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Pegfilgrastim parenteral

Updated 2 Feb 2023 | Neutropenia


Parenteral formulations of pegfilgrastim.

Drugs List

  • NEULASTA 6mg/0.6ml injection
  • pegfilgrastim 6mg/0.6ml injection
  • PELGRAZ 6mg/0.6ml injection
  • PELMEG 6mg/0.6ml solution for injection pre-filled syringe
  • ZIEXTENZO 6mg/0.6ml solution for injection pre-filled syringe
  • Therapeutic Indications


    Reduced duration of neutropenia
    Reduced incidence of febrile neutropenia



    One 6mg dose of pegfilgrastim is recommended at least 24 hours after each chemotherapy cycle.


    Administer subcutaneous injection into the thigh, abdomen or upper arm, a minimum of 24 hours after cytotoxic chemotherapy.

    The on-body injector should be applied to intact, non-irritated skin on the back of the arm or abdomen.

    The on-body injector delivers pegfilgrastim over approximately 45 minutes, around 27 hours after it is applied to the patient's skin.

    The on-body injector must only be used with the co-packed pegfilgrastim pre-filled syringe.


    Children under 18 years
    Chronic myeloid leukaemia
    Hereditary fructose intolerance
    Myelodysplastic syndrome
    Secondary acute myeloid leukaemia

    Precautions and Warnings

    Hypersensitivity to latex
    Acute myeloid leukaemia
    Breast cancer
    History of pulmonary infiltrates
    Lung cancer
    New onset acute myeloid leukaemia in patients below 55 years
    Recent history of pneumonia
    Sickle cell disease
    Sickle cell trait

    Incidence of thrombocytopenia and anaemia not reduced by treatment
    Treatment to be initiated and supervised by a specialist
    Needle cover contains a derivative of latex in some brands
    On-body injector contains acrylic adhesive: may cause allergic reactions
    Presentations with sorbitol unsuitable in hereditary fructose intolerance
    Record name and batch number of administered product
    Monitor full blood count and differential WBC before and during therapy
    Consider splenic rupture if patient has abdominal or shoulder pain
    Lung or breast cancer: Monitor for MDS and AML
    Monitor for symptoms of Capillary Leak Syndrome
    Monitor haematocrit values
    Monitor patients with sickle cell anaemia
    Monitor patients with sickle cell trait
    Monitor platelets
    Monitor spleen size
    Perform regular urinalysis
    Advise patient to seek medical advice if signs/symptoms of aortitis occur
    Discontinue treatment if Stevens-Johnson syndrome is confirmed
    Seek urgent medical attention if symptoms of Capillary Leak Syndrome occur
    May affect bone imaging results
    Discontinue if adult respiratory distress syndrome occurs
    Discontinue if leucocyte count exceeds 50x10 to the power of 9/L
    Discontinue if serious allergic or anaphylactic reaction occurs
    Discontinue if severe hypersensitivity reactions occur
    Discontinue or reduce dose if glomerulonephritis occurs
    Concurrent cytotoxic drugs: Maintain established dose regime (no increase)
    Female: Ensure adequate contraception during treatment
    Patient alert card available for some brands

    If aortitis is suspected it can usually be diagnosed by CT scan and generally resolves after withdrawal of pegfilgrastim.

    If the patient develops Stevens-Johnson syndrome with the use of pegfilgrastim, treatment must not be restarted at any time.

    Pregnancy and Lactation


    Pegfilgrastim is contraindicated during pregnancy.

    The manufacturer does not recommend using pegfilgrastim during pregnancy. Animal studies have shown reproductive toxicity. Human data is limited and as such a potential risk cannot be ruled out.


    Pegfilgrastim is contraindicated during breastfeeding.

    The manufacturer advises that the patient either discontinues pegfilgrastim or discontinues breastfeeding. The presence of pegfilgrastim in human breast milk and the effects on exposed infants are unknown.


    Advise the patient that if they suspect a device failure or malfunction with the on-body injector they must immediately inform their healthcare provider.

    On-body injector: Patient alert card available. Remind patient of the importance of carrying alert card with them at all times.

    Side Effects

    Acute febrile dermatosis (Sweet's syndrome)
    Acute myeloid leukaemia
    Adult respiratory distress syndrome
    Allergic reaction
    Altered liver function tests
    Application site reaction
    Back pain
    Bone pain
    Capillary leak syndrome
    Chest pain
    Contact dermatitis
    Cutaneous vasculitis
    Extremity pain
    Hypersensitivity reactions
    Increase in alkaline phosphatase
    Increase in lactate dehydrogenase
    Increased uric acid level
    Interstitial pneumonia
    Local pain (injection site)
    Local reaction at injection site
    Musculoskeletal pain
    Myelodysplastic syndrome
    Neck pain
    Pulmonary fibrosis
    Pulmonary haemorrhage
    Pulmonary infiltrates
    Pulmonary oedema
    Pulmonary reactions (acute)
    Respiratory failure
    Sickle cell crisis
    Splenic rupture
    Stevens-Johnson syndrome

    Effects on Laboratory Tests

    Positive bone imaging findings have been associated with growth factor therapy due to the increase in haematopoietic activity in the bone marrow.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2021

    Reference Sources

    Summary of Product Characteristics: Neulasta pre-filled syringe. Amgen Ltd. Revised November 2020.
    Summary of Product Characteristics: Neulasta on body injector. Amgen Ltd. Revised November 2020.
    Summary of Product Characteristics: Pelgraz 6mg solution for injection in pre-filled injector. Accord Healthcare Ltd. Revised November 2019.
    Summary of Product Characteristics: Pelgraz 6mg solution for injection in pre-filled syringe. Accord Healthcare Ltd. Revised November 2019.
    Summary of Product Characteristics: Pelmeg 6mg solution for injection in pre-filled syringe. Napp Pharmaceuticals Ltd. Revised October 2020.
    Summary of Product Characteristics: Ziextenzo 6mg solution for injection in pre-filled syringe. Sandoz Limited. Revised January 2020.

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