Pegfilgrastim (Neulasta®)

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

This medication can cause severe bone, joint, and/or muscle pain. This can happen when you start the medication to a few months after. Tell your providers about your symptoms and they can give you ways to relieve pain. If you have pain in your hip, thigh, and groin, it can be an atypical femur fracture. This is a type of fracture that is caused by certain medications. Tell your providers right away about any new pain in this area.

Some people may have an allergic reaction to this medication. Signs of an allergic reaction are:

• Shortness of breath or trouble breathing.
• Chest pain.
• Rash.
• Itching.
• Flushing (reddening of the skin, often on the face, neck, or chest).
• A drop in blood pressure (you may feel lightheaded, dizzy, or weak).

If you have any of these signs while you are getting an infusion, tell your provider right away. The infusion will be slowed down or stopped. Depending on your reaction, you may still be able to get the medication if you are given medicine to prevent a reaction or if the medication is given at a slower rate.

This medication can cause kidney problems, like an increased creatinine level. Your provider may monitor for kidney problems with blood tests. Symptoms may be:

• Less urine output than normal.
• Blood in the urine.
• Swelling in the ankles.
• Loss of appetite.

Tell your provider if you have any of these symptoms.

Capillary leak syndrome is when blood and parts of your blood leak out of your blood vessels and into your muscles and open spaces in your body. This can cause low blood pressure (hypotension) and can stop your organs from working correctly. Symptoms may be:

• A sudden drop in blood pressure.
• Weakness.
• Fatigue.
• Sudden swelling of the arms, legs, or other parts of the body.
• Nausea.
• Lightheadedness.

If you have any of these symptoms, tell your provider right away.

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor. 

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. 
• Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks. 

A secondary cancer happens as a result of cancer treatment for another cancer. This is rare, but you should know your risk. Secondary cancers can be related to chemotherapy and other anti-cancer medications. Often, a secondary cancer is a blood cancer. This can happen years after treatment and is often related to repeated treatments or high doses. Your provider will watch your labs closely. They may suggest you have a blood test called a complete blood count with differential. This is often done each year if you had high risk therapies.