When This Medicine Should Not Be Used:
This medicine is not right for everyone. You should not receive it if you had an allergic reaction to filgrastim or pegfilgrastim.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin.
• A nurse or other health provider will give you this medicine.
• You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
• Start using the medicine 24 hours or more after you finish your chemotherapy. However, do not use it within 24 hours before you begin another chemotherapy treatment.
• Do not shake the syringe. Do not use the medicine if it is cloudy, discolored, or has particles in it.
• If the medicine has been in the refrigerator, let it warm to room temperature for 30 minutes before you use it.
• You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.
• Each syringe should be used only once. Throw the syringe away after your dose. Do not save leftover medicine.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Missed dose: Call your doctor, treatment clinic, or home health caregiver for instructions if you miss a dose.
• If you store this medicine at home, keep it in the refrigerator. Do not freeze. Leave the medicine in the carton until you are ready to use it. You can leave the medicine out of the refrigerator for up to 5 days. If you do not use it in 5 days, put it back in the refrigerator. Any unused medicine left out of the refrigerator for more than 5 days should be thrown away.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how tbo-filgrastim works. Tell your doctor if you are using lithium.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have sickle cell disease.
• This medicine may cause the following problems:
  
  • Damage to the spleen, including possible rupture
  • Acute respiratory distress syndrome (ARDS)
  • Capillary leak syndrome (blood vessel problem)
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chest pain or tightness, trouble breathing
• Lightheadedness, dizziness, or fainting
• Pain on the left upper side your stomach or left shoulder
• Swelling of your hands, ankles, feet, or lower legs

If you notice these less serious side effects, talk with your doctor:

• Bone pain
• Pain, redness, itching, burning, or swelling where the shot was given

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088