS

The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling:

  • Splenic Rupture [see WARNINGS AND PRECAUTIONS]
  • Acute Respiratory Distress Syndrome [see WARNINGS AND PRECAUTIONS]
  • Serious Allergic Reactions [see WARNINGS AND PRECAUTIONS]
  • Allergies to Acrylics [see WARNINGS AND PRECAUTIONS]
  • Use in Patients with Sickle Cell Disorders [see WARNINGS AND PRECAUTIONS]
  • Glomerulonephritis [see WARNINGS AND PRECAUTIONS]
  • Leukocytosis [see WARNINGS AND PRECAUTIONS]
  • Capillary Leak Syndrome [see WARNINGS AND PRECAUTIONS]
  • Potential for Tumor Growth Stimulatory Effects on Malignant Cells [see WARNINGS AND PRECAUTIONS]
  • Aortitis [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Neulasta clinical trials safety data are based upon 932 patients receiving Neulasta in seven randomized clinical trials. The population was 21 to 88 years of age and 92% female. The ethnicity was 75% Caucasian, 18% Hispanic, 5% Black, and 1% Asian. Patients with breast (n = 823), lung and thoracic tumors (n = 53) and lymphoma (n = 56) received Neulasta after nonmyeloablative cytotoxic chemotherapy. Most patients received a single 100 mcg/kg (n = 259) or a single 6 mg (n = 546) dose per chemotherapy cycle over 4 cycles.

The following adverse reaction data in Table 2 are from a randomized, double-blind, placebo-controlled study in patients with metastatic or non-metastatic breast cancer receiving docetaxel 100 mg/m2 every 21 days (Study 3). A total of 928 patients were randomized to receive either 6 mg Neulasta (n = 467) or placebo (n = 461). The patients were 21 to 88 years of age and 99% female. The ethnicity was 66% Caucasian, 31% Hispanic, 2% Black, and < 1% Asian, Native American, or other.

The most common adverse reactions occurring in ≥ 5% of patients and with a between-group difference of ≥ 5% higher in the pegfilgrastim arm in placebo-controlled clinical trials are bone pain and pain in extremity.

Table 2. Adverse Reactions with ≥ 5% Higher Incidence in Neulasta Patients Compared to Placebo in Study 3

Body System
Adverse Reaction
Placebo
(N = 461)
Neulasta 6 mg SC on Day 2
(N = 467)
Musculoskeletal and connective tissue disorders
  Bone pain26%31%
  Pain in extremity4%9%

Leukocytosis

In clinical studies, leukocytosis (WBC counts > 100 x 109/L) was observed in less than 1% of 932 patients with non-myeloid malignancies receiving Neulasta. No complications attributable to leukocytosis were reported in clinical studies.

Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to pegfilgrastim in the studies described below with the incidence of antibodies in other studies or to other products may be misleading.

Binding antibodies to pegfilgrastim were detected using a BIAcore assay. The approximate limit of detection for this assay is 500 ng/mL. Pre-existing binding antibodies were detected in approximately 6% (51/849) of patients with metastatic breast cancer. Four of 521 pegfilgrastim-treated subjects who were negative at baseline developed binding antibodies to pegfilgrastim following treatment. None of these 4 patients had evidence of neutralizing antibodies detected using a cell-based bioassay.

Postmarketing Experience

The following adverse reactions have been identified during post approval use of Neulasta. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

  • Splenic rupture and splenomegaly (enlarged spleen) [see WARNINGS AND PRECAUTIONS]
  • Acute respiratory distress syndrome (ARDS) [see WARNINGS AND PRECAUTIONS]
  • Allergic reactions/hypersensitivity, including anaphylaxis, skin rash, urticaria, generalized erythema, and flushing [see WARNINGS AND PRECAUTIONS]
  • Sickle cell crisis [see WARNINGS AND PRECAUTIONS]
  • Glomerulonephritis [see WARNINGS AND PRECAUTIONS]
  • Leukocytosis [see WARNINGS AND PRECAUTIONS]
  • Capillary Leak Syndrome [see WARNINGS AND PRECAUTIONS]
  • Injection site reactions
  • Sweet’s syndrome (acute febrile neutrophilic dermatosis), cutaneous vasculitis
  • Application site reactions (including events such as application site hemorrhage, application site pain, application site discomfort, application site bruise, and application site erythema) have been reported with the use of the on-body injector for Neulasta.
  • Contact dermatitis and local skin reactions such as rash, pruritus, and urticaria have been reported with the use of the on-body injector for Neulasta, possibly indicating a hypersensitivity reaction to the adhesive.
  • Aortitis [see WARNINGS AND PRECAUTIONS]
  • Alveolar hemorrhage

Read the entire FDA prescribing information for Neulasta (Pegfilgrastim)

Related Resources for Neulasta

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Read the Neulasta User Reviews »

© Neulasta Patient Information is supplied by Cerner Multum, Inc. and Neulasta Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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