Neulasta contains the active substance pegfilgrastim. Pegfilgrastim is a protein produced by biotechnology in bacteria called E. coli. It belongs to a group of proteins called cytokines, and is very similar to a natural protein (granulocyte-colony stimulating factor) produced by your own body.

Neulasta is used to reduce the duration of neutropenia (low white blood cell count) and the occurrence of febrile neutropenia (low white blood cell count with a fever) which can be caused by the use of cytotoxic chemotherapy (medicines that destroy rapidly growing cells). White blood cells are important as they help your body fight infection. These cells are very sensitive to the effects of chemotherapy which can cause the number of these cells in your body to decrease. If white blood cells fall to a low level there may not be enough left in the body to fight bacteria and you may have an increased risk of infection.

Your doctor has given you Neulasta to encourage your bone marrow (part of the bone which makes blood cells) to produce more white blood cells that help your body fight infection.

Do not use Neulasta

·             if you are allergic to pegfilgrastim, filgrastim, or any of the other ingredients of this medicine.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before using Neulasta:

·             if you experience an allergic reaction including weakness, drop in blood pressure, difficulty breathing, swelling of the face (anaphylaxis), redness and flushing, skin rash and areas of the skin that itch.

·             if you have an allergy to latex. The needle cap on the pre-filled syringe contains a derivative of latex and may cause severe allergic reactions.

·             if you have an allergy to acrylic adhesives. The on‑body injector uses acrylic adhesive and may result in an allergic reaction.

·             if you experience a cough, fever and difficulty breathing. This can be a sign of Acute Respiratory Distress Syndrome (ARDS).

·             if you have any of the following or combination of the following side effects:

-              swelling or puffiness, which may be associated with passing water less frequently, difficulty breathing, abdominal swelling and feeling of fullness, and a general feeling of tiredness.

These could be symptoms of a condition called “Capillary Leak Syndrome” which causes blood to leak from the small blood vessels into your body. See section 4.

·             if you get left upper abdominal pain or pain at the tip of your shoulder. This may be a sign of a problem with your spleen (splenomegaly).

·             if you have recently had a serious lung infection (pneumonia), fluid in the lungs (pulmonary oedema), inflammation of the lungs (interstitial lung disease) or an abnormal chest x‑ray (lung infiltration).

·             if you are aware of any altered blood cell counts (e.g. increase in white blood cells or anaemia) or decreased blood platelet counts, which reduces the ability of your blood to clot (thrombocytopenia). Your doctor may want to monitor you more closely.

·             if you have sickle cell anaemia. Your doctor may monitor your condition more closely.

·             if you are a patient with breast cancer or lung cancer, Neulasta in combination with chemotherapy and/or radiation therapy may increase your risk of a precancerous blood condition called myelodysplastic syndrome (MDS) or a blood cancer called acute myeloid leukaemia (AML). Symptoms may include tiredness, fever, and easy bruising or bleeding.

·             if you have sudden signs of allergy such as rash, itching or hives on the skin, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing these could be signs of a severe allergic reaction.

·             If you have symptoms of inflammation of aorta (the large blood vessel which transports blood from the heart to the body), this has been reported rarely in cancer patients and healthy donors. The symptoms can include fever, abdominal pain, malaise, back pain and increased inflammatory markers. Tell your doctor if you experience those symptoms.

Your doctor will check your blood and urine regularly as Neulasta can harm the tiny filters inside your kidneys (glomerulonephritis).

Severe skin reactions (Stevens-Johnson syndrome) have been reported with the use of Neulasta. Stop using Neulasta and seek medical attention immediately if you notice any of the symptoms described in section 4.

You should talk to your doctor about your risks of developing cancers of the blood. If you develop or are likely to develop cancers of the blood, you should not use Neulasta, unless instructed by your doctor.

Loss of response to pegfilgrastim

If you experience a loss of response or failure to maintain a response with pegfilgrastim treatment, your doctor will investigate the reasons why including whether you have developed antibodies which neutralise pegfilgrastim’s activity.

Other medicines and Neulasta

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Pregnancy and breast-feeding

Ask your doctor or pharmacist for advice before taking any medicine. Neulasta has not been tested in pregnant women. It is important to tell your doctor if you:

·             are pregnant;

·             think you may be pregnant; or

·             are planning to have a baby.

Unless your doctor directs you otherwise, you must stop breast-feeding if you use Neulasta.

Driving and using machines

Neulasta has no or negligible effect on the ability to drive or use machines.

Neulasta contains sorbitol (E420) and sodium acetate

This medicine contains 30 mg sorbitol in each pre-filled syringe which is equivalent to 50 mg/mL.

This medicine contains less than 1 mmol sodium (23 mg) per 6 mg dose, that is to say essentially

‘sodium-free’.

Neulasta is for use in adults aged 18 and over.

Always take Neulasta exactly as your doctor has told you. You should check with your doctor or pharmacist if you are unsure. The usual dose is one 6 mg subcutaneous injection (injection under your skin) and it should be given at least 24 hours after your last dose of chemotherapy at the end of each chemotherapy cycle.

Using Neulasta with the on-body injector

Your doctor may decide that it would be more convenient for you to use Neulasta with the on‑body injector. For further information on use with the on‑body injector, please read the instructions for use at the end of this leaflet.

Check the instructions at the end of this leaflet and contact your healthcare provider if:

·             during the monitoring of your on‑body injector you are concerned that it is leaking; or

·             after the injection is complete you are concerned that you may not have received the full dose.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Please tell your doctor immediately if you have any of the following or combination of the following side effects:

·             swelling or puffiness, which may be associated with passing water less frequently, difficulty breathing, abdominal swelling and feeling of fullness, and a general feeling of tiredness. These symptoms generally develop in a rapid fashion.

These could be symptoms of an uncommon (may affect up to 1 in 100 people) condition called “Capillary Leak Syndrome” which causes blood to leak from the small blood vessels into your body and needs urgent medical attention.

Very common side effects (may affect more than 1 in 10 people):

·             bone pain. Your doctor will tell you what you can take to ease the bone pain.

·             nausea and headaches.

Common side effects (may affect up to 1 in 10 people):

·             rash, itchy red raised bumps (contact dermatitis/local skin reactions) have been seen with the on‑body injector.

·             pain at the site of injection.

·             application site reactions which may include redness, bleeding, bruising, pain and discomfort have been seen with the on‑body injector.

·             general aches and pains in the joints and muscles.

·             some changes may occur in your blood, but these will be detected by routine blood tests. Your white blood cell count may become high for a short period of time. Your platelet count may become low which might result in bruising.

Uncommon side effects (may affect up to 1 in 100 people):

·             allergic-type reactions, including redness and flushing, skin rash, and raised areas of the skin that itch.

·             serious allergic reactions, including anaphylaxis (weakness, drop in blood pressure, difficulty breathing, swelling of the face).

·             increased spleen size.

·             spleen rupture. Some cases of splenic rupture were fatal. It is important that you contact your doctor immediately if you experience pain in the upper left side of the abdomen or left shoulder pain since this may relate to a problem with your spleen.

·             breathing problems. If you have a cough, fever and difficulty breathing please tell your doctor.

·             Sweet’s syndrome (plum-coloured, raised, painful lesions on the limbs and sometimes the face and neck with fever) has occurred but other factors may play a role.

·             cutaneous vasculitis (inflammation of the blood vessels in the skin).

·             damage to the tiny filters inside your kidneys (glomerulonephritis).

·             redness at the site of injection.

·             coughing up blood (haemoptysis).

·             blood disorders (myelodysplastic syndrome [MDS] or acute myeloid leukaemia [AML]).

Rare side effects (may affect up to 1 in 1000 people):

·             inflammation of aorta (the large blood vessel which transports blood from the heart to the body), see section 2.

·             bleeding from the lung (pulmonary haemorrhage).

·            Stevens-Johnson syndrome, which can appear as reddish target-like or circular patches often

with central blisters on the trunk, skin peeling, ulcers of mouth, throat, nose, genitals and eyes

and can be preceded by fever and flu-like symptoms. Stop using Neulasta if you develop these

symptoms and contact your doctor or seek medical attention immediately. See also section 2.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects you can help provide more information on the safety of this medicine.

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and on the syringe label after EXP. The expiry date refers to the last day of that month.

Store in a refrigerator (2°C – 8°C).

The syringe for use with the on‑body injector must either be used within 12 hours after it has reached room temperature (not above 30°C) or disposed of.

Do not freeze. Neulasta  may be used if it is accidentally frozen for a single period of less than 24 hours.

Keep the container in the outer carton in order to protect from light.

Do not use this medicine if you notice it is cloudy or there are particles in it.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.