Monday, July 15, 2013

Neupogen and Neulasta (filgrastim and pegfilgrastim)

For people on chemo, keeping up the white blood cells, or more specifically neutrophils can sometimes be difficult.  Neutrophil granulocytes are part of the immune system and comprise the largest type of white blood cells we have.  If we have low white blood cells, specifically neutrophils, then we are at greater risk for infection.  Because these cells are rapidly dividing, they often fall victim to the same treatment as our cancer cells.  One of the reasons that chemo patients get a complete blood count (CBC) is to check on the white blood cells (as well as a host of other things).

If they find that your counts are low, one of the things which your oncologists may do is prescribe a dose of Neupogen (figrastim).  I have always been confused between Neupogen and another drug which does essentially the same thing, Neulasta (pegfilgrastim).   I finally asked what the difference was.  Neupogen is faster acting and is sort of a jump start, whereas Neulasta takes a big longer and does the same thing.  Both have side effects of aching bones and muscles (your legs and other long bones such as your humerus (upper arm) and your pelvis is where most of your marrow is...your marrow manufactures blood cells, so when you are given stimulators to make more blood cells of any type, then those bones can ache) which can be alleviated by taking a non-aspirin pain reliever such as acetaminophen (Tylenol).  Both can cause enlarged or even ruptured spleens (if you have pain in your upper left abdomen, let your doctor know) , and bruising.  Also, some people are allergic to it....and if  you show any sign of allergy, let your doctor know immediately.

Both drugs are given by injection approximately 24 hours after getting chemo.  The injection site can swell and bit and get a bit warm or sore (local injection site reaction), but this may be an indication of an allergic reaction, and it is worthwhile to let the doctor know.  I find it a bit annoying to go back 24 hours after, but it seems to be doing the trick....my counts today were  actually in the normal range!  I switched to Neulasta when it became apparent that the low counts were not a once in a while thing, but had become chronic.  It is important to note that they won't prevent all infections.....you are still at risk, but it does give you a fighting chance.

If you have sickle-cell disorder, then you need to make sure that your doctor knows.  Another thing to bear in mind, both Neulasta and Neupogen come in pre-loaded syringes.  Neulasta's syringe contains dry, natural latex, and if you have a latex sensitivity, you need to make sure that your oncologist (and the injection nurse) are aware of this.  I don't know if Neupogen's does or not, but it is worth asking.

One thing to be aware of, I got my PET scan on Tuesday morning, and I was supposed to get my Neulasta shot the same day, so I told the nurse I would come in after my PET. By mistake, someone had scheduled Neulasta the same day as chemo (a no-no)....the PET tech came in and said..."Um..when did you have your Neulasta?"  I told her I hadn't yet, I was going in to get it after I finished with her and had had lunch.  She was very relieved as if I had had it before getting the PET, the stimulation would have caused metabolic uptake and my legs/pelvis/arms would have shown increased activity and made the PET next to worthless....score one for the Goose!

Yes, there is a drug which stimulates red blood cell production, but this is VERY expensive and must only be used under certain conditions and diagnosis. According to my oncology nurse, the insurance criteria is very specific.


Hope this helps....it sure helped me understand what was what and why I was getting what I was.

Why the red and white dahlias?  Well....I didn't have anything which would really fit..so I thought they could represent red and white blood cells....

6 comments:

  1. There is some evidence that Claritin--only Claritin, not other antihistamines--can help alleviate the side effects of Neulasta. Some people take it a couple of days before and after the injection; others, like me, all the time.

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    1. Thanks, Mary. I have found taking it with the Halaven (eribulen) also helps with side effects. Since I had a lot of unusual, annoying but not debilitating for the most part and I am not given Benedryl, I thought I would try it, and it seems to help a bit with the fatigue. Since I'm now on Neulasta, I'll see if it helps with that, and I will prolong my dosing a little (I usually take it the day before and the day of the infusion).

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    2. Only Allegra is allowed by the med oncs at UF Health Orlando. They say it is far better than Claritin.

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  2. I took Claritin the day before, day of, and day after as in structed and had no luck with easing pain. The bone pain from Neulasta was so bad, I was either going to stop the injections altogether or was going to need pain meds. For me, it was worse than chemo and radiation.

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    1. How often did you get the injections? Just curious.

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    2. Ditto. Will be seeing the oncologist in charge of the cancer center to see if they can lower the dose. My WBC was 35.1 one week after the shot and I was in the ER because of the pain.

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