If you are about to go on a strong chemo path, or a dose-dense treatment like I was on, your oncologist may prescribe you a series of injections you do at home to help build your white blood cell count and help prevent neutropenia. I took two of these drugs, not at the same time, and this is my experience. Hopefully, by reading this the thought of giving yourself injections will be a little less scary. By the end of reading this, you’ll have a better idea of what you are injecting, how to store the prefilled syringes, and tips for injecting them.
What is Filgrastrim?
First of all, what is Zarxio or NEUPOGEN? These are products made of filgrastim. Filgrastim via our friends at Wiki:
Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes; it is a pharmaceutical analog of naturally occurring G-CSF. It is produced by recombinant DNA technology. The gene for human granulocyte colony-stimulating factor is inserted into the genetic material of Escherichia coli. The G-CSF then produced by E. coli is different from G-CSF naturally made in humans.
Filgrastim is used to treat neutropenia, stimulating the bone marrow to increase production of neutrophils. Causes of neutropenia include chemotherapy and bone marrow transplantation.
Filgrastim is also used to increase the number of hematopoietic stem cells in the blood before collection by leukapheresis for use in hematopoietic stem cell transplantation.
A number of companies make filgrastim. The first lisensee to make filgrastim was Amgen, who still makes it under the Neupogen name. Sandoz (Novartis) began making a bio-similar drug, filgrastim-sndz, March 1, 2015, under the name Zarxio. Bio-similar drugs are not generics. I took both of these drugs during my treatment, first Neupogen, then my doctor switched me to Zarxio halfway through treatment.
Injectable Medications: Think About the Good They Do Before You Think About the Needle
As soon as my oncologist said I would need this injectable drug (using needles!), my heart sank. I hate needles. Like, hate them. Not only would I be going through chemo and dealing with all the side effects of that, but I would also be injecting myself (with a needle!) daily for a week, after each chemotherapy treatment. 8 rounds of chemo x 7 injections = 56. I would be stabbing myself (with a needle!) 56 times in the belly. Did I mention I hate needles? That’s why I avoid going to the nurse and getting my yearly flu shot. Sorry, doc.
So, how did I get over my extreme aversion and do it? Because I had no choice. I have three kids at home who could not function without me, and I had no desire to spend time in the hospital because of neutropenic fever. I took a ‘look good feel better‘ class and met a woman who had just recently got out of the hospital from neutropenic fever. I actually looked forward to the injections after talking with her.
I just dived in and did the injections. Gritted (not grinned) and beared it. And while I rejoiced when I did the last injection, honestly, they weren’t really half as bad as I was gearing myself up for as soon as I started.
How to Store Neupogen or Zarxio
These drugs come in prefilled syringes, which I was prescribed. Store these drugs in your refrigerator and bring them to room temperature before injecting. I live an hour away from my chemo treatments and my oncologist, so each time I was prescribed these, my pharmacist would give me a disposable ice bag to keep these cold until I got home. Kaiser is nice like that.
Filgrastim Medication Injection Tips
Injecting a needle anywhere in your body does hurt. But it’s not life ending. I think it hurts more when you inject yourself with something because you are seeing the needle poke your skin. You will be injecting these subcutaneously, in the outer area of your upper arms, abdomen, thighs, or upper outer areas of the buttock. Your dosage will be based on your doctor’s prescription, but I was prescribed each dose for 7 days. And when to take it will depend on the drug itself. For Neupogen, the prescription said ‘daily for 7 days starting 24 hours after completion of chemotherapy’ and with Zarxio the prescription said ‘subcutaneously daily as directed on days 3 though 9 of cycle.’
Since these are stored in the refrigerator, they will need to be pulled out about 30 minutes before each injection. They can stay out a maximum of 24 hours but need to be discarded if left out for more than 24 hours. And note the time when you inject yourself with the first dose – they should be injected around the same time each day. Read each label for exact instructions for the drug you are taking.
Wash your hands before each injection. Swab your injection site with an alcohol swab. Your pharmacy should have boxes of these for sale really cheap. One of the oncology nurses who installed my picc line gave me a big box for the picc line flushings, and I also used these for the Neupogen and Zarxio injections.
My oncologist suggested me do the injections in my belly area, away from belly button and slightly below or left or right of the belly button. I don’t have a lot of fat in that area so I just squeezed a portion of my belly with my left hand and injected with my right. I switched from the left to the right side to help ease any discomfort by always injecting the same spot, but by the time I had 5 rounds behind me, I discovered my right side was so much more sensitive to the needle (as in I felt each injection and it hurt like a bitch) so I just kept sticking my left side, just in a different spot. After 7 injections (or 7 days in a row after each round of chemo), it did get a little sore but the actual injecting went so much better, and I had no bruising from the injections so it was fine. Your body will tell you where best to inject it.
When it is time to inject yourself, simply remove the cap from the prefilled syringe, insert the needle at a 90 degree or 45 degree angle and inject. For me, it went better if I did it slightly at an angle.
After injecting, make each needle safe to dispose of by covering the needle safely. Each syringe will be different, but with both the Neupogen and Zarxio there were built in guards that made this easy. With prefilled Neupogen, there was an orange needle guard that I slid into place protecting the needle after I injected myself. With the prefilled Zarxio, after each injection there was a spring mechanism that activated and hid the needle.
I’ll end this with saying that if you are getting ready to psyche yourself up for your first injection, don’t worry about it too much. Just know that these injections will probably end up saving your life. A little discomfort I guess is to be expected for that honor. 🙂 After all, if you are doing chemo, this stuff’s a walk in the park. Good luck, friend.