Neulasta (Pegfilgrastim) is used to reduce the chance of infection in people who have certain cancers and are also receiving chemotherapy medications, including taxotere for men being treated for advanced prostate cancer.
Chemotherapy is designed to kill fast growing cells. However, it can’t tell the difference between cancer cells and fast-growing healthy cells, including red and white blood cells. (This is why men can lose their hair and have damage to their nails since they are among the faster growing of our healthy cells). As a result, one of the most serious potential side effects of taxotere for men with advanced prostate cancer is to develop a low white blood cell count (neutropenia). Developing neutropenia can place men at risk for infections which can cause interruptions in receiving their chemotherapy on schedule.
Neulasta is a white blood cell booster to help support your natural defenses and help reduce the risk of infection. Neulasta is in a class of medications called colony stimulating factors which works by helping the body make more neutrophils by stimulating the bone marrow. These white blood cells help the body fight infections.
Neulasta comes as a solution (liquid) which is injected subcutaneously (under the skin). It is usually given as a single dose for each chemotherapy cycle, no sooner than 24 hours after the last dose of chemotherapy of the cycle is given and more than 14 days before beginning the next chemotherapy cycle.
Neulasta may be given to you by a healthcare provider, or you may be told to inject the medication yourself at home. If you will be injecting Neulasta at home follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. It is vital that you use it exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor and never shake the bottle. Don’t forget to ask your healthcare professional how to dispose of the used syringes and needles.
As with all medications there comes with them a risk of significant side effects. They include:
• 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 Neulasta. Call your doctor right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.
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 non-aspirin pain reliever, such as acetaminophen.
What else 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. As with all drugs you are encouraged to report negative side effects of prescription drugs to the FDA. You can do this by going to: www.fda.gov/medwatch or by calling 1-800-FDA-1088.
How to use Neulasta
• Read the Patient Information Leaflet provided by your pharmacist before you start using Neulasta and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.
• Avoid shaking this medication; doing so may make the drug ineffective.
• Remove the medication from the refrigerator 30 minutes before you inject it to allow it to reach room temperature.
• Inject this medication under the skin (subcutaneously) usually once during each chemotherapy cycle, or as directed by your doctor.
• The dosage is usually one 6 milligram injection, but it may be adjusted for small adults (weighing less than 100 pounds or 45 kilograms).
• Do not give this drug during the period 14 days before to 1 day after your chemotherapy. Giving this drug during this time may increase your risk of certain side effects. Consult your doctor for details.
• If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.
• Choose a new injection site each time you give yourself a dose. This will help prevent soreness. Never inject Neulasta into skin that is tender, red, bruised, and hard, or has scars or stretch marks.
Joel T. Nowak, M.A., M.S.W.