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Pegfilgrastim (Neulasta®)

Last Modified: March 11, 2012

Pronounced: peg-fil-GRAS-tim
Classification: Colony Stimulating Factor

About Pegfilgrastim

Pegfilgrastim is a type of colony stimulating factor, which is a group of medications that stimulate the production and function of blood cells, including white blood cells, red blood cells and platelets. Granulocyte colony-stimulating factor (G-CSF) is a protein produced by the body to increase production of white blood cells. Pegfilgrastim is a long-acting, man-made version of G-CSF that stimulates white blood cell production, and in particular, neutrophil production. A neutrophil is a type of white blood cell that is responsible for fighting infection and is often decreased during cancer therapy. When the number of these cells drops below 1000/mm3, it is called neutropenia and puts the patient at significant risk of infection. Pegfilgrastim is used to prevent or treat neutropenia related to chemotherapy.

How to Take Pegfilgrastim

Pegfilgrastim is given as an injection 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 and no more than 14 days before beginning the next chemotherapy cycle. Pegfilgrastim should be refrigerated. To lessen the sting of the injection, it should be taken out of the refrigerator 30 minutes ahead of time.

Possible Side Effects of Pegfilgrastim

There are a number of things you can do to manage the side effects of Pegfilgrastim. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Bone or Muscle Pain

Pegfilgrastim stimulates the bone marrow to produce many white blood cells, which can lead to pain in the bones. This pain is often felt in the bones or muscles of the thighs, hips and upper arms. Your healthcare team may not want you to take acetaminophen (Tylenol®) because it can "mask" a fever, so talk to them about what pain relievers you can take.

Irritation or Burning at the Injection Site

Some people experience redness, swelling, or itching at the site of injection. This is usually temporary. The injection is known to sting or burn if given when it is cold. Take the medication out of the refrigerator 30 minutes ahead of time to allow it to come up to room temperature before administration.

Low White Blood Cell Count (Leukopenia or Neutropenia)

Even though you are receiving pegfilgrastim, you may still experience neutropenia, or a low white blood cell count. White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Other Side Effects

Some less common side effects that have been reported include: elevation of liver enzymes, enlarged spleen, and rupture of the spleen, which can present as severe pain in the upper left side of the abdomen or the left shoulder. Call your doctor right away if you experience this pain.

This medication can cause serious allergic reactions or lung problems. Notify your healthcare provider right away if you develop shortness of breath or difficulty breathing, wheezing, swelling around the mouth or eyes, fast pulse, sweating or hives.


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