What is Neulasta Uses, warnings & interactions

Medically reviewed by  Jamie Winn, PharmD

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Neulasta (pegfilgrastim) is an injectable prescription medication that is manufactured by Amgen. It was approved by the U.S. Food and Drug Administration (FDA) in 2002 to help reduce your risk of serious infections when taking certain types of cancer treatment. Neulasta is a biological medication, which means it is produced from living organisms. It does not have a generic but is available in biosimilar forms.

If your doctor has prescribed Neulasta to you, you may want to know more about what it is and how it works. Here we’ll explain what Neulasta is used for, how it works, its side effects, and more.

What is Neulasta used for?

Neulasta is a leukocyte growth factor used to lower your risk of infection if you have certain types of cancer such as breast cancer and are receiving chemotherapy medications that are known to cause febrile neutropenia. It is also used to increase survival in patients who have received high doses of radiation.

How does Neulasta work?

Granulocyte-colony stimulating factor (G-CSF) is a hormone that causes a type of white blood cell called neutrophils to grow in your bone marrow. Neulasta is a synthetic version of this G-CSF hormone and works in the same way that natural G-CSF does. G-CSF stimulates your immune system to produce more neutrophils to help fight infections, prevent febrile neutropenia, and shorten the duration you have neutropenia.

What are the most commonly prescribed doses of Neulasta?

Neulasta injection: 6 mg/0.6 ml single-dose prefilled syringe

Neulasta Onpro: 6 mg/0.6 ml single-dose prefilled syringe along with an on-body injector (OBI)

Before taking Neulasta

Before you use Neulasta, tell your healthcare provider about your medical conditions, including:

• Sickle cell disorder
• Kidney problems
• Allergy to latex
• Are pregnant, plan on becoming pregnant, or are breastfeeding

How to take Neulasta

• Read the Full Prescribing Information, Instructions for Use, and Medication Guide that comes with Neulasta.
• This medication can be given as a subcutaneous injection (under the skin) by a healthcare provider or at home by you or a caregiver. You and your caregiver should be shown how to administer Neulasta before you use it.
• Children weighing less than 45 kg (99 lbs) should not be given a dose from a Neulasta prefilled syringe as it cannot be accurately measured.
• If you are prescribed Neulasta because you are receiving chemo, your last dose of Neulasta should be administered at least 14 days before and 24 hours after your dose of chemo.

Neulasta contraindications

Neulasta should not be used if you have had a serious allergic reaction to human granulocyte colony-stimulating factors such as pegfilgrastim or filgrastim or any inactive ingredients in its formulation.

Neulasta warnings

• Neulasta may rarely cause your spleen to rupture. If you develop upper left stomach or shoulder pain, call your doctor right away.
• If you develop acute respiratory distress syndrome (ARDS), Neulasta should be discontinued.
• The on-body injector for Neulasta uses acrylic adhesive. You should use it with caution as it can produce a significant reaction.
• Stop this medication if a sickle cell crisis occurs.
• Your platelets should be monitored while on this medication.
• If you have breast or lung cancer, you should also be monitored for symptoms of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

What drugs should not be taken with Neulasta?

When Neulasta is taken with other medications, it may change how they work or increase the frequency and severity of side effects. You should ask your doctor if any of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take may cause drug interactions with Neulasta.

What are some possible side effects of Neulasta?

The most common side effects of Neulasta seen in clinical trials include:

• Bone pain
• Injection site reactions
• Back pain
• Pain in the extremities (arms and legs)
• Abdominal pain
• Tiredness

Neulasta can sometimes cause more serious side effects, including:

• Severe, life-threatening allergic reactions (hives, swelling of your face or throat, shortness of breath, or trouble breathing)
• Sickle cell crisis
• Decreased platelet count
• Ruptured spleen
• Kidney injury
• Inflammation of your aorta (aortitis)
• Acute respiratory distress syndrome (ARDS)
• Increased white blood cell count
• Capillary leak syndrome (a rare condition that causes tiny blood vessels to leak)

Contact your healthcare professional for medical advice about any possible adverse effects you experience while taking Neulasta. You can report your adverse effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Neulasta alternatives

Your doctor can prescribe other medications if Neulasta is not right for you. Some alternative FDA-approved options include:

• Nyvepria (pegfilgrastim-apgf)
• Fylnetra (pegfilgrastim-pbbk)
• Fulphila (pegfilgrastim-jmdb)
• Udenyca (pegfilgrastim-cbqv)
• Ziextenzo (pegfilgrastim-bmez)
• Neupogen (filgrastim)
• Granix (tbo-filgrastim)

Neulasta FAQs

Can you take Neulasta while you are pregnant or breastfeeding?

Animal and human reproductive studies of the use of filgrastim products showed it was not associated with major birth defects, miscarriage, or adverse outcomes in the mom or fetus. It is not known whether Neulasta is found in human breast milk. It should be used with caution in nursing females. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.

How many hours after chemotherapy do you receive a Neulasta injection?

You will receive a Neulasta injection once during each chemotherapy cycle, at least 24 hours after the cycle’s last dose and 14 days before your first dose of the next cycle.

When do Neulasta’s effects peak?

While Neulasta starts to work right after you receive an injection, its peak effects occur between 16 hours to 5 days.

How long does a Neulasta injection last?

After a 6mg injection of Neulasta, it will typically be eliminated from your bloodstream in 14 days.

How should you store Neulasta?

Neulasta should be stored in its original carton in the refrigerator between 36°F to 46°F (2 °C to 8°C). You should take the prefilled syringe out of the refrigerator 30 minutes prior to using it so it can reach room temperature. Any Neulasta that has been left at room temperature for more than 48 hours should be thrown away.

How much does Neulasta cost?

Currently, there is no generic Neulasta available on the market. The average cost of 1 syringe of Neulasta 6mg/0.6ml is around $8,800. However, you can save on brand-name drugs like Neulasta through NiceRx if eligible for assistance.

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