Neulasta - patient leaflet, side effects, dosage

- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

• 1. What Neulasta is and what it is used for

• 2. What you need to know before you use Neulasta

• 3. How to use Neulasta

• 4. Possible side effects

• 5. How to store Neulasta

• 6. Contents of the pack and other information

1. What Neulasta is and what it is used for

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.

2. What you need to know before you use Neulasta

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

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’.

3. How to use Neulasta

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.

Injecting Neulasta yourself

Your doctor may decide that it would be more convenient for you to inject Neulasta yourself. Your doctor or nurse will show you how to inject yourself. Do not try to inject yourself if you have not been trained.

For further instructions on how to inject yourself with Neulasta, please read the section at the end of this leaflet.

Do not shake Neulasta vigorously as this may affect its activity.

If you use more Neulasta than you should

If you use more Neulasta than you should contact your doctor, pharmacist or nurse.

If you forget to inject Neulasta

If you are injecting yourself and have forgotten your dose of Neulasta, you should contact your doctor to discuss when you should inject the next dose.

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

4. Possible side effects

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 1,000 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 via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Neulasta

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).

You may take Neulasta out of the refrigerator and keep it at room temperature (not above 30°C) for no longer than 3 days. Once a syringe has been removed from the refrigerator and has reached room temperature (not above 30°C) it must either be used within 3 days 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.

6. Contents of the pack and other information

What Neulasta contains

• – The active substance is pegfilgrastim. Each pre-filled syringe contains 6 mg of pegfilgrastim in 0.6 mL of solution.

• – The other ingredients are sodium acetate, sorbitol (E420), polysorbate 20 and water for injections. See section 2.

What Neulasta looks like and contents of the pack

Neulasta is a clear, colourless solution for injection in a pre-filled syringe (6 mg/0.6 mL).

Each pack contains 1 glass pre-filled syringe with an attached stainless steel needle and needle cap.

The pre-filled syringe (with or without blister wrapping) may also be provided with an automatic needle guard.

Marketing Authorisation Holder and Manufacturer

Amgen Europe B.V.

Minervum 7061

4817 ZK Breda

The Netherlands

Marketing Authorisation Holder

Amgen Europe B.V.

Minervum 7061

4817 ZK Breda

The Netherlands

Manufacturer

Amgen Technology (Ireland) Unlimited Company

Pottery Road

Dun Laoghaire

Co Dublin

Ireland

Manufacturer

Amgen NV

Telecomlaan 5–7

1831 Diegem

Belgium

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

Belgie/Belgiqu­e/Belgien s.a. Amgen n.v. Tel/Tél: +32 (0)2 7752711	Lietuva Amgen Switzerland AG Vilniaus filialas Tel: +370 5 219 7474
Btnrapua Amjaxh Einrapmi EOOfl, Ten.: +359 (0)2 424 7440	Luxembourg/Lu­xemburg s.a. Amgen Belgique/Belgien Tel/Tel: +32 (0)2 7752711
Česká republika Amgen s.r.o. Tel: +420 221 773 500	Magyarorszag Amgen Kft. Tel.: +36 1 35 44 700
Danmark Amgen, filial af Amgen AB, Sverige Tlf: +45 39617500	Malta Amgen S.r.l. Italy Tel: +39 02 6241121
Deutschland Amgen GmbH Tel.: +49 89 1490960	Nederland Amgen B.V. Tel: +31 (0)76 5732500
Eesti Amgen Switzerland AG Vilniaus filialas Tel: +372 586 09553	Norge Amgen AB Tel: +47 23308000
EXXáSa Amgen EXXá^ OappaKeuTiKá E.n.E. Tn^.: +30 210 3447000	Österreich Amgen GmbH Tel: +43 (0)1 50 217
España Amgen S.A. Tel: +34 93 600 18 60	Polska Amgen Biotechnologia Sp. z o.o. Tel.: +48 22 581 3000

France Amgen S.A.S. Tel: +33 (0)9 69 363 363	Portugal Amgen Biofarmaceutica, Lda. Tel: +351 21 422 0606
Hrvatska Amgen d.o.o. Tel: +385 (0)1 562 57 20	Romania Amgen Romania SRL Tel: +4021 527 3000
Ireland Amgen Ireland Limited Tel: +353 1 8527400	Slovenija AMGEN zdravila d.o.o. Tel: +386 (0)1 585 1767
island Vistor hf. Simi: +354 535 7000	Slovenská republika Amgen Slovakia s.r.o. Tel: +421 2 321 114 49
Italia Amgen S.r.l. Tel: +39 02 6241121	Suomi/Finland Amgen AB, sivuliike Suomessa/Amgen AB, filial i Finland Puh/Tel: +358 (0)9 54900500
Konpo^ C.A. Papaellinas Ltd Tn^.: +357 22741 741	Sverige Amgen AB Tel: +46 (0)8 6951100
Latvija Amgen Switzerland AG Rigas filiäle Tel: +371 257 25888	United Kingdom (Northern Ireland) Amgen Limited Tel: +44 (0)1223 420305

This leaflet was last revised in

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site:

Instructions for injecting with the Neulasta pre-filled syringe

This section contains information on how to give yourself an injection of Neulasta. It is important that you do not try to give yourself the injection unless you have received training from your doctor, nurse, or pharmacist. If you have questions about how to inject, please ask your doctor, nurse, pharmacist for assistance.

How do you, or the person injecting you, use Neulasta pre-filled syringe?

You will need to give yourself the injection into the tissue just under the skin. This is known as a subcutaneous injection.

Equipment that you need

To give yourself a subcutaneous injection you will need:

• a pre-filled syringe of Neulasta; and
• alcohol wipes or similar.

What should I do before I give myself a subcutaneous injection of Neulasta?

• 1. Remove from the refrigerator.

• 2. Do not shake the pre-filled syringe.

• 3. Do not remove the cap from the syringe until you are ready to inject.

• 4. Check the expiry date on the pre-filled syringe label (EXP). Do not use it if the date has passed

the last day of the month shown.

• 5. Check the appearance of Neulasta. It must be a clear and colourless liquid. If there are particles in it, you must not use it.

• 6. For a more comfortable injection, let the pre-filled syringe stand for 30 minutes to reach room temperature or hold the pre-filled syringe gently in your hand for a few minutes. Do not warm Neulasta in any other way (for example, do not warm it in a microwave or in hot water).

• 7. Wash your hands thoroughly .

• 8. Find a comfortable, well-lit, clean surface and put all the equipment you need within reach.

How do I prepare my Neulasta injection?

Before you inject Neulasta you must do the following:

Hold the syringe barrel and gently take the cap from the needle without twisting. Pull straight as shown in pictures 1 and 2. Do not touch the needle or push the plunger.

• 2. You may notice a small air bubble in the pre-filled syringe. You do not have to remove the air bubble before injecting. Injecting the solution with the air bubble is harmless.

• 3. You can now use the pre-filled syringe.

Where should I give my injection?

The most suitable places to inject yourself are:

• the top of your thighs; and
• the abdomen, except for the area around the navel.

If someone else is injecting you, they can also use the back of your arms.

How do I give my injection?

• 1. Clean your skin by using an alcohol wipe.

• 2. Pinch (without squeezing) the skin using your thumb and forefinger. Insert the needle into the skin.

• 3. Push the plunger down with a slow constant pressure. Push the plunger all the way down as far as it will go to inject all the liquid.

• 4. After injecting the liquid, remove the needle and let go of your skin.

• 5. If you notice a spot of blood at the injection site, dab with a cotton ball or tissues. Do not rub the

injection site. If needed, you may cover the injection site with a plaster.

• 6. Do not use any Neulasta that is left in the syringe.

Remember

Only use each syringe for one injection. If you have any problems, please ask your doctor or nurse for help and advice.

Disposing of used syringes

• Do not put the cap back on used needles.
• Keep used syringes out of the sight and reach of children.
• The used syringe should be disposed of in accordance with local requirements. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Before you use a Neulasta pre-filled syringe with automatic needle guard, read this important

information:

• It is important that you do not try to give yourself the injection unless you have received

training from your doctor or healthcare provider.

• Neulasta is given as an injection into the tissue just under the skin (subcutaneous injection).

Tell your doctor 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.

D Do not remove the grey needle cap from the pre-filled syringe until you are ready to inject.

D Do not use the pre-filled syringe if it has been dropped on a hard surface. Use a new pre-filled

syringe and call your doctor or healthcare provider.

D Do not attempt to activate the pre-filled syringe prior to injection.

D Do not attempt to remove the clear pre-filled syringe safety guard from the pre-filled syringe.

D Do not attempt to remove the peelable label on the pre-filled syringe barrel before

administering your injection.

Call your doctor or healthcare provider if you have any questions.

	Step 1: Prepare
A	Remove the pre-filled syringe tray from the package and gather the supplies needed for your
	injection: alcohol wipes, a cotton ball or gauze pad, a plaster and a sharps disposal container
	(not included).

For a more comfortable injection, leave the pre-filled syringe at room temperature for about 30 minutes before injecting. Wash your hands thoroughly with soap and water.

On a clean, well-lit work surface, place the new pre-filled syringe and the other supplies.

D Do not try to warm the syringe by using a heat source such as hot water or microwave.

D Do not leave the pre-filled syringe exposed to direct sunlight.

D Do not shake the pre-filled syringe.

• Keep pre-filled syringes out of the sight and reach of children.

Open the tray, peeling away the cover. Grab the pre-filled syringe safety guard to remove the pre-filled syringe from the tray.

Grab here

For safety reasons:

D Do not grasp the plunger.

D Do not grasp the grey needle cap.

• The medicine is cloudy or there are particles in it. It must be a clear and colourless liquid.
• Any part appears cracked or broken.
• The grey needle cap is missing or not securely attached.
• The expiry date printed on the label has passed the last day of the month shown.

In all cases, call your doctor or healthcare provider.

Step 2: Get ready

Wash your hands thoroughly. Prepare and clean your injection site.

• Upper part of your thigh.
• Belly, except for a 5 cm (2-inch) area right around your belly button.
• Outer area of upper arm (only if someone else is giving you the injection).