Class: Supportive care

Generic Name: Filgrastim (fil-GRASS-tim), G-CSF, granulocyte – colony stimulating factor
Trade Name: Neupogen®

How is this drug used? Neupogen® is FDA approved to decrease the risk of infection in patients with non-myeloid cancers being treated with chemotherapy associated with febrile neutropenia (low levels of white blood cells accompanied by a fever), to decrease the duration of neutropenia with or without fever in patients with acute myeloid leukemia following chemotherapy treatment, and for stimulating the production of white blood cells prior to bone marrow/stem cell transplantation. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Neupogen® belongs to a group of drugs called colony stimulating factors. Neupogen® stimulates the growth of neutrophils, a type of white blood cell, which are important immune cells that fight infection caused by bacteria, viruses or fungus. Neutrophils can be damaged by chemotherapy and leave patients susceptible to severe infection. Neupogen® works by binding to areas on immature blood cells, which stimulates the blood cells to grow, reproduce and mature into neutrophils. Neupogen® is also used to produce blood cells prior to bone marrow or stem cell transplantation, so that a larger number can be collected prior to treatment and used for infusion following treatment.

How is Neupogen® typically given (administered)? Neupogen® is given as an injection under the skin (subcutaneous) or rarely into a vein (intravenous).  Some patients will be allowed to give themselves injections of Neupogen® at home.

How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with Neupogen®.  Typically, blood will be drawn to check levels of blood cells.

Patients will also be monitored for allergic-type reactions to Neupogen®, although this is uncommon. Patients experiencing skin abnormalities, difficulty in breathing, wheezing, facial swelling, rapid heart rate or dizziness should contact their healthcare provider immediately.  Patients’ lung function will also be monitored, as Neupogen® may cause respiratory distress. If patients experience fever and difficulty breathing, they should tell their healthcare provider immediately. In addition, an uncommon side effect that may occur with treatment with Neupogen® is splenic rupture. Patients experiencing severe abdominal pain or shoulder tip pain should contact their healthcare provider immediately.

What are the most common side effects associated with treatment with Neupogen®?

• Bone pain
• Tenderness at the site of injection
• Abnormalities in some blood test levels
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What can patients do to help alleviate or prevent discomfort and side effects?

• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)

Are there any special precautions patients should be aware of before starting treatment?

• If Neupogen® is being administered at home, patients should make sure that they know how to safely store the drug and dispose of needles.
• Patients should ensure that they have their blood drawn and evaluated as directed by their doctor – important information, including responses to Neupogen® as well as to therapy, is obtained from these blood tests.
• Neupogen® should be kept refrigerated. Patients may take Neupogen® out of the refrigerator approximately 30 minutes prior to administration.
• Patients should not shake vials of Neupogen®.
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?

• Signs of splenic rupture – abdominal or shoulder tip pain
• Signs of an allergic reaction – skin abnormalities (rash, hives), difficulty in breathing, wheezing, rapid heart rate or dizziness, facial swelling, decreased blood pressure
• Signs of pulmonary reaction – fever and difficulty breathing
• Yellowing of skin or eyes?
• Swelling of ankles or feet?
• Signs of infection (fever, chills, cough, sore throat, redness, swelling)

What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Copyright © 2010 CancerConnect Last updated 07/10.

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