Chemocare.com
Care During Chemotherapy and Beyond

Neupogen

Generic Name: Filgrastim

Trade Names: Neupogen®, Granix®, Zarxio®

Other Names: G-CSF, granulocyte-colony stimulating factor

Chemocare.com uses generic names in all descriptions of drugs. Neupogen, Granix and Zarxio are trade names for filgrastim. Granulocyte - colony stimulating factor (G-CSF) is another name for filgrastim. In some cases, health care professionals may use the trade name Neupogen, Granix or Zarxio when referring to the generic drug name filgrastim.

Drug type: Filgrastim is a biologic response modifier. It is classified as a colony stimulating factor and a hematopoietic agent. (For more detail, see "How this drug works" section below)

What Filgrastim Is Used For:

  • Filgrastim is used to stimulate the production of granulocytes (a type of white blood cell) in patients undergoing therapy that will cause low white blood cell counts. This medication is used to prevent infection and neutropenic (low white blood cells) fevers caused by chemotherapy.
  • Filgrastim is a support medication. It does not treat cancer.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Filgrastim Is Given:

  • Filgrastim may be given subcutaneous (the layer between the skin and muscle) injection or infused into a vein (intravenous, IV).
  • Filgrastim is generally given on a daily basis. The number of days you receive filgrastim will be prescribed by your doctor.
  • Filgrastim should be refrigerated. Remove from refrigerator 30 minutes before injection. Do not shake the medication. Protect from light.

The amount of filgrastim that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of filgrastim.

  • Most people will not experience all of the filgrastim side effects listed.
  • Filgrastim side effects are often predictable in terms of their onset, duration, and severity.
  • Filgrastim side effects will improve after therapy is complete.
  • Filgrastim side effects may be quite manageable. There are many options to minimize or prevent the side effects of filgrastim.

Filgrastim is a support medication. The following list includes side effects attributed to filgrastim. Other side effects experienced were attributed to the chemotherapy and/or the disease.

The following side effects are common (occurring in greater than 30%) for patients taking filgrastim:

  • Thrombocytopenia (low platelet counts)
  • Nausea
  • Fever
  • Bone pain. Bone pain may be relieved with over the counter medications which includes pain relievers such as NSAIDS (ibuprofen) or antihistamines (claritin). Talk with your doctor before taking any over the counter agents.

These side effects are less common side effects (occurring in about 10-29%) of patients receiving filgrastim:

  • Blood test abnormalities (temporary elevation in lactate dehydrogenase, and alkaline phosphatase). These will return to normal once treatment is discontinued.
  • Tenderness and redness at the site of injection.
  • Petechia (a small red or purple bump, which is caused by bleeding under the skin)
  • Back pain
  • Epistaxis (Nosebleeds)
  • Cough
  • Dyspnea (Shortness of breath)

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
  • Shortness of breath
  • Rapid heart beat
  • Bleeding that does not stop after a few minutes
  • Any new rashes on your skin

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Bone pain that does not go away despite taking recommended pain reliever

Always inform your health care provider if you experience any unusual symptoms.

Filgrastim Precautions:

  • The manufacturer recommends that the first dose of filgrastim be given no sooner than 24 hours after chemotherapy. Your doctor will discontinue therapy with filgrastim when your white blood cell count has reached acceptable levels.
  • Filgrastim may be inadvisable if you have had a hypersensitivity reaction to filgrastim or E. coli-derived proteins.
  • The packaging of some dosage forms may contain latex.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking filgrastim.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use the pregnancy only when benefit to the mother outweighs risk to the fetus).
  • For women: Do not conceive a child (get pregnant) while taking filgrastim. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Talk to your doctor before breast feeding while taking this medication.

Filgrastim Self-Care Tips:

  • If you are performing your own subcutaneous self-injections, remove the syringe from the refrigerator 30 minutes prior to injection. This will reduce local stinging at the injection site.
  • You may experience bone or joint pain as a result of this medication. Ask your healthcare provider if you may take a mild pain medicine to relieve this. Acetaminophen (Tylenol®) may help.
  • Apply a warm compress if you have any pain, redness or swelling at the injection site, and notify your doctor.
  • This medication causes little nausea. But if you should experience nausea, taking anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges, and chewing gum may also help.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty or rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure ot discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Filgrastim:

You will be checked regularly by your health care professional while you are taking filgrastim to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) will be ordered by your doctor.

How Filgrastim Works:

Colony-Stimulating Factors:

Blood cells are made in the body's bone marrow (the soft, sponge-like material found inside bones). There are three major types of blood cells; white blood cells, which fight infection; red blood cells, which carry oxygen and remove waste products from organs and tissues; and platelets, which enable the blood to clot.

Cancer treatments such as chemotherapy and radiation therapy can effect these cells which put a person at risk for developing infections, anemia, and bleeding problems. Colony-stimulating factors are substances that stimulate the production of blood cells and promote their ability to function. They do not directly affect tumors, but though their role in stimulating blood cells, they can be helpful as support of a person's immune system during cancer treatment.

Filgrastim is a growth factor that stimulates the production, maturation, and activation of neutrophils (a type of white blood cell). Filgrastim also stimulates the release of neutrophils from the bone marrow. In patients receiving chemotherapy, filgrastim can accelerate the recovery of neutrophils, reducing the neutropenic phase (the time in which people are susceptible to infections).

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

References:

  1. Neupogen (filgrastim) [prescribing information]. Thousand Oaks, CA: Amgen; July 2015.
  2. Filgrastim. Lexicomp Online® [May 4, 2017]. Lexi-Drugs. Hudson, Ohio; Lexi-Comp, Inc.; May 19, 2017.

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