Neulastim

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Neulastim uses

• Indications and usage
• Dosage and administration
• Dosage forms and strengths
• Contraindications
• Warnings and precautions
• Adverse reactions
• Drug interactions
• Use in specific populations
• Overdosage
• Description
• Clinical pharmacology
• Nonclinical toxicology
• Clinical studies
• How supplied/storage and handling
• Patient counseling information
• Neulastim reviews

• Indications and Usage (1.2) 11/2015
  

• Dosage and Administration (2.1, 2.2, 2.3) 11/2015

1 INDICATIONS AND USAGE

Neulastim is a leukocyte growth factor indicated to

• Decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
  

• Increase survival in patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Subsyndrome of Acute Radiation Syndrome). (1.2)

Neulastim is not indicated for the mobilization of peripheral blood progenitor cells for hematopoietic stem cell transplantation.

1.1 Patients with Cancer Receiving Myelosuppressive Chemotherapy

Neulastim is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia [ see Clinical Studies ( 14.1 ) ].

Neulastim is not indicated for the mobilization of peripheral blood progenitor cells for hematopoietic stem cell transplantation.

1.2 Patients with Hematopoietic Subsyndrome of Acute Radiation Syndrome

Neulastim is indicated to increase survival in patients acutely exposed to myelosuppressive doses of radiation [see Dosage and Administration ( 2.2 ) and Clinical Studies ( 14.2 )].

2 DOSAGE AND ADMINISTRATION

• Patients with cancer receiving myelosuppressive chemotherapy
  

  ○ 6 mg administered subcutaneously once per chemotherapy cycle.
  

  ○ Do not administer between 14 days before and 24 hours after administration of cytotoxic chemotherapy. (2.1)
  

  ○ Use weight based dosing for pediatric patients weighing less than 45 kg; refer to Table 1. (2.3)
  

• Patients acutely exposed to myelosuppressive doses of radiation
  

  ○ Two doses, 6 mg each, administered subcutaneously one week apart. Administer the first dose as soon as possible after suspected or confirmed exposure to myelosuppressive doses of radiation, and a second dose one week after. (2.2)
  

  ○ Use weight based dosing for pediatric patients weighing less than 45 kg; refer to Table 1. (2.3)

2.1 Patients with Cancer Receiving Myelosuppressive Chemotherapy

The recommended dosage of Neulastim is a single subcutaneous injection of 6 mg administered once per chemotherapy cycle. For dosing in pediatric patients weighing less than 45 kg, refer to Table 1. Do not administer Neulastim between 14 days before and 24 hours after administration of cytotoxic chemotherapy.

2.2 Patients with Hematopoietic Subsyndrome of Acute Radiation Syndrome

The recommended dose of Neulastim is two doses, 6 mg each, administered subcutaneously one week apart. For dosing in pediatric patients weighing less than 45 kg, refer to Table 1. Administer the first dose as soon as possible after suspected or confirmed exposure to radiation levels greater than 2 gray. Administer the second dose one week after the first dose.

Obtain a baseline complete blood count (CBC). Do not delay administration of Neulastim if a CBC is not readily available. Estimate a patient’s absorbed radiation dose (i.e., level of radiation exposure) based on information from public health authorities, biodosimetry if available, or clinical findings such as time to onset of vomiting or lymphocyte depletion kinetics.

2.3 Administration

Neulastim is administered subcutaneously via a single-dose prefilled syringe for manual use or for use with the On-body Injector for Neulastim, which is co-packaged with a single-dose prefilled syringe. Use of the On-body Injector for Neulastim is not recommended for patients with Hematopoietic Subsyndrome of Acute Radiation Syndrome. Use of the On-body Injector for Neulastim has not been studied in pediatric patients.

Prior to use‚ remove the carton from the refrigerator and allow the Neulastim prefilled syringe to reach room temperature for a minimum of 30 minutes. Discard any prefilled syringe left at room temperature for greater than 48 hours.

Visually inspect parenteral drug products (prefilled syringe) for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not administer Neulastim if discoloration or particulates are observed.

The needle cap on the prefilled syringes contains dry natural rubber (derived from latex); persons with latex allergies should not administer these products.

Pediatric P atients weighing less than 45 kg

The Neulastim prefilled syringe is not designed to allow for direct administration of doses less than 0.6 mL (6 mg). The syringe does not bear graduation marks, which are necessary to accurately measure doses of Neulastim less than 0.6 mL (6 mg) for direct administration to patients. Thus, the direct administration to patients requiring dosing of less than 0.6 mL (6 mg) is not recommended due to the potential for dosing errors. Refer to Table 1.

Body Weight	Neulastim Dose	Volume to Administer
Less than 10 kg*	See below*	See below*
10 - 20 kg	1.5 mg	0.15 mL
21 - 30 kg	2.5 mg	0.25 mL
31 - 44 kg	4 mg	0.4 mL

*For pediatric patients weighing less than 10 kg, administer 0.1 mg/kg (0.01 mL/kg) of Neulastim.

2.4 Special Healthcare Provider Instructions for the On-body Injector for Neulastim

A healthcare provider must fill the On-body Injector with Neulasta using the prefilled syringe and then apply the On-body Injector for Neulastim to the patient’s skin . The back of the arm may only be used if there is a caregiver available to monitor the status of the On-body Injector for Neulastim. Approximately 27 hours after the On-body Injector for Neulastim is applied to the patient’s skin, Neulasta will be delivered over approximately 45 minutes. A healthcare provider may initiate administration with the On-body Injector for Neulastim on the same day as the administration of cytotoxic chemotherapy, as long as the On-body Injector for Neulastim delivers Neulastim no less than 24 hours after administration of cytotoxic chemotherapy.

The prefilled syringe co-packaged in Neulastim Onpro^TM kit must only be used with the On-body Injector for Neulastim. The prefilled syringe contains additional solution to compensate for liquid loss during delivery through the On-body Injector for Neulastim. If the prefilled syringe co-packaged in Neulastim Onpro kit is used for manual subcutaneous injection, the patient will receive an overdose. If the single-dose prefilled syringe for manual use is used with the On-body Injector for Neulastim, the patient may receive less than the recommended dose.

Do not use the On-body Injector for Neulastim to deliver any other drug product except the Neulastim prefilled syringe co-packaged with the On-body Injector for Neulastim.

The On-body Injector for Neulastim should be applied to intact, non-irritated skin on the arm or abdomen.

A missed dose could occur due to an On-body Injector for Neulastim failure or leakage. If the patient misses a dose, a new dose should be administered by single-dose prefilled syringe for manual use, as soon as possible after detection.

Refer to the Healthcare Provider Instructions for Use for the On-body Injector for Neulasta for full administration information.

2.5 Advice to Give to Patients Regarding Administration via the On-body Injector for Neulastim

Advise patients to avoid activities such as traveling, driving, or operating heavy machinery during hours 26-29 following application of the On-body Injector for Neulastim (this includes the 45-minute delivery period plus an hour post-delivery). Patients should have a caregiver nearby for the first use.

Refer the patient to the dose delivery information written on the Patient Instructions for Use. Provide training to patients to ensure they understand when the dose delivery of Neulastim will begin and how to monitor the On-body Injector for Neulastim for completed delivery. Ensure patients understand how to identify signs of malfunction of On-body Injector for Neulasta [ s ee Warnings and Precautions ( 5.3 ) and Patient Counseling Information ( 17 )] .

3 DOSAGE FORMS AND STRENGTHS

• Injection: 6 mg/0.6 mL solution in a single-dose prefilled syringe for manual use only.
  

• Injection: 6 mg/0.6 mL solution in a single-dose prefilled syringe co-packaged with the On-body Injector for Neulastim (Neulasta Onpro kit).

• Injection: 6 mg/0.6 mL solution in a single-dose prefilled syringe for manual use only. (3)
  

• Injection: 6 mg/0.6 mL solution in a single-dose prefilled syringe co-packaged with the On-body Injector for Neulastim. (3)

4 CONTRAINDICATIONS

Do not administer Neulastim to patients with a history of serious allergic reactions to Neulastim or filgrastim.

Patients with a history of serious allergic reactions to human granulocyte colony-stimulating factors such as Neulastim or filgrastim. (4)

5 WARNINGS AND PRECAUTIONS

• Fatal splenic rupture: Evaluate patients who report left upper abdominal or shoulder pain for an enlarged spleen or splenic rupture.
  

• Acute respiratory distress syndrome (ARDS): Evaluate patients who develop fever, lung infiltrates, or respiratory distress. Discontinue Neulasta in patients with ARDS. (5.2)
  

• Serious allergic reactions, including anaphylaxis: Permanently discontinue Neulasta in patients with serious allergic reactions. (5.3)
  

• The On-body Injector for Neulastim uses acrylic adhesive. For patients who have reactions to acrylic adhesives, use of this product may result in a significant reaction. (5.4)
  

• Fatal sickle cell crises: Have occurred. (5.5)
  

• Glomerulonephritis: Evaluate and consider dose-reduction or interruption of Neulastim if causality is likely. (5.6)

5.1 Splenic Rupture

Splenic rupture, including fatal cases, can occur following the administration of Neulastim. Evaluate for an enlarged spleen or splenic rupture in patients who report left upper abdominal or shoulder pain after receiving Neulastim.

5.2 Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome can occur in patients receiving Neulastim. Evaluate patients who develop fever and lung infiltrates or respiratory distress after receiving Neulastim, for ARDS. Discontinue Neulastim in patients with ARDS.

5.3 Serious Allergic Reactions

Serious allergic reactions, including anaphylaxis, can occur in patients receiving Neulastim. The majority of reported events occurred upon initial exposure. Allergic reactions, including anaphylaxis, can recur within days after the discontinuation of initial anti-allergic treatment. Permanently discontinue Neulastim in patients with serious allergic reactions. Do not administer Neulastim to patients with a history of serious allergic reactions to Neulastim or filgrastim.

5.4 Allergies to Acrylics

The On-body Injector for Neulastim uses acrylic adhesive. For patients who have reactions to acrylic adhesives, use of this product may result in a significant reaction.

5.5 Use in Patients with Sickle Cell Disorders

Severe sickle cell crises can occur in patients with sickle cell disorders receiving Neulastim. Severe and sometimes fatal sickle cell crises can occur in patients with sickle cell disorders receiving filgrastim, the parent compound of Neulastim.

5.6 Glomerulonephritis

Glomerulonephritis has occurred in patients receiving Neulastim. The diagnoses were based upon azotemia, hematuria, proteinuria, and renal biopsy. Generally, events of glomerulonephritis resolved after dose reduction or discontinuation of Neulastim. If glomerulonephritis is suspected, evaluate for cause. If causality is likely, consider dose-reduction or interruption of Neulastim.

5.7 Leukocytosis

White blood cell (WBC) counts of 100 x 10⁹/L or greater have been observed in patients receiving Neulastim. Monitoring of complete blood count (CBC) during Neulastim therapy is recommended.

5.8 Capillary Leak Syndrome

Capillary leak syndrome has been reported after G-CSF administration, including Neulastim, and is characterized by hypotension, hypoalbuminemia, edema and hemoconcentration. Episodes vary in frequency, severity and may be life-threatening if treatment is delayed. Patients who develop symptoms of capillary leak syndrome should be closely monitored and receive standard symptomatic treatment, which may include a need for intensive care.

5.9 Potential for Tumor Growth Stimulatory Effects on Malignant Cells

The granulocyte-colony stimulating factor (G-CSF) receptor through which Neulastim and filgrastim act has been found on tumor cell lines. The possibility that Neulastim acts as a growth factor for any tumor type, including myeloid malignancies and myelodysplasia, diseases for which Neulastim is not approved, cannot be excluded.

6 ADVERSE REACTIONS

The following serious adverse reactions are discussed in greater detail in other sections of the labeling:

• Splenic Rupture [ s ee Warnings and Precautions ]
  

• Acute Respiratory Distress Syndrome [ s ee Warnings and Precautions ( 5.2 )]
  

• Serious Allergic Reactions [ s ee Warnings and Precautions ( 5.3 )]
  

• Allergies to Acrylics [ s ee Warnings and Precautions ( 5.4 )]
  

• Use in Patients with Sickle Cell Disorders [ s ee Warnings and Precautions ( 5.5 )]
  

• Glomerulonephritis [ s ee Warnings and Precautions ( 5.6 )]
  

• Leukocytosis [ s ee Warnings and Precautions ( 5.7 )]
  

• Capillary Leak Syndrome [ s ee Warnings and Precautions ( 5.8 )]
  

• Potential for Tumor Growth Stimulatory Effects on Malignant Cells [ s ee Warnings and Precautions ( 5.9 )]

Most common adverse reactions (≥ 5% difference in incidence compared to placebo) are bone pain and pain in extremity. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact Amgen Inc. at 1-800-77-AMGEN (1-800-772-6436) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Neulastim clinical trials safety data are based upon 932 patients receiving Neulastim in seven randomized clinical trials. The population was 21 to 88 years of age and 92% female. The ethnicity was 75% Caucasian, 18% Hispanic, 5% Black, and 1% Asian. Patients with breast (n = 823), lung and thoracic tumors (n = 53) and lymphoma (n = 56) received Neulastim after nonmyeloablative cytotoxic chemotherapy. Most patients received a single 100 mcg/kg (n = 259) or a single 6 mg (n = 546) dose per chemotherapy cycle over 4 cycles.

The following adverse reaction data in Table 2 are from a randomized, double-blind, placebo-controlled study in patients with metastatic or non-metastatic breast cancer receiving docetaxel 100 mg/m² every 21 days (Study 3). A total of 928 patients were randomized to receive either 6 mg Neulastim (n = 467) or placebo (n = 461). The patients were 21 to 88 years of age and 99% female. The ethnicity was 66% Caucasian, 31% Hispanic, 2% Black, and < 1% Asian, Native American, or other.

The most common adverse reactions occurring in ≥ 5% of patients and with a between-group difference of ≥ 5% higher in the Neulastim arm in placebo-controlled clinical trials are bone pain and pain in extremity.

System Organ Class Preferred Term	Placebo (N = 461)	Neulastim 6 mg SC on Day 2 (N = 467)
Musculoskeletal and connective tissue disorders
Bone pain	26%	31%
Pain in extremity	4%	9%

L eukocytosis

In clinical studies, leukocytosis (WBC counts > 100 x 10⁹/L) was observed in less than 1% of 932 patients with non-myeloid malignancies receiving Neulastim. No complications attributable to leukocytosis were reported in clinical studies.

6.2 Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity. Binding antibodies to Neulastim were detected using a BIAcore assay. The approximate limit of detection for this assay is 500 ng/mL. Pre-existing binding antibodies were detected in approximately 6% of patients with metastatic breast cancer. Four of 521 pegfilgrastim-treated subjects who were negative at baseline developed binding antibodies to Neulastim following treatment. None of these 4 patients had evidence of neutralizing antibodies detected using a cell-based bioassay.

The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay, and the observed incidence of antibody positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to Neulastim with the incidence of antibodies to other products may be misleading.

6.3 Postmarketing Experience

The following adverse reactions have been identified during post approval use of Neulastim. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

• Splenic rupture and splenomegaly (enlarged spleen) [see Warnings and Precautions ( 5.1 )]
  

• Acute respiratory distress syndrome (ARDS) [see Warnings and Precautions ( 5.2 )]
  

• Allergic reactions/hypersensitivity, including anaphylaxis, skin rash, urticaria, generalized erythema, and flushing [see Warnings and Precautions ( 5.3 )]
  

• Sickle cell crisis [see Warnings and Precautions ( 5.5 )]
  

• Glomerulonephritis [see Warnings and Precautions ( 5.6 )]
  

• Leukocytosis [see Warnings and Precautions ( 5.7 )]
  

• Capillary Leak Syndrome [see Warnings and Precautions ( 5.8 )]
  

• Injection site reactions
  

• Sweet’s syndrome (acute febrile neutrophilic dermatosis), cutaneous vasculitis

7 DRUG INTERACTIONS

No formal drug interaction studies between Neulastim and other drugs have been performed. Increased hematopoietic activity of the bone marrow in response to growth factor therapy may result in transiently positive bone-imaging changes. Consider these findings when interpreting bone-imaging results.

8 USE IN SPECIFIC POPULATIONS

• Pregnancy: Based on animal data, may cause fetal harm.
  

• Nursing Mothers: Caution should be exercised when administered to a nursing woman. (8.3)

8.1 Pregnancy

Preg n ancy Category C

There are no adequate and well-controlled studies in pregnant women. Neulastim was embryotoxic and increased pregnancy loss in pregnant rabbits that received cumulative doses approximately 4 times the recommended human dose (based on body surface area). Signs of maternal toxicity occurred at these doses. Neulastim should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

In animal reproduction studies, when pregnant rabbits received Neulastim at cumulative doses approximately 4 times the recommended human dose (based on body surface area), increased embryolethality and spontaneous abortions occurred. Signs of maternal toxicity (reductions in body weight gain/food consumption) and decreased fetal weights occurred at maternal doses approximately equivalent to the recommended human dose (based on body surface area). There were no structural anomalies observed in rabbit offspring at any dose tested. No evidence of reproductive/developmental toxicity occurred in the offspring of pregnant rats that received cumulative doses of Neulastim approximately 10 times the recommended human dose (based on body surface area) [ s ee Nonclinical Toxicology ( 13.3 )] .

8.3 Nursing Mothers

It is not known whether Neulastim is secreted in human milk. Other recombinant G-CSF products are poorly secreted in breast milk, and G-CSF is not orally absorbed by neonates. Caution should be exercised when administered to a nursing woman.

8.4 Pediatric Use

The safety and effectiveness of Neulastim have been established in pediatric patients. No overall differences in safety were identified between adult and pediatric patients based on postmarketing surveillance and review of the scientific literature.

Use of Neulastim in pediatric patients for chemotherapy-induced neutropenia is based on adequate and well-controlled studies in adults with additional pharmacokinetic and safety data in pediatric patients with sarcoma [see Clinical Pharmacology and Clinical Studies ( 14.1 )].

The use of Neulastim to increase survival in pediatric patients acutely exposed to myelosuppressive doses of radiation is based on efficacy studies conducted in animals and clinical data supporting the use of Neulastim in patients with cancer receiving myelosuppressive chemotherapy. Efficacy studies of Neulastim could not be conducted in humans with acute radiation syndrome for ethical and feasibility reasons. Results from population modeling and simulation indicate that two doses of Neulastim (Table 1), administered one week apart provide pediatric patients with exposures comparable to that in adults receiving two 6 mg doses one week apart [see Dosage and Administration ( 2.3 ) , Clinical Pharmacology ( 12.3 ) and Clinical Studies ( 14.2 )].

8.5 Geriatric Use

Of the 932 patients with cancer who received Neulastim in clinical studies, 139 (15%) were aged 65 and over, and 18 (2%) were aged 75 and over. No overall differences in safety or effectiveness were observed between patients aged 65 and older and younger patients.

8.6 Renal Impairment

Renal dysfunction had no effect on the pharmacokinetics of Neulastim. Therefore, Neulastim dose adjustment in patients with renal dysfunction is not necessary [ see Clinical Pharmacology ( 12.3 )] .

10 OVERDOSAGE

The maximum amount of Neulastim that can be safely administered in single or multiple doses has not been determined. Single subcutaneous doses of 300 mcg/kg have been administered to 8 healthy volunteers and 3 patients with non-small cell lung cancer without serious adverse effects. These patients experienced a mean maximum absolute neutrophil count (ANC) of 55 x 10⁹/L, with a corresponding mean maximum WBC of 67 x 10⁹/L. The absolute maximum ANC observed was 96 x 10⁹/L with a corresponding absolute maximum WBC observed of 120 x 10⁹/L. The duration of leukocytosis ranged from 6 to 13 days. The effectiveness of leukapheresis in the management of symptomatic individuals with Neulasta-induced leukocytosis has not been studied.

11 DESCRIPTION

Neulastim (pegfilgrastim) is a covalent conjugate of recombinant methionyl human G-CSF (filgrastim) and monomethoxypolyethylene glycol. Filgrastim is a water-soluble 175 amino acid protein with a molecular weight of approximately 19 kilodaltons (kD). Filgrastim is obtained from the bacterial fermentation of a strain of E coli transformed with a genetically engineered plasmid containing the human G-CSF gene. To produce Neulastim, a 20 kD monomethoxypolyethylene glycol molecule is covalently bound to the N-terminal methionyl residue of filgrastim. The average molecular weight of Neulastim is approximately 39 kD.

Neulastim is provided in two presentations:

• Neulastim for manual subcutaneous injection is supplied in 0.6 mL prefilled syringes. The prefilled syringe does not bear graduation marks and is designed to deliver the entire contents of the syringe (6 mg/0.6 mL).
  

• On-body Injector for Neulasta is supplied with a prefilled syringe containing 0.64 mL of Neulastim in solution that delivers 0.6 mL of Neulastim in solution when used with the On-body Injector for Neulastim. The syringe does not bear graduation marks and is only to be used with the On-body Injector for Neulastim.

The delivered 0.6 mL dose from either the prefilled syringe for manual subcutaneous injection or the On-body Injector for Neulastim contains 6 mg Neulastim (based on protein weight) in a sterile, clear, colorless, preservative-free solution (pH 4.0) containing acetate (0.35 mg), polysorbate 20 (0.02 mg), sodium (0.02 mg), and sorbitol (30 mg) in Water for Injection, USP.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Neulastim is a colony-stimulating factor that acts on hematopoietic cells by binding to specific cell surface receptors, thereby stimulating proliferation, differentiation, commitment, and end cell functional activation.

12.2 Pharmacodynamics

Animal data and clinical data in humans suggest a correlation between Neulastim exposure and the duration of severe neutropenia as a predictor of efficacy. Selection of the dosing regimen of Neulastim is based on reducing the duration of severe neutropenia.

12.3 Pharmacokinetics

The pharmacokinetics of Neulastim was studied in 379 patients with cancer. The pharmacokinetics of Neulastim was nonlinear, and clearance decreased with increases in dose. Neutrophil receptor binding is an important component of the clearance of Neulastim, and serum clearance is directly related to the number of neutrophils. In addition to numbers of neutrophils, body weight appeared to be a factor. Patients with higher body weights experienced higher systemic exposure to Neulastim after receiving a dose normalized for body weight. A large variability in the pharmacokinetics of Neulastim was observed. The half-life of Neulastim ranged from 15 to 80 hours after subcutaneous injection. In healthy volunteers, the pharmacokinetics of Neulastim were comparable when delivered subcutaneously via a manual prefilled syringe versus via the On-body Injector for Neulastim.

Specific Populations

No gender-related differences were observed in the pharmacokinetics of Neulastim, and no differences were observed in the pharmacokinetics of geriatric patients (≥ 65 years of age) compared with younger patients (< 65 years of age) [see Use in Specific Populations ( 8.5 )].

Renal Impairment

In a study of 30 subjects with varying degrees of renal dysfunction, including end stage renal disease, renal dysfunction had no effect on the pharmacokinetics of Neulastim [ see Use in Specific Populations ( 8.6 )].

Pediatric Patients with Cancer Receiving Myelosuppressive Chemotherapy

The pharmacokinetics and safety of Neulastim were studied in 37 pediatric patients with sarcoma in Study 4 [see Clinical Studies 14.1 ]. The mean (± standard deviation [SD]) systemic exposure (AUC_0-inf) of Neulastim after subcutaneous administration at 100 mcg/kg was 47.9 (± 22.5) mcg·hr/mL in the youngest age group (0 to 5 years, n = 11), 22.0 (± 13.1) mcg·hr/mL in the 6 to 11 years age group (n = 10), and 29.3 (± 23.2) mcg·hr/mL in the 12 to 21 years age group (n = 13). The terminal elimination half-lives of the corresponding age groups were 30.1 (± 38.2) hours, 20.2 (± 11.3) hours, and 21.2 (± 16.0) hours, respectively.

Patients Acutely Exposed to Myelosuppressive Doses of Radiation

The pharmacokinetics of Neulastim is not available in patients acutely exposed to myelosuppressive doses of radiation. Based on limited pharmacokinetic data in irradiated non-human primates, the area under the concentration-time curve (AUC), reflecting the exposure to Neulastim in non-human primates following a 300 mcg/kg dose of Neulastim, appears to be greater than in humans receiving a 6 mg dose. Results from population modeling and simulation indicate that two 6 mg doses of Neulastim administered one week apart in adults result in clinically relevant effects on duration of grade 3 and 4 neutropenia. In addition, weight based dosing in pediatric patients weighing less than 45 kg [see Dosing and Administration, Section 2.3 , Table 1] provides exposures comparable to those in adults receiving two 6 mg doses one week apart.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

No carcinogenicity or mutagenesis studies have been performed with Neulastim.

Neulastim did not affect reproductive performance or fertility in male or female rats at cumulative weekly doses approximately 6 to 9 times higher than the recommended human dose.

13.3 Reproductive and Developmental Toxicology

Pregnant rabbits were dosed with Neulastim subcutaneously every other day during the period of organogenesis. At cumulative doses ranging from the approximate human dose to approximately 4 times the recommended human dose (based on body surface area), treated rabbits exhibited decreased maternal food consumption, maternal weight loss, as well as reduced fetal body weights and delayed ossification of the fetal skull; however, no structural anomalies were observed in the offspring from either study. Increased incidences of post-implantation losses and spontaneous abortions (more than half the pregnancies) were observed at cumulative doses approximately 4 times the recommended human dose, which were not seen when pregnant rabbits were exposed to the recommended human dose.

Three studies were conducted in pregnant rats dosed with Neulastim at cumulative doses up to approximately 10 times the recommended human dose at the following stages of gestation: during the period of organogenesis, from mating through the first half of pregnancy, and from the first trimester through delivery and lactation. No evidence of fetal loss or structural malformations was observed in any study. Cumulative doses equivalent to approximately 3 and 10 times the recommended human dose resulted in transient evidence of wavy ribs in fetuses of treated mothers (detected at the end of gestation but no longer present in pups evaluated at the end of lactation).

14 CLINICAL STUDIES

14.1 Patients with Cancer Receiving Myelosuppressive Chemotherapy

Neulastim was evaluated in three randomized, double-blind, controlled studies. Studies 1 and 2 were active-controlled studies that employed doxorubicin 60 mg/m² and docetaxel 75 mg/m² administered every 21 days for up to 4 cycles for the treatment of metastatic breast cancer. Study 1 investigated the utility of a fixed dose of Neulastim. Study 2 employed a weight-adjusted dose. In the absence of growth factor support, similar chemotherapy regimens have been reported to result in a 100% incidence of severe neutropenia with a mean duration of 5 to 7 days and a 30% to 40% incidence of febrile neutropenia. Based on the correlation between the duration of severe neutropenia and the incidence of febrile neutropenia found in studies with filgrastim, duration of severe neutropenia was chosen as the primary endpoint in both studies, and the efficacy of Neulastim was demonstrated by establishing comparability to filgrastim-treated patients in the mean days of severe neutropenia.

In Study 1, 157 patients were randomized to receive a single subcutaneous injection of Neulastim (6 mg) on day 2 of each chemotherapy cycle or daily subcutaneous filgrastim (5 mcg/kg/day) beginning on day 2 of each chemotherapy cycle. In Study 2, 310 patients were randomized to receive a single subcutaneous injection of Neulastim (100 mcg/kg) on day 2 or daily subcutaneous filgrastim (5 mcg/kg/day) beginning on day 2 of each chemotherapy cycle.

Both studies met the major efficacy outcome measure of demonstrating that the mean days of severe neutropenia of Neulasta-treated patients did not exceed that of filgrastim-treated patients by more than 1 day in cycle 1 of chemotherapy. The mean days of cycle 1 severe neutropenia in Study 1 were 1.8 days in the Neulastim arm compared to 1.6 days in the filgrastim arm [difference in means 0.2 (95% CI -0.2, 0.6)] and in Study 2 were 1.7 days in the Neulastim arm compared to 1.6 days in the filgrastim arm [difference in means 0.1 (95% CI -0.2, 0.4)].

A secondary endpoint in both studies was days of severe neutropenia in cycles 2 through 4 with results similar to those for cycle 1.

Study 3 was a randomized, double-blind, placebo-controlled study that employed docetaxel 100 mg/m² administered every 21 days for up to 4 cycles for the treatment of metastatic or non-metastatic breast cancer. In this study, 928 patients were randomized to receive a single subcutaneous injection of Neulastim (6 mg) or placebo on day 2 of each chemotherapy cycle. Study 3 met the major trial outcome measure of demonstrating that the incidence of febrile neutropenia (defined as temperature ≥ 38.2°C and ANC ≤ 0.5 x 10⁹/L) was lower for Neulasta-treated patients as compared to placebo-treated patients (1% versus 17%, respectively, p < 0.001). The incidence of hospitalizations (1% versus 14%) and IV anti-infective use (2% versus 10%) for the treatment of febrile neutropenia was also lower in the Neulasta-treated patients compared to the placebo-treated patients.

Study 4 was a multicenter, randomized, open-label study to evaluate the efficacy, safety, and pharmacokinetics [see Clinical Pharmacology ( 12.3 )] of Neulastim in pediatric and young adult patients with sarcoma. Patients with sarcoma receiving chemotherapy age 0 to 21 years were eligible. Patients were randomized to receive subcutaneous Neulastim as a single dose of 100 mcg/kg (n = 37) or subcutaneous filgrastim at a dose 5 mcg/kg/day (n = 6) following myelosuppressive chemotherapy. Recovery of neutrophil counts was similar in the Neulastim and filgrastim groups. The most common adverse reaction reported was bone pain.

14.2 Patients with Hematopoietic Subsyndrome of Acute Radiation Syndrome

Efficacy studies of Neulastim could not be conducted in humans with acute radiation syndrome for ethical and feasibility reasons. Approval of this indication was based on efficacy studies conducted in animals and data supporting Neulasta’s effect on severe neutropenia in patients with cancer receiving myelosuppressive chemotherapy [see Dosage and Administration ( 2.1 )].

The recommended dose of Neulastim is two doses, 6 mg each, administered one week apart for humans exposed to myelosuppressive doses of radiation. For pediatric patients weighing less than 45 kg, dosing of Neulastim is weight based and is provided in Table 1 [see Dosage and Administration ( 2.3 )]. This dosing regimen is based on population modeling and simulation analyses. The exposure associated with this dosing regimen is expected to provide sufficient pharmacodynamic activity to treat humans exposed to myelosuppressive doses of radiation [see Clinical Pharmacology ( 12.3 )]. The safety of Neulastim at a dose of 6 mg has been assessed on the basis of clinical experience in patients with cancer receiving myelosuppressive chemotherapy.

The efficacy of Neulastim for the acute radiation syndrome setting was studied in a randomized, placebo-controlled non-human primate model of radiation injury. Rhesus macaques were randomized to either a control (n = 23) or treated (n = 23) cohort. On study day 0, animals (n = 6 to 8 per irradiation day) were exposed to total body irradiation (TBI) of 7.50 ± 0.15 Gy delivered at 0.8 ± 0.03 Gy/min, representing a dose that would be lethal in 50% of animals by 60 days of follow-up (LD50/60). Animals were administered subcutaneous injections of a blinded treatment (control article [5% dextrose in water] or Neulastim [300-319 mcg/kg/day]) on study day 1 and on study day 8. The primary endpoint was survival. Animals received medical management consisting of intravenous fluids, antibiotics, blood transfusions, and other support as required.

Neulastim significantly (at 0.0014 level of significance) increased 60-day survival in irradiated non-human primates: 91% survival (21/23) in the Neulastim group compared to 48% survival (11/23) in the control group.

16 HOW SUPPLIED/STORAGE AND HANDLING

Neulastim single-dose prefilled syringe for manual use

Neulastim is supplied in a prefilled single-dose syringe for manual use containing 6 mg Neulastim, supplied with a 27-gauge, 1/2-inch needle with an UltraSafe^® Needle Guard.

The needle cap of the prefilled syringe contains dry natural rubber (a derivative of latex).

Neulastim is provided in a dispensing pack containing one sterile 6 mg/0.6 mL prefilled syringe (NDC 55513-190-01).

Neulastim prefilled syringe does not bear graduation marks and is intended only to deliver the entire contents of the syringe (6 mg/0.6 mL) for direct administration. Use of the prefilled syringe is not recommended for direct administration for pediatric patients weighing less than 45 kg who require doses that are less than the full contents of the syringe.

Store refrigerated between 36° F to 46°F (2°C to 8°C) in the carton to protect from light. Do not shake. Discard syringes stored at room temperature for more than 48 hours. Avoid freezing; if frozen, thaw in the refrigerator before administration. Discard syringe if frozen more than once.

Neulastim Onpro ^TM kit

Neulastim Onpro kit is provided in a carton containing one sterile prefilled syringe and one sterile On-body Injector for Neulastim (NDC 55513-192-01).

The single-dose prefilled syringe contains 0.64 mL of solution that delivers 6 mg/0.6 mL of pegfilgrastim when used with the On-body Injector for Neulastim. The prefilled syringe is supplied with a 27-gauge, 1/2-inch needle. The syringe does not bear graduation marks and is only to be used with the On-body Injector for Neulastim.

The needle cap of the prefilled syringe contains dry natural rubber (a derivative of latex).

Store Neulastim Onpro kit in the refrigerator at 36°F to 46°F (2°C to 8°C) until ready for use. Because the On-body Injector for Neulasta is at room temperature during the period of use, Neulastim Onpro kit should not be held at room temperature longer than 12 hours prior to use. Discard Neulastim Onpro kit if stored at room temperature for more than 12 hours.

Do not use the On-body Injector for Neulastim if its packaging has been previously opened.

17 PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Patient Information).

Advise patients of the following risks and potential risks with Neulastim:

• Splenic rupture and splenomegaly
  

• Acute Respiratory Distress Syndrome
  

• Serious allergic reactions
  

• Sickle cell crisis
  

• Glomerulonephritis
  

• Capillary Leak Syndrome

Advise patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Subsyndrome of Acute Radiation Syndrome) that efficacy studies of Neulastim for this indication could not be conducted in humans for ethical and feasibility reasons and that, therefore, approval of this use was based on efficacy studies conducted in animals [see Clinical Studies ( 14.2 )].

Instruct patients who self-administer Neulastim using the single-dose prefilled syringe of the:

• Importance of following the Instructions for Use.
  

• Dangers of reusing syringes.
  

• Importance of following local requirements for proper disposal of used syringes.

Advise patients on the use of the On-body Injector for Neulastim:

• Review the Patient Information and Patient Instructions for Use with the patient and provide the instructions to the patient.
  

• Refer the patient to the dose delivery information written on the Patient Instructions for Use.
  

• Tell the patient when their dose delivery of Neulastim will begin and when their dose delivery should be completed.
  

• Advise the patient that serious allergic reactions can happen with Neulastim. Patients should have a caregiver nearby for the first use. Patients should plan to be in a place where they can appropriately monitor the On-body Injector for Neulasta during the approximately 45 minute Neulasta delivery and for an hour after the delivery. Advise the patient to avoid traveling, driving, or operating heavy machinery during hours 26-29 following application of the On-body Injector for Neulastim.
  

• If the On-body Injector for Neulastim is placed on the back of the arm, remind the patient that a caregiver must be available to monitor the On-body Injector for Neulastim.
  

• If a patient calls the healthcare provider regarding any On-body Injector for Neulastim problems, the healthcare provider is advised to call Amgen at 1-800-772-6436.
  

• Advise the patient:
  • to call their healthcare provider immediately if the status light on the On-body Injector for Neulasta is flashing red.
    

  • to inform their healthcare provider if the adhesive on the On-body Injector for Neulasta becomes saturated with fluid, or there is dripping, as this may be evidence of significant product leakage, resulting in inadequate or missed dose.
    

  • to keep the On-body Injector for Neulasta dry for approximately the last 3 hours prior to the dose delivery start to better enable potential leak detection.
    

  • that the On-body Injector for Neulasta should only be exposed to temperatures between 41°F and 104°F (5°C-40°C).
    

  • to keep the On-body Injector for Neulastim at least 4 inches away from electrical equipment such as cell phones, cordless telephones, microwaves, and other common appliances. Failure to keep the On-body Injector for Neulastim at least this recommended distance may interfere with operation and can lead to a missed or incomplete dose of Neulastim.
    

  • that if the needle is exposed after On-body Injector for Neulasta removal, place the used On-body Injector for Neulasta in a sharps disposal container to avoid accidental needle stick and call their healthcare provider immediately.
    

  • to remove the On-body Injector for Neulastim after the green light shines continuously and to place the used On-body Injector for Neulastim in a sharps disposal container .

• Advise the patient:
  • do not reapply the On-body Injector for Neulasta if the On-body Injector for Neulasta comes off before full dose is delivered and instead call their healthcare provider immediately.
    

  • avoid bumping the On-body Injector for Neulasta or knocking the On-body Injector for Neulastim off the body.
    

  • do not expose the On-body Injector for Neulasta to medical imaging studies, e.g. X-ray scan, MRI, CT scan, ultrasound, and oxygen rich environments such as hyperbaric chambers to avoid On-body Injector for Neulasta damage and patient injury.

• Advise the patient to avoid:
  • airport X-ray scans and request a manual pat down instead; remind patients who elect to request a manual pat down to exercise care to avoid having the On-body Injector for Neulasta dislodged during the pat down process.
    

  • sleeping on the On-body Injector for Neulasta or applying pressure on the On-body Injector for Neulasta as this may affect On-body Injector for Neulasta performance.
    

  • getting body lotions, creams, oils, and cleaning agents near the On-body Injector for Neulasta as these products may loosen the adhesive.
    

  • using hot tubs, whirlpools, or saunas and avoid exposing the On-body Injector for Neulasta to direct sunlight as these may affect the drug.
    

  • peeling off or disturbing the On-body Injector for Neulasta adhesive before delivery of full dose is complete.

Neulastim^® (pegfilgrastim)

Manufactured by:

Amgen Inc.

One Amgen Center Drive

Thousand Oaks, California 91320-1799

U.S. License No. 1080

Patent: http://pat.amgen.com/neulasta /

© 2002-2016 Amgen Inc. All rights reserved.

www.neulasta.com

1-800-77-AMGEN (1-800-772-6436)

10/2016

v19

Patient Information Neulastim ® (nu-las-tah) (pegfilgrastim) i njection Single-Dose Prefilled Syringe

What is Neulastim? Neulastim is a man-made form of granulocyte colony-stimulating factor (G-CSF). G-CSF is a substance produced by the body. It stimulates the growth of neutrophils, a type of white blood cell important in the body’s fight against infection. Acute Radiation Syndrome: The effectiveness of Neulastim for this use was only studied in animals, because it could not be studied in people.

Do not take Neulastim if you have had a serious allergic reaction to human G-CSFs such as Neulastim or filgrastim products.

Before you receive Neulastim, tell your healthcare provider about all of your medical conditions, including if you: have a sickle cell disorder. have kidney problems. are allergic to latex. The needle cap on the prefilled syringe contains dry natural rubber (derived from latex). You should not give Neulastim using the prefilled syringe if you have latex allergies. are pregnant or plan to become pregnant. It is not known if Neulastim will harm your unborn baby. are breastfeeding or plan to breastfeed. It is not known if Neulastim passes into your breast milk. Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

How will I receive Neulastim? Neulastim is given as an injection under your skin (subcutaneous injection) by a healthcare provider . If your healthcare provider decides that the subcutaneous injections can be given at home by you or your caregiver, follow the detailed “Instructions for Use” that comes with your Neulastim for information on how to prepare and inject a dose of Neulastim. You and your caregiver will be shown how to prepare and inject Neulastim before you use it. You should not inject a dose of Neulasta to children weighing less than 45 kg from a Neulastim prefilled syringe. A dose less than 0.6 mL (6 mg) cannot be accurately measured using the Neulastim prefilled syringe. If you are receiving Neulastim because you are also receiving chemotherapy, the last dose of Neulastim should be injected at least 14 days before and 24 hours after your dose of chemotherapy. If you miss a dose of Neulastim, talk to your healthcare provider about when you should give your next dose.

What are possible side effects of Neulastim? Neulastim may cause serious side effects, including: 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 your left shoulder. A s erious lung problem called Acute Respiratory Distress Syndrome (ARDS). Call your healthcare provider or get emergency care right away if you have shortness of breath with or without a fever, trouble breathing, or a fast rate of breathing. Serious allergic reactions. Neulastim 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 Neulasta and call your healthcare provider or get emergency medical help right away. Sickle cell crises. You may have a serious sickle cell crisis if you have a sickle cell disorder and receive Neulastim. Serious sickle cell crises have happened in people with sickle cell disorders receiving Neulastim 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). Neulastim can cause kidney injury. Call your healthcare provider right away if you develop any of the following symptoms: ○ swelling of your face or ankles ○ blood in your urine or dark colored urine ○ you urinate less than usual Increased white blood cell count (leukocy tosis) . Your healthcare provider will check your blood during treatment with Neulastim. Capillary Leak Syndrome . Neulastim 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 (abdomen) and feeling of fullness ○ dizziness or feeling faint ○ a general feeling of tiredness The most common side effects of Neulastim are pain in the bones, arms, and legs. These are not all the possible side effects of Neulastim. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store Neulastim? Store Neulastim in the refrigerator between 36ºF to 46ºF (2ºC to 8ºC). Do not freeze. Keep the prefilled syringe in the original carton to protect from light or physical damage. Do not shake the prefilled syringe. Take Neulastim out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection. Throw away (dispose of) any Neulastim that has been left at room temperature, 68ºF to 77ºF (20ºC to 25ºC), for more than 48 hours. Keep the Neulastim prefilled syringe out of the reach of children.

General information about the safe and effective use of Neulastim. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Neulastim for a condition for which it was not prescribed. Do not give Neulastim to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Neulastim that is written for health professionals.

What are the ingredients in Neulastim? Active ingredient: Neulastim Inactive ingredients: acetate, polysorbate 20, sodium, and sorbitol in water for injection. Neulastim® (pegfilgrastim) Manufactured by: Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 U.S. License No. 1080 Patent: http://pat.amgen.com/neulasta/ ©2002- 2016 Amgen Inc. All rights reserved. For more information go to www.neulasta.com, or call 1-800-77-AMGEN (1-800-772-6436). 1xxxxx v13

This Patient Information has been approved by the U.S. Food and Drug Administration. Revised: 4/2016

Patient Information

Neulastim ^® (nu-las-tah)

(pegfilgrastim)

injection

On-body Injector for Neulastim

Read this Patient Information before you receive Neulastim and each time you receive Neulastim with the On-body Injector for Neulastim. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or your treatment.

What is the most important information I need to know about receiving Neulastim with the On-body Injector for Neulastim?

• See the Instructions for Use for the On-body Injector for Neulastim f or detailed information about the On-body Injector for Neulastim and important information about your dose delivery that has been written by your healthcare provider .
  

  ○ Know the time that delivery of your dose of Neulastim is expected to start.
  

  ○ Avoid traveling, driving, or operating heavy machinery during hour 26 through hour 29 after the On-body Injector for Neulastim is applied. Avoid activities and places that may interfere with monitoring during the 45-minute period that Neulastim is expected to be delivered by the On-body Injector for Neulastim, and for 1 hour after delivery.
  

• A caregiver should be with you the first time that you receive Neulastim with the On-body Injector for Neulastim.
  

• If you have an allergic reaction during the delivery of Neulastim, remove the O n-body I njector for Neulastim by grabbing the edge of the adhesive pad and peeling off the O n-body I njector for Neulastim . Get emergency medical help right away.
  

• You should only receive a dose of Neulastim on the day your healthcare provider tells you.
  

• You should not receive your dose of Neulastim any sooner than 24 hours after you finish receiving your chemotherapy. The On-body Injector for Neulastim is programmed to deliver your dose about 27 hours after your healthcare provider places the On-body Injector for Neulastim on your skin.
  

• Do not expose the On-body Injector for Neulastim to the following because the On-body Injector for Neulastim may be damaged and you could be injured:
  

  - MRI
  

  - X-ray
  

  - CT-Scan
  

  - Ultrasound
  

  - Oxygen rich environments, such as hyperbaric chambers
  

• Avoid airport X-ray scans. Request a manual pat down instead. Use care during a manual pat down to help prevent the On-body Injector for Neulasta from being accidentally removed.
  

• Keep the On-body Injector for Neulastim at least 4 inches away from electrical equipment such as cell phones, cordless telephones, microwaves and other common appliances. If the On-body Injector for Neulastim is too close to electrical equipment, it may not work correctly and can lead to a missed or incomplete dose of Neulastim.
  

• The On-body Injector is for adult patients only.
  

• Call your healthcare provider right away if the:
  

  - On-body Injector for Neulastim comes off before or during a dose delivery. Do not re-apply it.
  

  - On-body Injector for Neulastim is leaking.
  

  - adhesive on your On-body Injector for Neulastim becomes noticeably wet (saturated) with fluid, or there is dripping. This may mean that Neulastim is leaking out of your On-body Injector for Neulastim. If this happens you may only receive some of your dose of Neulastim, or you may not receive a dose at all.
  

  - On-body Injector for Neulastim status light is flashing red.

What is Neulastim?

Neulastim is a prescription medicine used to help reduce the chance of infection due to a low white blood cell count, in people with certain types of cancer (non-myeloid), who receive anti-cancer medicines (chemotherapy) that can cause fever and low blood cell count.

Who should not take Neulastim?

Do not take Neulastim if you have had a serious allergic reaction to Neulastim (Neulasta^®) or to filgrastim (Neupogen^®).

What should I tell my healthcare provider before receiving Neulastim?

Before you receive Neulastim, tell your healthcare provider if you:

• have sickle cell trait or sickle cell disease
  

• have had severe skin reactions to acrylic adhesives
  

• are allergic to latex
  

• have problems with your kidneys
  

• have any other medical problems
  

• are pregnant or plan to become pregnant. It is not known if Neulastim may harm your unborn baby.
  

  Pregnancy Registry: There is a pregnancy registry for women who become pregnant during treatment with Neulastim. The purpose of this registry is to collect information about the health of you and your baby. You are encouraged to enroll in this registry. Your healthcare provider may enroll you, or you may enroll by calling 1-800-AMGEN (1-800-772-6436).
  

  
  

• are breastfeeding or plan to breastfeed. It is not known if Neulastim 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 Neulastim?

See the Instructions for Use for detailed information about how you will receive a dose of Neulastim with the On-body Injector for Neulastim, and how to remove and dispose of the O n-body I njector for Neulastim.

• See the section “What is the most important information I need to know about receiving Neulastim with the On-body Injector for Neulastim?”
  

• Neulastim is given as an injection under the skin (subcutaneous). Your healthcare provider will use a prefilled syringe with Neulastim to fill the On-body Injector prior to applying it. The prefilled syringe with Neulastim and the On-body Injector are provided to your healthcare provider as part of Neulastim Onpro^TM kit. The On-body Injector for Neulastim will be applied to the stomach area (abdomen) or back of your arm by your healthcare provider. If the On-body Injector for Neulastim was placed on the back of your arm, a caregiver must be available to monitor the On-body Injector for Neulastim.
  

• Your healthcare provider should place the On-body Injector for Neulastim on an area of your skin that does not have swelling, redness, cuts, wounds, or abrasions. Tell your healthcare provider about any skin reactions that happen in the On-body Injector for Neulastim application area after it has been applied.
  

• The On-body Injector for Neulastim is programmed to deliver your dose about 27 hours after your healthcare provider places the On-body Injector for Neulastim on your skin.
  

• The dose of Neulastim will be delivered over about 45 minutes. During dose delivery and for 1 hour after delivery, it is best to stay in a place where you or a caregiver can monitor the On-body Injector for Neulastim to make sure you receive your full dose of Neulastim and watch for symptoms of an allergic reaction.
  

• Keep the On-body Injector for Neulastim dry for about the last 3 hours before the dose delivery is expected to start. This will help you to better detect possible leaking from the On-body Injector for Neulastim.
  

• Only expose the On-body Injector for Neulastim to temperatures between 41°F to 104°F (5°C to 40°C).

What should I avoid while the On-body Injector for Neulastim is in place?

While the On-body Injector for Neulastim is in place you should avoid:

• traveling, driving or operating heavy machinery during hour 26 through hour 29 after the On-body Injector for Neulastim is applied.
  

• sleeping on the On-body Injector for Neulastim or applying pressure on the On-body Injector for Neulastim. The On-body Injector for Neulastim may not work properly.
  

• bumping the On-body Injector for Neulastim or knocking it off your body.
  

• getting body lotion, creams, oils, and skin cleansing products near the On-body Injector for Neulastim. These products may loosen the adhesive that holds the On-body Injector for Neulastim onto your body.
  

• using hot tubs, whirlpools, or saunas, and direct sunlight. These may affect Neulastim.
  

• peeling off or disturbing the On-body Injector for Neulastim adhesive before you receive your full dose of Neulastim.

What are possible side effects of Neulastim?

Neulastim can cause serious side effects, including:

• Spleen rupture. Your spleen may become enlarged or may rupture during treatment with Neulastim. A ruptured spleen can cause death. Call your healthcare provider right away if you have pain in your left upper stomach area or left shoulder area. This pain could mean your spleen is enlarged or ruptured.
  

• A serious lung problem called Acute Respiratory Distress Syndrome (ARDS). Call your healthcare provider or get emergency medical help right away if you get any of these symptoms of ARDS: fever, shortness of breath, trouble breathing, or a fast rate of breathing.
  

• Serious allergic reactions. Get emergency medical help right away if you get any of these symptoms of a serious allergic reaction with Neulastim: shortness of breath, wheezing, dizziness, swelling around the mouth or eyes, fast pulse, sweating, and hives.
  

  If you have an allergic reaction during the delivery of Neulastim, remove the On-body Injector for Neulastim by g rabbing the edge of the adhesive pad and peeling off the On-body Injector for Neulastim . Get emergency medical help right away.
  

• Sickle cell crises. Severe sickle cell crises, and sometimes death, can happen in people with sickle cell trait or disease who receive filgrastim, a medicine similar to Neulastim (pegfilgrastim).
  

• Kidney injury (glomerulonephritis) . Kidney injury has been seen in patients who received Neulastim. You should notify your healthcare provider right away if you experience puffiness in your face or ankles, blood in your urine or brown colored urine or you notice you urinate less than usual.
  

• Increased white blood cell count (leukocytosis). Your doctor will check your blood during treatment with Neulastim.
  

• Capillary Leak Syndrome. Neulastim 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 often
  

  ○ trouble breathing
  

  ○ swelling of your stomach-area (abdomen) and feeling of fullness
  

  ○ dizziness or feeling faint
  

  ○ a general feeling of tiredness

The most common side effect of Neulastim is pain in the bones and in your arms and legs.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Neulastim. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Neulastim

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. If you would like more information about Neulastim, talk with your healthcare provider or pharmacist. You can ask your pharmacist for information about Neulastim that is written for health professionals.

For more information, go to www.neulasta.com or call 1-844-696-3852 (1-844-MYNEULASTA).

What are the ingredients in Neulastim?

Active ingredient: Neulastim

Inactive ingredients: acetate, polysorbate 20, and sodium, sorbitol in Water for Injection.

This Patient Information has been approved by the U.S. Food and Drug Administration.

Neulastim^® (pegfilgrastim)

Manufactured by:

Amgen Inc.

One Amgen Center Drive

Thousand Oaks, California 91320-1799

US License No. 1080

Patent: http://pat.amgen.com/neulasta/

© 2002 to 2015 Amgen Inc. All rights reserved.

www.neulasta.com

1-844-MYNEULASTA (1-844-696-3852)

Issued: 11/2015

v3

Neulastim ® (pegfilgrastim) Onpro TM kit Healthcare Provider Instructions for Use

Guide to P arts

Neulastim Prefilled Syringe

On -body Injector for Neulastim

Important

READ THE FOLLOWING INSTRUCTIONS BEFORE USING Neulastim ONPRO KIT

Warning: Do not use Neulastim Onpro kit to deliver any other drug product.

See Prescribing Information for information on Neulastim. The On-body Injector is for adult patients only. The On-body Injector is not recommended for patients with Hematopoietic Subsyndrome of Acute Radiation Syndrome. Store Neulastim Onpro kit in the refrigerator at 36° F to 46° F (2° C to 8° C) until ready for use. If Neulastim Onpro kit is stored at room temperature for more than 12 hours, do not use. Start again with a new Neulastim Onpro kit. Keep the prefilled syringe in Neulastim Onpro kit carton until use to protect from light. For patients who have had severe skin reactions to acrylic adhesives, consider the benefit:risk profile before administering Neulastim via the On-body Injector for Neulastim. - The On-body Injector should be applied to intact, non-irritated skin on the abdomen or back of the arm. The back of the arm may only be used if there is a caregiver available to monitor the status of the On-body Injector.

Do not freeze Neulastim Onpro kit. Do not shake the prefilled syringe. Do not separate the components of Neulastim Onpro kit until ready for use. Do not modify the On-body Injector. Do not warm Neulastim Onpro kit components using a heat source. Do not use Neulastim Onpro kit if expiry date on the carton or any of Neulastim Onpro kit components has passed. Do not use if the name Neulastim does not appear on Neulastim Onpro kit carton. Do not attempt to reapply On-body Injector. Do not use if either the On-body Injector or prefilled syringe is dropped. Start again with a new Neulastim Onpro kit.

For all questions, call Amgen at 1-800-772-6436. If a patient calls you regarding any On-body Injector problems, call Amgen at 1-800-772-6436.

Step 1: Prepare
A		Remove Neulastim Onpro kit from the refrigerator. Check to make sure it contains:
	One Neulastim prefilled syringe One On-body Injector for Neulastim Neulastim Patient Information Neulastim Prescribing Information		Instructions for use for healthcare provider Instructions for use for patient Reference Guide
Do not use the On-body Injector if its packaging has been previously opened.

B	Choose the patient’s injection site .
Choose the flattest site for the On-body Injector application. Consult with the patient regarding their ability to remove and monitor the entire On-body Injector .
You can use the left or right side of the abdomen, except for a two-inch area right around navel. You can use the back of upper arm only if there is a caregiver available to monitor the status of the On-body Injector.
Do not apply the On-body Injector on areas with scar tissue, moles, or excessive hair. In case of excessive hair, carefully trim hair to get the On-body Injector close to the skin. Do not apply the On-body Injector on areas where belts, waistbands, or tight clothing may rub against, disturb, or dislodge the On-body Injector. Do not apply the On-body Injector on surgical sites. Do not apply the On-body Injector on areas where the On-body Injector will be affected by folds in the skin.

			The following is an overview of On-body Injector preparation steps. Read this section first. When ready, proceed to Step 2: Get Ready s ection.
Before you apply the On-body Injector to the patient, locate the medicine port on the blue needle cover to fill the On-body Injector with Neulastim.
Please n ote:				During filling, beeping will sound and the On-body Injector will be activated.
After activation, you will have three minutes to:
	1.	Completely empty syringe contents into the medicine port.
	2.	Remove the syringe from the port and dispose.
	3.	Remove the blue needle cover from back of the On-body Injector.
	4.	Peel away the two pieces of white adhesive backing from the back of the On-body Injector.
	5.	Attach the On-body Injector to the back of patient’s upper arm or abdomen.
The On-body Injector will deploy the cannula in three minutes, even if not applied to the patient. If not on patient’s body in three minutes, do not use the On-body Injector. Start again with a new Neulastim Onpro kit.
When you feel you are ready, please continue...
C Wash hands thoroughly. Prepare and clean the On-body Injector application site.
Choose an area larger than the adhesive backing, and clean it with an alcohol swab. Thoroughly clean the application site as this will help the On-body Injector adhere to the skin. Do not use any cleaner other than alcohol, especially those containing lotions or aloe. Allow the skin to completely dry. Do not touch this area again before attaching the On-body Injector.

Step 2: Get Ready
A	Remove Neulastim prefilled syringe from tray.
For safety reasons:
Do not grasp the gray needle cap.
Do not remove the gray needle cap until ready to fill the On-body Injector.
Do not grasp the plunger rod.
B	Insp ect medicine and Neulastim prefi lled syringe. Neulastim liquid should always be clear and colorless .

• Do not use if the liquid contains particulate matter or discoloration is observed prior to administration.
  

• Do not use if any part appears cracked or broken.
  

• Do not use if the gray needle cap is missing or not securely attached.
  

• Do not use if the expiration date printed on the label has passed.
  

• Do not remove the gray needle cap until ready to fill the On-body Injector.

In all the above cases, start again with a new kit. Call Amgen at 1-800-772-6436.

Neulastim prefilled syringe gray needle cap contains dry natural rubber, which is derived from latex.

C	Remove air bubbles in syringe without expelling medicine.
Carefully remove the gray needle cap straight out and away from your body. Gently tap the syringe with your finger until air bubbles rise to the top. Slowly push air out of the syringe, taking care to expel air only, not medicine. A small droplet at the tip of the needle during air purging is normal. Do not recap the syringe.

D	Center the needle directly over the medicine port at a 90 degree angle. Insert all the way into the port, avoiding sides.
Insert needle into medicine port at a 90 degree angle only. Do not insert the needle more than once. Do not bend the needle. Avoid spilling the medicine. Do not remove the blue needle cover before filling the On-body Injector.

E	Push the plunger rod to empty entire syringe contents. During filling, you will hear beeping. The status light will flash amber, indicating you now have three minutes to apply the On-body Injector to the patient.
Discard used syringe in sharps container.

F	Check to see if the On-body Injector is full and the amber light is flashing .
You should see the amber status light flashing and a black line next to FULL on the fill indicator. If this is not the case, do not use. Start again with a new Neulastim Onpro kit, and call Amgen at 1-800-772-6436.
G	Firmly lift and remove the blue needle cover away from the On -body Injector.
A drop of medicine may be visible on the needle tip when the blue needle cover is removed.

Step 3: Apply
A	Peel away both pull tabs to show the adhesive. Never touch hands or gloves to the adhesive.
Do not touch or contaminate the automatic needle area. Do not pull off the adhesive pad or fold it. Do not use if the needle or cannula is extended past the adhesive or is extended before the On-body Injector is placed on the patient. Do not place adhesive on skin that is damp. In all cases, start again with a new kit. Call Amgen at 1-800-772-6436.

B	Before the cannula deploys, securely apply the On-body Injector so it is visible and can be monitored by the patient or caregiver.
You now have time to carefully apply the On-body Injector without folding or wrinkling the adhesive.
Do not touch the adhesive. Grasp the On-body Injector’s plastic case with your fingertips and only by sides, keeping fingers off of the adhesive. Do not let the adhesive bend or curl while applying the On-body Injector to skin. Once on the skin, gently pat around the entire adhesive so it lies down without folds or wrinkles. Then, gently hold the top of the On-body Injector and run finger around the adhesive to create a secure attachment.
		Do not worry if the On-body Injector is quiet. When three minutes are up, the On-body Injector will beep telling you the cannula is about to insert.

C	Wait for the status light to turn green. This means the cannula has been inserted. Do not remove the On-body Injector during cannula insertion to avoid needle stick injury to you or to the patient.
		Check the quality of adhesion before sending the patient home.
If the adhesive is wrinkled in front of the cannula window or has folds anywhere that prevent the On -body Injector from securely adhering, remove the On-body Injector. Start again with a new kit and call Amgen at 1-800-772-6436.

Step 4: Finish
A	Fill in the Dose Delivery Information section in the patient instructions. Be sure to include when the On-body Injector was applied, when the dose will begin, and your contact information. Review this information with the patient.
Review each step in the patient instructions with the patient. Give the patient the instructions for use, reference guide, patient information and prescribing information to take home.
Before the patient goes home, make sure the patient understands:
The On-body Injector will always flash a slow green light to let them know it is working properly. After approximately 27 hours, beeps will signal that the dose delivery will begin in two minutes. When the dose delivery starts it will take about 45 minutes to complete. During this time, the On-body Injector will flash a fast green light. The patient should remain in a place where they can monitor the On-body Injector for the entire dose delivery. The patient should avoid activities and settings that may interfere with monitoring during the dosing of Neulastim administered by the On-body Injector. For example, avoid traveling, driving, or operating heavy machinery during hours 26-29 following application of the On-body Injector (this includes the approximately 45-minute delivery period plus an hour post-delivery). If the patient has an allergic reaction during the delivery of Neulastim, the patient should remove the On-body Injector and call his or her healthcare provider or seek emergency care right away. If placed on the back of the arm, remind the patient that a caregiver must be available to monitor the On-body Injector. When the dose delivery is complete, the patient or caregiver will hear a beep and see a solid green light. Always dispose of the empty On-body Injector in a sharps disposal container as instructed by your healthcare provider or by state or local laws. Keep the On-body Injector at least four inches away from electrical equipment such as cell phones, cordless telephones, microwaves and other common appliances. Failure to keep the On-body Injector at least this recommended distance may interfere with operation and can lead to a missed or incomplete dose of Neulastim.

Attention!

What to do if you hear beeping or when you look at status light and it is flashing red.

If at any time the On-body Injector beeps continuously for five minutes, and the status light is flashing red, take the On-body Injector off of the patient. Do not apply the On-body Injector to the patient if red error light is on. Do not leave the On-body Injector on the patient if red error light is on. In all cases, do not use. Start over with a new Neulastim Onpro kit, and call Amgen at 1-800-772-6436.

What to do if the adhesive becomes saturated with fluid or the On-body Injector is dripping.

If the patient reports an On-body Injector leak, they might not have received full dose. Schedule a follow-up appointment, and report the incident to Amgen at 1-800-772-6436.

Neulastim^® (pegfilgrastim)

Manufactured by:

Amgen Inc.

One Amgen Center Drive

Thousand Oaks, California 91320-1799

US License No. 1080

Patent: http://pat.amgen.com/neulasta/

© 2002 to 2016 Amgen Inc. All rights reserved.

www.neulasta.com 1-844-MYNEULASTA (1-844-696-3852)

Issued: 10/2016

v6

Do not expose the On-body Injector for Neulastim to the following environments as the On-body Injector may be damaged and the patient could be injured:

• MRI
  

• X-ray
  

• CT-Scan
  

• Ultrasound
  

• Oxygen rich environments such as hyperbaric chambers

Symbol	Meaning
	Do not reuse this On-body Injector.
	Refer to Instructions for Use
	Do not use if packaging is damaged.
	Temperature Limitation
	Humidity Limitation
	Expiration Date (use by date)
	Reference/model number
	Lot Number
	Type BF medical device (protection from electrical shock)
	Sterilized by ethylene oxide
	Waterproof up to 8 feet for 1 hour
	Prescription use only
	Not MRI-safe
	On-body Injector for Neulastim® (pegfilgrastim)
	Neulastim® (pegfilgrastim) Prefilled Syringe

Electromagnetic Compatibility

The information contained in this section (such as separation distances) is, in general, specifically written in regard to the On-body Injector for Neulastim. The numbers provided will not guarantee faultless operation but should provide reasonable assurance of such. This information may not be applicable to other medical electrical equipment; older equipment may be particularly susceptible to interference.

General Notes:

Medical electrical equipment requires special precautions regarding electromagnetic compatibility (EMC), and needs to be installed and put into service according to the EMC information provided in this document.

Portable and mobile RF communications equipment can affect medical electrical equipment.

Cables and accessories not specified within the instructions for use are not authorized. Using cables and/or accessories may adversely impact safety, performance, and electromagnetic compatibility (increased emission and decreased immunity).

Care should be taken if the On-body Injector for Neulastim is used adjacent to other electrical equipment; if adjacent use is inevitable, the On-body Injector for Neulastim should be observed to verify normal operation in this setting.

Electromagnetic Emissions
The On-body Injector for Neulastim is intended for use in the electromagnetic environment specified below. The user of the On-body Injector for Neulastim should ensure that it is used in such an environment.
Emissions	Compliance according to	Electromagnetic environment
RF Emissions (CISPR 11)	Group 1	The On-body Injector for Neulastim uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby equipment.
CISPR B Emissions Classification	Class B

Electromagnetic Immunity
The On-body Injector for Neulastim is intended for use in the electromagnetic environment specified below. The user of this equipment should ensure that it is used in such an environment.
Immunity Test	IEC 60601 Test Level	Compliance Level	Electromagnetic Environment - Guidance
ESD IEC 61000-4-2	±6 kV Contact ±8 kV Air	6 kV Contact ±8 kV Air	Floors should be wood, concrete or ceramic tile. If floors are synthetic, the r/h should be at least 30%.
Power Frequency 50/60 Hz Magnetic Field IEC 61000-4-8	3 A/m	3 A/m	Power frequency magnetic fields should be that of typical commercial or hospital environment.
Radiated RF Fields 61000-4-3	3 V/m 80 MHz to 2.5 GHz	(E1)=3 V/m	Portable and mobile communications equipment should be separated from the On-body Injector for Neulastim by no less than the distances calculated/listed below: D=(3.5/V1)(√P)150 kHz to 80 MHz D=(3.5/E1)(√P)80 to 800 MHz D=(7/E1)(√P)800 MHz to 2.5 GHz Where P is the max power in watts and D is the recommended separation distance in meters. Field strengths from fixed transmitters, as determined by an electromagnetic site survey, should be less than the compliance levels (V1 and E1). Interference may occur in the vicinity of equipment containing a transmitter.

Recommended separation distances between portable and mobile RF communications equipment and the On-body Injector for Neulastim
You can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the On-body Injector for Neulastim, as recommended below, according to the maximum power of the communication equipment.
Rated maximum output power of transmitter, in watts	Separation distance according to frequency of transmitter, in meters
	150 kHz to 80 MHz D=(3.5/V1)(√P)	80 MHz to 800 MHz D=(3.5/E1)(√P)	800 MHz to 2.5 GHz D=(7/E1)(√P)
0.01	0.11667	0.11667	0.23333
0.1	0.36894	0.36894	0.73785
1	1.1667	1.1667	2.3333
10	3.6894	3.6894	7.3785
100	11.667	11.667	23.333

Neulastim Prefilled Syringe On body Injector for Neulastim Choose the patient’s injection site. STOP Wash hands thoroughly. Prepare and clean the On body Injector application site. Remove Neulastim prefilled syringe from tray. Inspect medicine and Neulastim prefilled syringe. Neulastim liquid should always be clear and colorless. Remove air bubbles in syringe without expelling medicine. Center the needle directly over the medicine port at a 90 degree angle. Insert all the way into the port, avoiding sides. Push the plunger rod to empty entire syringe contents. During filling, you will hear beeping. The status light will flash amber, indicating you now have three minutes to apply the On body Injector to the patient. Check to see if the On body Injector is full and the amber light is flashing. Firmly lift and remove the blue needle cover away from the On body Injector. Peel away both pull tabs to show the adhesive. Never touch hands or gloves to the adhesive. Do not touch the adhesive. Grasp the On body Injector’s plastic case with your fingertips and only by sides, keeping fingers off of the adhesive. You now have time to carefully apply the On body Injector without folding or wrinkling the adhesive. STOP Wait for the status light to turn green. This means the cannula has been inserted. If the adhesive is wrinkled in front of the cannula window or has folds anywhere that prevent the On body Injector from securely adhering, remove the On body Injector. Start again with a new kit and call Amgen at 1-800-772-6436. What to do if you hear beeping or when you look at status light and it is flashing red. What to do if the adhesive becomes saturated with fluid or the On body Injector is dripping. Do not reuse this On-body Injector. Single-use only Refer to Instructions for Use Do not use if packageing is damaged. Temperature Limitation Humidity Limitation Expiration Date (use by date) Reference/model number Lot Number Type BF medical device (protection from electrical shock) Sterilized by ethylene oxide Waterproof up to 8 feet for 1 hour Prescription use only Not MRI-safe On-body Injector for Neulasta® (pegfilgrastim) Neulasta® (pegfilgrastim) Prefilled Syringe

{SIDE 1 Information}

Patient Instructions for Use

On-body Injector for Neulastim Description

The On-body Injector for Neulastim is intended for delivery of Neulastim. The On-body Injector is small, for one-time use, lightweight, battery-powered, and waterproof up to 8 feet for 1 hour. Your healthcare provider will use a prefilled syringe with Neulastim to fill the On-body Injector prior to applying it. The prefilled syringe with Neulastim and the On-body Injector are provided to your healthcare provider as part of Neulastim Onpro^TM kit. The On-body Injector is applied directly to your skin using a self-adhesive backing. The On-body Injector informs you of its status with sounds and lights.

The On-body Injector contains electronic components as well as: a plastic housing, acrylic adhesive, batteries, a cannula introducer (needle) and a cannula. The On-body Injector is approximately: 2.4 in long, 1.6 in wide, 0.7 in height (62 mm long, 41 mm wide, 17 mm height).

Warnings

Before you receive Neulastim, tell your healthcare provider if you:

• Have sickle cell trait or sickle cell disease
  

• Have problems with your kidneys
  

• Have any other medical problems
  

• Are pregnant or plan to become pregnant. It is not known if Neulastim may harm your unborn baby.
  

• Are breastfeeding or plan to breastfeed. It is not known if Neulastim passes into your breastmilk.

DO NOT take Neulastim if you have had a serious allergic reaction to Neulastim (Neulasta^®) or to filgrastim (Neupogen^®).

Tell your healthcare provider if you are allergic to latex. A prefilled syringe is used to fill the On-body Injector by your healthcare provider prior to applying the On-body Injector. The prefilled syringe gray needle cap contains dry natural rubber, which is derived from latex. Latex may be transferred to your skin.

Tell your healthcare provider if you have had severe skin reactions to acrylic adhesives.

The On-body Injector is for adult patients only.

Avoid activities and places that may interfere with monitoring during the dosing of Neulastim administered by the On-body Injector. For example, AVOID traveling, driving, or operating heavy machinery during hours 26-29 following application of the On-body Injector for Neulastim (this includes the 45-minute dose delivery period plus an hour post-delivery).

If you must travel by airplane before the approximately 45-minute dose delivery period with the On-body Injector, avoid airport X-ray scans. Request a manual pat down instead. Use care during a manual pat down to help prevent the On-body Injector from being accidentally removed. For more information go to:

http://www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions

If you have an allergic reaction during the delivery of Neulastim, remove the On-body Injector by grabbing the edge of the adhesive pad and peeling off the On-body Injector. Get emergency medical help right away.

Call your healthcare provider immediately if you have severe pain or skin discomfort around your On-body Injector.

Call your healthcare provider right away if you have pain in your left upper stomach area or left shoulder area. This pain could mean your spleen is enlarged or ruptured.

Call your healthcare provider or get emergency medical help right away if you get any of these symptoms of acute respiratory distress syndrome (ARDS): fever, shortness of breath, trouble breathing, or a fast rate of breathing.

Call your healthcare provider right away if you experience any of these symptoms of kidney injury (glomerulonephritis): puffiness in your face or ankles, blood in your urine or brown colored urine or you notice you urinate less than usual.

Keep children away from the used On-body Injector.

You should only receive a dose of Neulastim on the day your healthcare provider tells you.

You should not receive your dose of Neulastim any sooner than 24 hours after you finish receiving your chemotherapy. The On-body Injector for Neulastim is programmed to deliver your dose about 27 hours after your healthcare provider places the On-body Injector on your skin.

DO NOT expose the On-body Injector to the following because the On-body Injector may be damaged and you could be injured:

• MRI
  

• X-ray
  

• CT-Scan
  

• Ultrasound
  

• Oxygen rich environments, such as hyperbaric chambers

DO NOT use hot tubs, whirlpools, or saunas while wearing the On-body Injector. This may affect your medicine.

DO NOT expose the On-body Injector to direct sunlight. If the On-body Injector is exposed to direct sunlight for more than one hour, it may affect your medicine. Wear the On-body Injector under clothing.

DO NOT sleep on the On-body Injector or apply pressure during wear, especially during dose delivery. This may affect the On-body Injector performance.

DO NOT peel off or disturb the On-body Injector’s adhesive before your full dose is complete. This may result in a missed or incomplete dose of Neulastim.

Precautions

Environmental:

Keep the On-body Injector dry for the last three hours prior to the dose delivery start.

Only expose the On-body Injector to temperatures between 41° F and 104° F (5° C - 40° C).

Keep the On-body Injector at least four inches away from electrical equipment such as cell phones, cordless telephones, microwaves and other common appliances. Failure to keep the On-body Injector at least this recommended distance may interfere with operation and can lead to a missed or incomplete dose of Neulastim.

Activity Related:

Avoid getting body lotions, creams, oils or cleaning agents near the On-body Injector as these products may loosen the adhesive.

Be careful not to bump the On-body Injector or knock the On-body Injector off your body.

Biohazard:

Properly dispose of the On-body Injector:

• The On-body Injector contains batteries, electronics, and a needle. The On-body Injector should be placed in a sharps disposal container, with an appropriate sized opening, regardless of whether or not the needle is exposed. Follow instructions provided by your healthcare provider or by state or local laws.
  

• To participate in Amgen’s voluntary disposal program, please call 1-844-MYNEULASTA (1-844-696-3852) or visit www.neulasta.com to enroll.
  

• For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to FDA’s website at: http://www.fda.gov/safesharpsdisposal.

Risks

You can avoid most risks related to using the On-body Injector for Neulastim by following the Patient Instructions for Use. Immediately call your healthcare provider if any of the following occur:

• The adhesive becomes noticeably wet (saturated) with fluid, or you see dripping
  

• If the On-body Injector fill indicator is not at the empty position after On-body Injector removal (You should see a black line next to the EMPTY indicator.)
  

• The On-body Injector comes off from the skin before or during a dose delivery (D O NOT re-apply it.)
  

• Status light is flashing red
  

• Allergic reaction
  

• Persistent or worsening redness or tenderness at the application site (may be a sign of infection)
  

• Severe pain or skin discomfort around your On-body Injector
  

• Any concern about your medication
  

• If the needle is exposed after On-body Injector removal

{SIDE 2 Information}

On-body Injector for Neulastim ® (nu-las-tah) (pegfilgrastim) Injection Patient Instructions for Use

Dose Delivery Information

Your On-body Injector was applied:

__________________________________________________________

Day Time AM / PM

Your dose delivery will start around:

__________________________________________________________

Day Time AM / PM

Name of Healthcare Provider:

__________________________________________________________

Last, First

Healthcare Provider contact number:

__________________________________________________________

On-body Injector lot number:

__________________________________________________________

Important Information

This On-body Injector delivers Neulastim with an under-the-skin (subcutaneous) injection. See Patient Information for medicine information.

If you have concerns about your medication, call your healthcare provider immediately. Serious allergic reactions can happen with Neulastim. Ask your caregiver to be nearby for the first use. Plan to be in a place where you or your caregiver can appropriately monitor the On-body Injector for Neulastim during the approximately 45 minute Neulastim delivery and for an hour after the delivery.

Avoid activities and places that may interfere with monitoring during the dosing of Neulastim administered by the On-body Injector (hours 26-29).

If you have an allergic reaction during the delivery of Neulastim, remove the On-body Injector by grabbing the edge of the adhesive pad and peeling off the On-body Injector. Get emergency medical help right away.

The On-body Injector should be applied to intact, non-irritated skin on the stomach area (abdomen) or back of the arm. The back of the arm may only be used if there is a caregiver available to monitor the status of the On-body Injector.

Call your healthcare provider immediately if you have severe pain or skin discomfort around your On-body Injector.

Be careful not to bump the On-body Injector or knock the On-body Injector off your body.

Avoid getting body lotions, creams, oils or cleaning agents near the On-body Injector as these products may loosen the adhesive.

Keep the On-body Injector dry for the last three hours prior to the dose delivery start.

Only expose the On-body Injector to temperatures between 41° F and 104° F (5° C and 40° C).

After On-body Injector removal, properly dispose of it in a sharps disposal container as instructed by your healthcare provider or by state or local laws.

Keep the On-body Injector at least four inches away from electrical equipment such as cell phones, cordless telephones, microwaves and other common appliances. Failure to keep the On-body Injector at least this recommended distance may interfere with operation and can lead to a missed or incomplete dose of Neulastim.

Do not use hot tubs, whirlpools, or saunas while wearing the On-body Injector. This may affect your medicine.

Do not expose the On-body Injector to direct sunlight. If the On-body Injector is exposed to direct sunlight for more than one hour, it may affect your medicine. Wear the On-body Injector under clothing.

Do not sleep on the On-body Injector or apply pressure during wearing, especially during dose delivery. This may affect On-body Injector performance.

Do not peel off or disturb the On-body Injector adhesive before your full dose is complete. This may result in a missed or incomplete dose of Neulastim.

A healthcare provider who is familiar with Neulastim should answer your questions. For general questions or support call 1-844-MYNEULASTA (1-844-696-3852) or visit www.neulasta.com.

Guide to Parts for On-body Injector for Neulastim

The On-body Injector is working properly.

If at any time you hear beeping, check the status light. If it is flashing red, call your healthcare provider immediately.

FULL EMPTY

Fill indicator

After your dose delivery is complete, check to see if the black line on your On-body Injector fill indicator is at empty.

On-body Injector Placement

Step 1: Monitor On-body Injector
A	Check your status light occasionally for appr oximately 27 hours. Since it fl ashes slowly, watch for at least 10 seconds. If the status light is fl ashing green, it is okay.
	If at any time you hear beeping, check the status light. If it is flashing red, call your healthcare provider immediately.
If the On-body Injector for Neulastim was placed on the back of your arm, a caregiver must be available to monitor the status of the On-body Injector.

B	After approximately 27 hours, your On-body Injector will beep to let you know your dose delivery will begin in 2 minutes . When the dose delivery starts , it will take about 45 minutes to complete. During this time, the On-body Injector will flash a fast green light.
	If at any time you hear beeping, check the status light. If it is flashing red, call your healthcare provider immediately.
DO NOT remove the On-body Injector before the dose delivery is complete.

Step 2: Monitor Dose Delivery
	For the next 45 minutes, monitor your On-body Injector frequently for leaks during dose delivery. If the On-body Injector was placed on the back of your arm, a caregiver must be available to monitor your On-body Injector .
If the adhesive becomes noticeably wet ( saturated ) with fluid, or you see dripping, call your healthcare provider immediately.

A		Your dose delivery will take around 45 minutes to complete.
	You may hear a series of clicks. This is okay. A beep will sound when the dose delivery is complete.

Step 3: Remove On-body I njector When Dose Delivery Is Complete
A	When beeping starts, check to see the color of the status light.
	Check to see if the status light is SOLID GREEN or has switched off. This means the dose is complete. Remember, any time you see a leak, call your healthcare provider immediately . If the dose is complete, go to the next step.	If you see the status light is flashing red, your On-body Injector is not functioning properly. Call your healthcare provider immediately, as you may not have received a full dose.

B		Grab the edge of the adhesive pad. Slowly peel off the On-body Injector .
	If medicine has leaked or the adhesive is noticeably wet (saturated), call your healthcare provider immediately as you may not have received your full dose. Remove any extra adhesive using soap and water.
	D o not grasp the On-body Injector itself to try to pull it off of your body.

Step 4: Finish
		Check to see if your On-body Injector is empty.
	You should see a black line next to the EMPTY indicator. If the On-body Injector is not empty, call your healthcare provider immediately.
	Check your status light again. Watch for at least 10 seconds. If the status light is solid green or it has switched off, it is okay. If you hear beeping, or when you check the status light and it is flashing red, call your healthcare provider immediately. After On-body Injector removal, place the On-body Injector in a sharps disposal container whether the needle is exposed or not. If the needle is exposed, call your healthcare provider immediately.

A	Record the end state of your On-body Injector .
	Mark the box of the description that represents your On-body Injector after it has been used.
			Status light is s olid green or the status light has switched off. This means that
			the delivery is complete.
			O n-body I njector leaked, call your healthcare provider immediately.
			Status light is r ed, call your healthcare provider immediately.
B	Properly dispose of the On-body Injector.
	The On-body Injector contains batteries, electronics, and a needle. Dispose of it in a sharps disposal container as instructed by your healthcare provider or by state or local laws. To participate in Amgen’s voluntary disposal program, please call 1-844-MYNEULASTA (1-844-696-3852) or visit www.neulasta.com to enroll. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to FDA’s website at: http://www.fda.gov/safesharpsdisposal. Keep children away from the used On-body Injector.

Attention!
What to do if you hear beeping or when you look at the status light and it is flashing red.
	If the status light is flashing red, you may not have received your full dose. Call your healthcare provider immediately.

What to do if the On-body Injector adhesive becomes noticeably wet ( saturated ) with fluid, or you see dripping.

If the adhesive becomes saturated with fluid, or you see dripping, your medicine may have leaked out. Even with a leak, the status light may remain green and the fill indicator may be at EMPTY. Call your healthcare provider immediately as you may not have received your full dose.

Note: It is normal to see a few drops of fluid at the application site, but not normal to see a noticeably wet (saturated) adhesive.

What do I do if the On-body Injector comes off before the full dose is delivered?

Call your healthcare provider immediately if the On-body Injector at any time comes away from your skin before your full dose delivery, DO NOT reapply it.

What if there is blood at my application site after the On-body Injector has been removed?

If there is blood, press a clean cotton ball or gauze pad on the application site. Apply an adhesive bandage if needed.

What if my application site is red or tender after On-body Injector removal?

Call your healthcare provider immediately if you experience persistent or worsening redness or tenderness at the application site, as this can be a sign of infection.

Neulastim^® (pegfilgrastim)

Manufactured by:

Amgen Inc.

One Amgen Center Drive

Thousand Oaks, California 91320-1799

US License No. 1080

Patent: http://pat.amgen.com/neulasta/

© 2002 to 2016 Amgen Inc. All rights reserved.

www.neulasta.com

1-844-MYNEULASTA (1-844-696-3852) Issued: 10/2016 v5

Guide to Parts for On-body Injector for Neulastim The On-body Injector is working properly. Fill indicator On-body Injector Placement Check your status light occasionally for approximately 27 hours. Since it flashes slowly, watch for at least 10 seconds. If the status light is flashing green, it is okay. 27 Hours If the On-body Injector for Neulastim was placed on the back of your arm, a caregiver must be available to monitor the status of the On-body Injector. After approximately 27 hours, your On-body Injector will beep to let you know your dose delivery will begin in 2 minutes. When the dose delivery starts, it will take about 45 minutes to complete. During this time, the On-body Injector will flash a fast green light. For the next 45 minutes, monitor your On-body Injector frequently for leaks during dose delivery. If the On-body Injector was placed on the back of your arm, a caregiver must be available to monitor your On-body Injector. Your dose delivery will take around 45 minutes to complete. When beeping starts, check to see the color of the status light. Grab the edge of the adhesive pad. Slowly peel off the On-body Injector. You should see a black line next to the EMPTY indicator. If the On-body Injector is not empty, call your healthcare provider immediately. If the status light is flashing red, you may not have received your full dose. Call your healthcare provider immediately. What to do if the On-body Injector adhesive becomes noticeably wet (saturated) with fluid, or you see dripping.

Instructions for Use

Neulastim (nu-las-tah)

(pegfilgrastim)

Injection, for subcutaneous use

Single-Dose Prefilled Syringe

Guide to parts
Before use		After use

Important: The needle is covered by the gray needle cap before use.

Important

Read the Patient Information for important information you need to know about Neulastim before using these Instructions for Use.

Before you use a Neulastim prefilled syringe, read this important information.

Storing the prefilled syringe

• Store Neulastim in the refrigerator between 36°F to 46°F (2°C to 8°C).
  

• Do not freeze.
  

• Keep the prefilled syringe in the original carton to protect from light or physical damage.
  

• Take the prefilled syringe out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection.
  

• Throw away (dispose of) any Neulastim that has been left at room temperature, 68°F to 77°F (20°C to 25°C), for more than 48 hours.
  

• Keep the Neulastim prefilled syringe out of the reach of children.

Using the prefilled syringe

• It is important that you do not try to give the injection unless you or your caregiver has received training from your healthcare provider.
  

• Make sure the name Neulastim appears on the carton and prefilled syringe label.
  

• Check the carton and prefilled syringe label to make sure the dose strength is 6 mg.
  

• You should not inject a dose of Neulasta to children weighing less than 45 kg from a Neulastim prefilled syringe. A dose less than 0.6 mL (6 mg) cannot be accurately measured using the Neulastim prefilled syringe.
  

• Do not use a prefilled syringe after the expiration date on the label.
  

• Do not shake the prefilled syringe.
  

• Do not remove the gray needle cap from the prefilled syringe until you are ready to inject.
  

• Do not use the prefilled syringe if the carton is open or damaged.
  

• Do not use a prefilled syringe if it has been dropped on a hard surface. The prefilled syringe may be broken even if you cannot see the break. Use a new prefilled syringe.
  

• Do not slide the blue safety guard over the needle before you give the injection. This will “activate” or lock the blue safety guard. Use another prefilled syringe that has not been activated and is ready to use.
  

• The gray needle cap on the prefilled syringe contains dry natural rubber (made from latex). Tell your healthcare provider if you are allergic to latex. You should not give Neulastim using the prefilled syringe if you have latex allergies.

Call your healthcare provider if you have any questions.

Step 1: Prepare

A Remove the prefilled syringe carton from the refrigerator.

Put the original carton with any unused prefilled syringes back in the refrigerator.

Remove the syringe tray from the carton. On a clean, well-lit surface, place the syringe tray at room temperature for 30 minutes before you give an injection.

• Do not use the prefilled syringe if the carton is damaged.
  

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

• Do not leave the prefilled syringe in direct sunlight.
  

• Do not shake the prefilled syringe.

Open the tray by peeling away the cover. Grab the blue safety guard to remove the prefilled syringe from the tray.

For safety reasons:

• Do not grab the plunger rod.
  

• Do not grab the gray needle cap.

B Inspect the medicine and prefilled syringe.

Make sure the medicine in the prefilled syringe is clear and colorless.

• Do not use the prefilled syringe if:
  • The medicine is cloudy or discolored or contains flakes or particles.
    

  • Any part appears cracked or broken.
    

  • The prefilled syringe has been dropped.
    

  • The gray needle cap is missing or not securely attached.
    

  • The expiration date printed on the label has passed.

In all cases, use a new prefilled syringe and call your healthcare provider.

C Gather all materials needed for the injection.

Wash your hands thoroughly with soap and water.

On a clean, well-lit work surface, place the:

• Prefilled syringe
  

• Alcohol wipe
  

• Cotton ball or gauze pad
  

• Adhesive bandage
  

• Sharps disposal container

Step 2: Get ready

D Prepare and clean the injection site(s).

You can use:

• Thigh
  

• Stomach area (abdomen), except for a 2-inch area right around the navel (belly button)
  

• Upper outer area of the buttocks (only if someone else is giving you the injection)
  

• Outer area of upper arm (only if someone else is giving you the injection)

Clean the injection site with an alcohol wipe. Let the skin dry.

• Do not touch this area again before injecting.
  

• If you want to use the same injection site, make sure it is not the same spot on the injection site you used for a previous injection.
  

• Do not inject into areas where the skin is tender, bruised, red, or hard. Avoid injecting into areas with scars or stretch marks.

E Hold the prefilled syringe by the syringe barrel. Carefully pull the gray needle cap straight off and away from the body.

• Do not remove the gray needle cap from the prefilled syringe until you are ready to inject.
  

• Do not twist or bend the gray needle cap.
  

• Do not hold the prefilled syringe by the plunger rod.
  

• Do not put the gray needle cap back onto the prefilled syringe.

Important: Throw the gray needle cap into the sharps disposal container.

Step 3: Subcutaneous (under the skin) injection

F Pinch the injection site to create a firm surface.

Important: Keep skin pinched while injecting.

G Hold the pinch. Insert the needle into the skin at 45 to 90 degrees.

H Using slow and constant pressure, push the plunger rod until it reaches the bottom.

When done, gently pull the syringe off of the skin.

Important: When you remove the syringe, if it looks like the medicine is still in the syringe barrel, this means you have not received a full dose. Call your healthcare provider right away.

Step 4: Finish

I

For your safety, pull the blue safety guard until it clicks and covers the needle.

Once extended, the blue safety guard will lock into position and will not slide back over the needle.

Keep your hands away from the needle at all times.

J Discard (throw away) the used prefilled syringe.

• Put the used prefilled syringe in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) the syringe in the household trash.
  

• If you do not have a FDA-cleared sharps disposal container, you may use a household container that is:
  • made of a heavy-duty plastic,
    

  • can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out,
    

  • upright and stable during use,
    

  • leak-resistant, and
    

  • properly labeled to warn of hazardous waste inside the container.
  
  

• When your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the FDA’s website at: http://www.fda.gov/safesharpsdisposal

• Do not reuse the prefilled syringe.
  

• Do not recycle the prefilled syringe or sharps disposal container or throw them into household trash.

Important: Always keep the sharps disposal container out of the reach of children.

K Examine the injection site.

If there is blood, press a cotton ball or gauze pad on the injection site. Do not rub the injection site. Apply an adhesive bandage if needed.

This Instructions for Use has been approved by the U.S. Food and Drug Administration.

Manufactured by:

Amgen Inc.

One Amgen Center Drive

Thousand Oaks, California 91320-1799

U.S. License No. 1080

© 2002-2016 Amgen Inc. All rights reserved.

1xxxxxx

Revised: 4/2016 v1

Guide to parts - Before use Guide to parts - After use Grab the blue safety guard to remove the prefilled syringe from the tray. Inspect the medicine and prefilled syringe. Prefilled syringe Alcohol wipeCotton ball or gauze padAdhesive bandageSharps disposal container Prepare and clean the injection site(s). Hold the prefilled syringe by the syringe barrel. Carefully pull the gray needle cap straight off and away from the body. Important: Throw the gray needle cap into the sharps disposal container. Pinch the injection site to create a firm surface. Hold the pinch. Insert the needle into the skin at 45 to 90 degrees. Using slow and constant pressure, push the plunger rod until it reaches the bottom. STOP Before you finish! For your safety, pull the blue safety guard until it clicks and covers the needle. Discard (throw away) the used prefilled syringe.

Principal Display Panel

NDC 55513-190-01

1 - 0.6 mL Single Dose Prefilled Syringe

AMGEN^®

Neulastim ^®

(pegfilgrastim) injection

Pegylated Recombinant Methionyl Human Granulocyte Colony-Stimulating Factor

(PEG-r-metHuG-CSF) derived from E Coli

6 mg

6 mg in 0.6 mL Single Dose Prefilled Syringe

For Subcutaneous Use Only

This Product Contains Dry Natural Rubber

Sterile Solution – No Preservative

Rx Only

Manufactured by Amgen Inc.

Thousand Oaks, CA 91320-1799 U.S.A.

U.S. License No. 1080

Principal Display PanelNDC 55513-190-011 - 0.6 mL Single Dose Prefilled SyringeAMGEN®Neulasta ®(pegfilgrastim) injectionPegylated Recombinant Methionyl Human Granulocyte Colony-Stimulating Factor(PEG-r-metHuG-CSF) derived from E Coli6 mg6 mg in 0.6 mL Single Dose Prefilled SyringeFor Subcutaneous Use OnlyThis Product Contains Dry Natural RubberSterile Solution – No PreservativeRx OnlyManufactured by Amgen Inc. Thousand Oaks, CA 91320-1799 U.S.A.U.S. License No. 1080

Principal Display Panel

NDC 55513-192-01

1 - Single Dose Neulastim Prefilled Syringe

1 - Sterile On-body Injector for Neulastim

AMGEN^®

Neulastim^® Onpro kit

(pegfilgrastim) injection

Pegylated Recombinant Methionyl Human Granulocyte Colony-Stimulating Factor

(PEG-r-metHuG-CSF) derived from E Coli

6 mg/0.6 mL*

6 mg/0.6 mL*

*Prefilled syringe contains 0.64 mL to deliver 6 mg/0.6 mL when used with on-body injector

For Subcutaneous Use Only

Carton Contents (intended to be dispensed as a unit):

• 1 sterile On-body Injector for Neulastim
  

• 1 Neulastim prefilled syringe labeled for use with on-body injector only
  

• 1 patient instructions for use
  

• 1 healthcare provider instructions for use, 1 package insert
  

• 1 reference guide

This Product Contains Dry Natural Rubber

Store at 2° to 8°C (36° to 46°F).

Do Not Freeze or Shake. Keep in Carton to Protect from Light.

See package insert for full prescribing information and Instructions for Use

Enhanced Features see enclosed instructions

Rx Only

Neulastim pharmaceutical active ingredients containing related brand and generic drugs:

• Pegfilgrastim

Neulastim available forms, composition, doses:

• Injectable; Injection; Pegfilgrastim 10 mg / ml
• Injectable; Injection; Pegfilgrastim 6 mg / ml

Neulastim destination | category:

• Human:
• Hematopoietic agents

Neulastim Anatomical Therapeutic Chemical codes:

• L03AA13 - Pegfilgrastim

Neulastim pharmaceutical companies:

• DKSH
• Firma Chun Cheong
• Roche

References

1. Dailymed."NEULASTA (PEGFILGRASTIM) KIT NEULASTA (PEGFILGRASTIM) INJECTION [AMGEN INC]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
2. "Pegfilgrastim". https://pubchem.ncbi.nlm.nih.gov/su... (accessed August 28, 2018).
3. "Pegfilgrastim - DrugBank". http://www.drugbank.ca/drugs/DB0001... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Neulastim?

Depending on the reaction of the Neulastim after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Neulastim not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Neulastim addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

Review

sdrugs.com conducted a study on Neulastim, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Neulastim consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Rachana Salvi, MD Pharmacology