Filgrastim is used to treat neutropenia (lack of certain white blood cells) in patients receiving certain cancer medications, undergoing a bone marrow transplant, or caused by other conditions.

Neupogen, Zarxio, and Nivestym can be used in a procedure called leukapheresis, where white blood cells needed for a stem cell transplant are removed from the body.

Neupogen is also used in patients who have been exposed to a certain amount of radiation.

Filgrastim may also be used for purposes not listed in this medication guide.

Filgrastim can cause a serious lung problem called acute respiratory distress syndrome (ARDS) and a rare but serious side effect called capillary leak syndrome. Call your doctor or seek emergency medical attention right away if you have fever with shortness of breath or rapid breathing, stuffy or runny nose followed by tiredness, thirst, decreased urination, and sudden swelling or weight gain.

Filgrastim can cause your spleen to become enlarged and rupture (tear). Call your doctor right away if you have left-sided upper stomach pain or left shoulder pain.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Filgrastim is injected under the skin or into a vein. A healthcare provider may teach you or your caregiver how to properly use this medication at home.

Doses are based on weight. Your dose may change if you gain or lose weight.

Your healthcare provider will show you where to inject filgrastim. Do not inject into the same place two times in a row.

Do not inject into areas where the skin is tender, bruised, red, or hard. Avoid injecting into skin that has scars or stretch marks.

Do not change your dose or stop using a medicine without your doctor's advice.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes. Do not switch brand forms without your doctor's advice.

Ask your doctor or pharmacist if you don't understand how to use an injection.

Prepare an injection only when you are ready to give it. Call your pharmacist if the medicine looks cloudy, has changed colors or has particles in it.

Do not reuse a needle or syringe. Place them in a puncture-proof "sharps" container and dispose of it following state or local laws. Keep out of the reach of children and pets.

Your blood will need to be tested often. You may need medical tests to help determine how long you should use filgrastim.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using filgrastim.

Store filgrastim in the original container in a refrigerator, away from light. Do not freeze and do not shake.

Do not warm the medicine with hot water, sunlight, or a microwave.

Take the medicine out of the refrigerator and let it reach room temperature for 30 minutes before using.

Do not leave Neupogen, Nivestym or Releuko out for longer than 24 hours. Do not leave Zarxio out for longer than 4 days.

Throw away a prefilled syringe or vial (bottle) after one use, even if there is still medicine left inside.

You should not use filgrastim if you are allergic to filgrastim or other granulocyte colony stimulating factor such as pegfilgrastim, tbo-filgrastim, sargramostim, or eflapegrastim.

Using filgrastim may increase your risk of developing myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) if you have certain medical conditions. Ask your doctor about this risk.

Tell your doctor if you have or have ever had:

• sickle cell anemia (a hemoglobin blood cell disorder);

• latex allergy;

• radiation treatment; or

• kidney disease.

It is not known if filgrastim will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Ask a doctor if it is safe to breastfeed while using this medicine.

Call your doctor for instructions if you miss a dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Get emergency medical help if you have signs of an allergic reaction: hives, sweating, rash, dizziness, fast heart rate, wheezing, difficult breathing, swelling of your face, lips, tongue, or throat.

Filgrastim can cause a serious lung problem called acute respiratory distress syndrome (ARDS) and a rare but serious side effect called capillary leak syndrome. Call your doctor or seek emergency medical attention right away if you have fever with shortness of breath or rapid breathing, stuffy or runny nose followed by tiredness, thirst, decreased urination, and sudden swelling or weight gain.

Filgrastim can cause your spleen to become enlarged, and it could rupture (tear). Call your doctor right away if you have left-sided upper stomach pain or left shoulder pain.

Some side effects may occur during the injection. Tell your medical caregiver if you feel dizzy, nauseated, light-headed, itchy, sweaty, or have a headache, chest tightness, back pain, trouble breathing, or swelling in your face.

Filgrastim may cause serious side effects. Call your doctor at once if you have:

• easy bruising, unusual bleeding, purple or red spots of your skin or under your skin;

• fever, tiredness, stomach pain, back pain;

• signs of sickle cell anemia crisis--pain or difficulty breathing;

• inflammation of your blood vessels--numbness or tingling, skin rash, fever, headache, body aches, night sweats, weight loss, feeling or weak or tired; or

• kidney problems--swelling, urinating less, feeling tired or short of breath.

Common side effects of filgrastim may include:

• fever, pain, cough, trouble breathing;

• nosebleeds;

• anemia (low red blood cells);

• bone pain;

• diarrhea;

• headache;

• numbness; or

• rash, hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Do not use filgrastim within 24 hours before or after you receive chemotherapy, or within 24 hours after a bone marrow transplant.

Other drugs may affect filgrastim, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.