How chemotherapy affects your body

Chemotherapy can weaken your natural defenses

Cancer cells and blood cells Low white blood cell count with fever Infection may be a risk throughout your chemotherapy treatment.
Cancer cells and blood cells

Chemotherapy works by killing fast-growing cancer cells.

Unfortunately, chemotherapy drugs can't tell the difference between cancer cells and fast-growing healthy cells, such as the bone marrow that produces blood cells. A possible side effect of some strong chemotherapy is a low count of neutrophils, a type of white blood cell that is important in fighting infections.

Low white blood cell count with fever

Having a low neutrophil count is a condition known as neutropenia.

Neutropenia can raise your risk of developing certain types of infections. A low white blood cell count with fever, also known as febrile neutropenia, can be a sign of a serious infection. You should call your doctor or nurse right away if you get a fever higher than 100.5°F (38°C).

Infection may be a risk throughout your chemotherapy treatment.

Infection may be a risk throughout your chemotherapy treatment.

Your treatment plan may consist of multiple chemotherapy cycles. The risk of infection is present in every one of them. Helping to reduce that risk should be an important consideration for you and your physician.

NEUPOGEN® can help during strong chemotherapy

White blood cell counts before chemotherapy White blood cell counts during strong chemotherapy White blood cells counts after NEUPOGEN®

Before chemotherapy:

White blood cells are a key part of your natural defenses. At natural levels, white blood cells help protect your body against infection.

White blood cell counts before chemotherapy

With strong chemotherapy:

Strong chemotherapy can reduce your white blood cell count. This may put you at risk for certain types of infection.

White blood cell counts during strong chemotherapy

After NEUPOGEN®:

NEUPOGEN® can help stimulate the production of neutrophils, shortening the time and depth of a low white blood cell count after chemotherapy. This can help your body fight infection.

White blood cells counts after NEUPOGEN®

Steps to help reduce the risk of infection

Protect yourself during treatment with strong chemotherapy

Once you begin chemotherapy, the following steps and precautions can help you avoid getting an infection:

  • Be careful to prevent cuts or scrapes, because they can provide entry points for infection
  • If you get a cut or scrape, cover it with a clean bandage until it heals
  • To prevent cuts when shaving, consider using an electric razor instead of a blade
  • Handle sharp objects with caution
  • Wear protective gloves when performing tasks that expose you to a risk of cuts or scrapes, such as gardening
  • Cook food thoroughly to kill infection-causing bacteria that may be in raw food
  • Wash your hands regularly with soap and plenty of water to avoid getting an infection from things that you touch
  • Use hand sanitizer if you have no access to soap and water
  • Ask your friends and family to wash their hands before coming into contact with you
  • Avoid people with colds or the flu
  • Avoid large crowds, which may include sick people
  • Bathe daily and dry your skin gently
  • Use lotion to help prevent cracks in your skin

If you have any of the following signs of infection, report them to your doctor immediately:

  • Fever higher than 100.5°F (38°C)
  • Chills
  • Cough or sore throat
  • Severe constipation, loose stools, or diarrhea for more than 24 hours
  • Mouth ulcers or sores in the throat or around the rectum
  • Vomiting that continues 12 hours after treatment
  • Painful or frequent urination, or inability to urinate for more than 4 hours
  • Unusual vaginal discharge or itching
  • Redness, swelling, or soreness of the skin around an implanted port
  • Shortness of breath/chest pain
  • Irregular or rapid heartbeat
  • Blood in urine or stool
See More See Less

Important Safety Information

Do not take NEUPOGEN® if you have had a serious allergic reaction to human G-CSFs such as (filgrastim) or (pegfilgrastim) products.

Before you take NEUPOGEN®, tell your healthcare provider all about your medical conditions, including if you:

  • have a sickle cell disorder.
  • have kidney problems.
  • are receiving radiation therapy.
  • are allergic to latex. The needle cap on the prefilled syringe contains dry natural rubber (derived from latex). You should not give NEUPOGEN® using the prefilled syringe if you have latex allergies. Ask your healthcare provider about using the vial if you have latex allergies.
  • are pregnant, or plan to become pregnant. It is not known if NEUPOGEN® will harm your unborn baby.
  • are breastfeeding, or plan to breastfeed. It is not known if NEUPOGEN® passes into your breast milk.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

How will I receive NEUPOGEN®?

  • NEUPOGEN® injections can be given by a healthcare provider by intravenous (IV) infusion or under your skin (subcutaneous injection). Your healthcare provider may decide subcutaneous injections can be given at home by you or your caregiver. If NEUPOGEN® is given at home, see the detailed "Instructions for Use" that comes with your NEUPOGEN® for information on how to prepare and inject a dose of NEUPOGEN®.
  • You and your caregiver should be shown how to prepare and inject NEUPOGEN® before you use it, by your healthcare provider.
  • Your healthcare provider will tell you how much NEUPOGEN® to inject and when to inject it. Do not change your dose or stop NEUPOGEN® unless your healthcare provider tells you to.
  • If you are receiving NEUPOGEN® because you are also receiving chemotherapy, your dose of NEUPOGEN® should be injected at least 24 hours before or 24 hours after your dose of chemotherapy.

What are possible side effects of NEUPOGEN®?

  • Spleen rupture. Your spleen may become enlarged and can rupture. A ruptured spleen can cause death. Call your healthcare provider right away if you have pain in the left upper stomach area or left shoulder.
  • A serious lung problem called Acute Respiratory Distress Syndrome (ARDS). Call your healthcare provider or get emergency medical help right away if you have shortness of breath with or without a fever, trouble breathing, or a fast rate of breathing.
  • Serious allergic reactions. NEUPOGEN® can cause serious allergic reactions. These reactions can cause a rash over your whole body, shortness of breath, wheezing, dizziness, swelling around your mouth or eyes, fast heart rate, and sweating. If you have any of these symptoms, stop using NEUPOGEN®, and call your healthcare provider or get emergency help right away.
  • Sickle cell crises. You may have a serious sickle cell crisis if you have a sickle cell disorder and receive NEUPOGEN®. Serious sickle cell crises have happened in people with sickle cell disorders receiving NEUPOGEN® that has sometimes led to death. Call your healthcare provider right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.
  • Kidney injury (glomerulonephritis). NEUPOGEN® can cause kidney injury. Call your healthcare provider right away if you develop any of the following symptoms:
    • swelling of your face and ankles
    • blood in your urine or dark colored urine
    • you urinate less than usual
  • Capillary Leak Syndrome. NEUPOGEN® can cause fluid to leak from blood vessels into your body's tissues. This condition is called "Capillary Leak Syndrome" (CLS). CLS can quickly cause you to have symptoms that may become life-threatening. Get emergency medical help right away if you develop any of the following symptoms:
    • swelling or puffiness and are urinating less than usual
    • trouble breathing
    • swelling of your stomach-area and feeling of fullness
    • dizziness or feeling faint
    • a general feeling of tiredness
  • Decreased platelet count (thrombocytopenia). Your healthcare provider will check your blood during treatment with NEUPOGEN®. Tell your healthcare provider if you have unusual bleeding or bruising during treatment with NEUPOGEN®. This could be a sign of decreased platelet counts, which may reduce the ability of your blood to clot.
  • Increased white blood cell count (leukocytosis). Your healthcare provider will check your blood during treatment with NEUPOGEN®.
  • Inflammation of your blood vessels (cutaneous vasculitis). Tell your healthcare provider if you develop purple spots or redness of your skin.

The most common side effects of NEUPOGEN® include aching in the bones and muscles. These are not all the possible side effect of NEUPOGEN®. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-332-1088.

Please see the NEUPOGEN® Patient Information for additional information.

The last dose of NEUPOGEN® (filgrastim) should be injected at least 24 hours before your next dose of chemotherapy. NEUPOGEN® should be injected at the same time each day. If you miss a dose, contact your doctor or nurse.

You must always use the correct dose of NEUPOGEN®. Too little may not protect you against infections, and too much may cause too many neutrophils to be in your blood. If you are giving someone else NEUPOGEN® injections, it is important that you know how to inject, how much to inject, and how often to inject.

For more information, please see the NEUPOGEN® Patient Product Information and talk to your doctor.

No use NEUPOGEN® durante las 24 horas anteriores ni las 24 horas posteriores a la administración de quimioterapia fuerte. NEUPOGEN® debe inyectarse a la misma hora todos los días. Si se salta una dosis, póngase en contacto con el médico o el enfermero.

Es indispensable que use siempre la dosis correcta de NEUPOGEN®. Una cantidad insuficiente quizás no ayude a reducir el riesgo de contraer infecciones, y un exceso podría generar demasiados neutrófilos en la sangre. Si usted le administra las inyecciones de NEUPOGEN® a otra persona, es importante que sepa cómo inyectar el medicamento, las dosis que debe inyectar y con qué frecuencia debe poner las inyecciones.

Para obtener más información sobre cómo preparar y administrar una inyección de NEUPOGEN® consulte la información del producto para los pacientes y la información de prescripción de NEUPOGEN®. Si tiene preguntas, deberá hablar con su médico.