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Pegfilgrastim (Neulasta)

pegfilgrastim

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What Is Pegfilgratism (Neulasta)?

Pegfilgrastim (pronounced [peg fil GRA stim]), which is also known by the brand name, Neulasta, is a ahente ng hematopoietic that is used to treat neutropenia. Neulasta was the first medication produced based on the active element pegfilgrastim. Pegfilgrastim is not a hazardous drug, nor is it a form of chemotherapy. Several different biosimilars based on Neulasta have been produced to date.

What Is Neutropenia?

Neutropenia occurs when you have too few neutrophils, a type of white blood cell that helps our bodies fight off infections. Having neutropenia indicates a higher risk of developing serious bacterial and fungal infections. Neutropenia is a very common side effect of cancer patients undergoing chemotherapy.

Febrile neutropenia is a more serious condition where the neutrophil count drops to a dangerously low level where there are not enough white blood cells to fight off infections. This could potentially lead to life-threatening infections.

Mekanismo ng Pagkilos

Ang Pegfilgrastim ay isang blood cell colony-stimulating agent (CSA) at matagumpay na ginamit ng mga pasyente ng cancer upang pasiglahin ang paglaki ng mga white blood cell, mas partikular na mga neutrophil. Ginagawa ito sa pamamagitan ng pagpapasigla sa paggawa ng mga neutrophil nang direkta mula sa utak ng buto.

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How is Neulasta Used?

Magagamit na Mga Pormulasyon

Available lang ang Neulasta bilang subcutaneous (sa ilalim ng balat) na iniksyon o bilang isang espesyal na patch ng balat (kilala rin bilang on-body injector [OBI] o Neulasta OnPro). Ang Neulasta injection ay available bilang single-use na prefilled syringe para sa subcutaneous injection sa isang dosis na 6 mg/0.6 ml.

Pegfilgrastim (Neulasta)

Subcutaneous Injection

Ang mga lugar ng pag-iniksyon ay maaaring kabilang ang itaas na bahagi ng puwit, harap ng mga hita, ibabang bahagi ng tiyan (2 pulgada ang layo mula sa pusod), o ang itaas na panlabas na mga braso. Huwag mag-iniksyon sa mga lugar kung saan ang balat ay malambot, bugbog, pula, nangangaliskis, o matigas, at iwasan ang mga lugar na may mga peklat o mga stretch mark. Pagkatapos ng iniksyon, huwag kuskusin ang lugar ng iniksyon. Huwag hawakan ang prefilled syringe kung ikaw ay allergic sa latex, at huwag mag-imbak ng hindi nagamit na gamot sa prefilled syringe para magamit sa ibang pagkakataon. Hindi mo dapat subukang bigyan ang iyong sarili ng subcutaneous injection hanggang sa matanggap mo ang naaangkop na pagsasanay mula sa iyong healthcare provider.

Specialized Skin Patch (On-Body Injector, OBI)

Ang Neulasta OnPro Patch ay isang sistema na ipo-program ng iyong health care provider para awtomatikong maihatid ang gamot sa katawan mga 27 oras pagkatapos ng chemotherapy. Ito ay maginhawa para sa maraming mga pasyente dahil nakakatipid sila ng paglalakbay sa opisina ng doktor sa araw pagkatapos matanggap ang chemotherapy.

Missed Dose

If you miss a dose, contact your physician immediately to reschedule. If the OBI malfunctions and fails to deliver medication as scheduled, consult your physician immediately to schedule for the administration of a manual injection as soon as possible.

Storage

Store Neulasta in the refrigerator and avoid freezing. If frozen, thaw in the refrigerator before use. Neulasta should be thawed (taken out of the refrigerator) for 30 minutes at room temperature before injecting. It can be left at room temperature for up to 48 hours. Do not shake the vials, and keep them protected from light by storing them in their original containers. The OBI kit should be kept refrigerated until 30 minutes prior to use and should not be left at room temperature for more than 12 hours.

Disposal

Dispose of Neulasta if it has been left at room temperature for more than 48 hours for the syringe or 12 hours for the OBI kit. Dispose of Neulasta if it has been frozen more than once. After injection, dispose of any unused Neulasta left in the prefilled syringe. Be sure to dispose of the pre-filled syringes in an FDA-cleared sharps disposal container (not in the household trash).

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Ano ang Dapat Iwasan Habang Kumukuha ng Pegfilgrastim

Habang nasa pegfilgrastim therapy, dapat mong sundin ang ilang mga pag-iingat. Palaging sabihin sa iyong manggagamot ang tungkol sa anumang gamot na iniinom mo na. Huwag uminom ng anumang gamot o gamot (kahit na mga herbal o over-the-counter na gamot) nang walang paunang pahintulot mula sa iyong manggagamot o parmasyutiko, dahil maaaring may mga pakikipag-ugnayan sila sa Neulasta. Iwasan ang pag-inom ng Neulasta sa loob ng 14 na araw bago o 24 na oras pagkatapos magkaroon ng chemotherapy.

Pregnancy and Neulasta

Pregnant women, women who are planning to become pregnant, and breastfeeding women must consult a physician prior to initiating Neulasta. The risk to the fetus or baby is unknown.

Mga side effect

As with any other medication, you may encounter side effects while taking pegfilgrastim. A few things to keep in mind are:

  • You may not have all the side effects listed below. Many people may experience little to no side effects.
  • The severity of side effects may vary from person to person, so do not compare your side effects with other people’s experiences.
  • Most of the side effects will improve when therapy is discontinued.
  • Do not hide any symptoms; when you feel any discomfort, do not hesitate to tell your physician or pharmacist about it.

Note: The side effects listed below are not a comprehensive list of all side effects. Talk to your doctor if you have questions. 

Some of the more serious side effects of Neulasta are:

Injection-site Pain

Most needles are painful, but Neulasta is especially known for causing some pain in the injection site, even for a while after the injection is complete. This is also often accompanied by mild bruising, swelling, or redness at the injection site.

Injection site pain can be controlled using over-the-counter painkillers such as Tylenol or Motrin, but usually, they resolve on their own within a few days. Consult your doctor or pharmacist prior to starting any new over-the-counter therapies.

Bone and Muscle Aches

This is the most common side effect of Neulasta since it stimulates the bone marrow (a spongy substance found inside of bone), causing it to swell and cause potential bone pain. It commonly starts about 1 to 2 days after receiving a Neulasta dose and can last up to a week, depending on the person.

Bone or muscle pains can be controlled using over-the-counter painkillers such as Tylenol or Motrin. Consult your doctor or pharmacist before starting any new over-the-counter therapies.

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Thrombocytopenia, Leukocytosis

It is essential to keep up with regular blood tests, especially the complete blood count test (CBC). The CBC blood test is capable of detecting potential side effects of Neulasta, including leukocytosis (high white blood cells level) and thrombocytopenia (low platelet count). Contact your physician if any unusual bleeding or bruising occurs.

Lung Problem Called Acute Respiratory Distress Syndrome (ARDS)

Contact a physician or get emergency medical help right away if you have shortness of breath with or without a fever, trouble breathing, or a fast rate of breathing.

Kidney Injury

Call your doctor right away if you experience puffiness in your face or ankles, blood in your urine, or brown-colored urine. Also, contact your doctor if you notice you urinate less than usual.

Capillary Leak Syndrome (CLS)

Neulasta can cause fluid to leak from blood vessels into your body’s tissues. CLS can quickly cause you to have symptoms that may become life-threatening. Get emergency medical help right away if you develop any of the following symptoms: swelling or puffiness, urinating less often, trouble breathing, swelling of the abdominal area, and feeling of fullness, dizziness, or faintness.

Inflammation of Blood Vessels

Contact your physician if you develop purple spots or redness on your skin.

Rupture of the Spleen

A ruptured spleen is one of the most severe side effects of Neulasta. The spleen may become enlarged and may possibly rupture, which can be fatal. Call your doctor right away if you have pain in the upper left stomach (abdomen) or your left shoulder.

Less severe side effects can include:

  • Pinagpapawisan
  • Maitim na Ihi

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Mga pag-iingat

Maliban kung inaprubahan ng iyong manggagamot, ang pegfilgrastim ay karaniwang hindi inirerekomenda para sa:

  • Mga pasyenteng may allergy sa human granulocyte colony-stimulating factor (CFS) tulad ng filgrastim o mga produktong pegfilgrastim. Ang mga reaksiyong alerdyi ay maaaring maging sanhi ng pantal sa buong katawan, igsi ng paghinga, paghinga, pagkahilo, pamamaga sa paligid ng iyong bibig o mata, mabilis na tibok ng puso, at pagpapawis. Kung mayroon kang alinman sa mga sintomas na ito, ihinto ang paggamit ng Neulasta, at tawagan ang iyong doktor o humingi kaagad ng tulong na pang-emerhensiya.
  • Mga pasyenteng may sickle cell disorder. Ang paggamit ng Neulasta ay maaaring humantong sa isang kundisyong tinatawag na sickle cell crisis, na maaaring nagbabanta sa buhay at nangangailangan ng paghinto ng Neulasta.
  • Mga pasyente na tumatanggap ng radiation therapy. Maaaring pataasin ng Neulasta ang panganib na magkaroon ng precancerous na kondisyon na tinatawag na myelodysplastic syndrome (MDS) o isang uri ng kanser sa dugo na tinatawag na acute myeloid leukemia (AML).

Mga FAQ

Is Neulasta a chemo agent?

No, it is not a chemotherapy agent. Instead, it helps treat a major side effect of chemotherapy called neutropenia (low white blood cell count). Chemotherapy drugs are directed at combating your cancer cells, while Neulasta is designed to combat the after-effects of a chemotherapy session.

How is Neulasta taken?

Neulasta is only available as an injection. It can be injected subcutaneously (under the skin) or as a specialized skin patch (also known as an on-body injector [OBJ] or Neulasta OnPro) programmed by a healthcare provider. You should not attempt to give yourself a subcutaneous injection until you have received the appropriate training from your healthcare provider.

MGA SANGGUNIAN:

Burris, H. A., Belani, C. P., Kaufman, P. A., Gordon, A. N., Schwartzberg, L. S., Paroly, W. S., Shahin, S., Dreiling, L., & Saven, A. (2016, September 21). Pegfilgrastim on the Same Day Versus Next Day of Chemotherapy in Patients With Breast Cancer, Non–Small-Cell Lung Cancer, Ovarian Cancer, and Non-Hodgkin’s Lymphoma: Results of Four Multicenter, Double-Blind, Randomized Phase II Studies. Journal of Oncology Practice. 2010 6:3, 133-140. Retrieved November 5, 2021, from https://ascopubs.org/doi/10.1200/JOP.091094

Cancer Statistics. (2020, September 25). National Cancer Institute. Retrieved November 5, 2021, from https://www.cancer.gov/about-cancer/understanding/statistics

FastStats. (2021, October 19). Leading Causes of Death. Retrieved November 5, 2021, from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Highlights of Prescribing Information. (2019, April). Food and Drug Administration (FDA). Retrieved November 5, 2021, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/125031s198lbl.pdf

Instructions for Use Neulasta (Pegfilgrastim). (2016, December). Amgen – Neulasta. Retrieved November 5, 2021, from https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/neulasta/neulasta_pfs_ifu.ashx

Neulasta® (pegfilgrastim) Onpro®. (2021). Resources by Amgen. Retrieved November 5, 2021, from https://www.neulasta.com/resources/

Neulasta: Drug Information. (2018, April 30). Breastcancer.Org. Retrieved November 5, 2021, from https://www.breastcancer.org/treatment/druglist/neulasta

Neulasta: Uses, dosage, side effects, warnings. Drugs.com. (n.d.). Retrieved November 4, 2021, from https://www.drugs.com/Neulasta.html.

Pegfilgrastim (Subcutaneous Route) Side Effects – Mayo Clinic. (2021, February 1). Mayo Clinic. Retrieved November 5, 2021, from https://www.mayoclinic.org/drugs-supplements/pegfilgrastim-subcutaneous-route/side-effects/drg-20066866?p=1

Pegfilgrastim. In: Lexi-drugs online [database on the Internet]. Hudson (OH): Lexicomp, Inc.; 2016 [updated 329 Oct 2021; cited 4 Nov 2021]. Available from: http://online.lexi.com

Pegfilgrastim. In: In Depth Answers [database on the Internet]. Greenwood Village (CO): IBM Corporation; 2017 [cited 2021 Nov 4]. Available from: www.micromedexsolutions.com

Weiser, P. P. (2021, May 6). All About Neulasta. Healthline. Retrieved November 5, 2021, from https://www.healthline.com/health/drugs/neulasta#what-it-is

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MEDICALLY REVIEWED NI Dr. Dania Jaradat, PharmD

Dr. Dania Jaradat, PharmD was born and raised in Torrance, California. She graduated from Marshall B. Ketchum University. The most rewarding part of her job is to keep the line between pharmacist and patient open and to educate patients on medication management. In her free time, she enjoys traveling to different countries, spending time with her husband and son, and reading. See Author Biography

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