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NIVESTYM™ (filgrastim-aafi)

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NIVESTYM™ Quick Finder

17 PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use). Review the steps for direct patient administration with patients and caregivers. Training by the healthcare provider should aim to...

17 PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use). Review the steps for direct patient administration with patients and caregivers. Training by the healthcare provider should aim to ensure that patients and caregivers can successfully perform all of the steps in the Instructions for Use of NIVESTYM vial and prefilled syringe, including showing the patient or caregiver how to measure the required dose, particularly if a patient is on a dose other than the entire prefilled syringe. If a patient or caregiver is not able to demonstrate that they can measure the dose and administer the product successfully, you should consider whether the patient is an appropriate candidate for self-administration of NIVESTYM or whether the patient would benefit from a different NIVESTYM presentation. Advise patients of the following risks and potential risks with NIVESTYM:

  • Rupture or enlargement of the spleen may occur. Symptoms include left upper quadrant abdominal pain or left shoulder pain. Advise patients to report pain in these areas to their physician immediately [see Warnings and Precautions (5.1)].
  • Dyspnea, with or without fever, progressing to Acute Respiratory Distress Syndrome, may occur.
    Advise patients to report dyspnea to their physician immediately [see Warnings and Precautions (5.2)].
  • Serious allergic reactions may occur, which may be signaled by rash‚ facial edema‚ wheezing‚ dyspnea‚ hypotension‚ or tachycardia. Advise patients to seek immediate medical attention if signs or symptoms of hypersensitivity reaction occur [see Warnings and Precautions (5.3)].
  • In patients with sickle cell disease, sickle cell crisis and death have occurred. Discuss potential risks and benefits for patients with sickle cell disease prior to the administration of human granulocyte colony-stimulating factors [see Warnings and Precautions (5.4)].
  • Glomerulonephritis may occur. Symptoms include swelling of the face or ankles, dark colored urine or blood in the urine, or a decrease in urine production. Advise patients to report signs or symptoms of glomerulonephritis to their physician immediately [see Warnings and Precautions (5.5)].
  • There may be an increased risk of Myelodysplastic Syndrome and/or Acute Myeloid Leukemia in patients with congenital neutropenia who receive filgrastim products and in patients with breast and lung cancer who receive filgrastim products in conjunction with chemotherapy and/or radiation therapy. Symptoms of MDS and AML may include tiredness, fever, and easy bruising or bleeding. Advise patients to report to their physician signs and symptoms of MDS/AML [see Warnings and Precautions (5.8)].
  • Cutaneous vasculitis may occur, which may be signaled by purpura or erythema. Advise patients to report signs or symptoms of vasculitis to their physician immediately [see Warnings and Precautions (5.11)].
  • Aortitis may occur. Symptoms may include fever, abdominal pain, malaise, back pain, and increased inflammatory markers. Advise patients to report signs and symptoms of aortitis to their physician immediately [see Warnings and Precautions (5.15)].

Instruct patients who self-administer NIVESTYM using the prefilled syringe or single-dose vial of the:

  • Importance of following the applicable Instructions for Use.
  • Dangers of reusing needles, syringes, or unused portions of single-dose vials.
  • Importance of following local requirements for proper disposal of used syringes, needles, and unused vials.
  • Importance of informing the healthcare provider if difficulty occurs when measuring or administering partial contents of the NIVESTYM prefilled syringe. If difficulty occurs, use of the NIVESTYM vial may be considered.
  • Difference in product concentration of the NIVESTYM prefilled syringe in comparison to the NIVESTYM vial. When switching patients from the NIVESTYM prefilled syringe to the NIVESTYM vial, or vice versa, ensure that patients understand the correct volume to be administered since the concentration of NIVESTYM differs between the prefilled syringe and the vial.
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What is NIVESTYM?

NIVESTYM 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.

...

What is NIVESTYM?

NIVESTYM 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.

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

Before you take NIVESTYM, tell your healthcare provider about all of your medical conditions, including if you:

  • have a sickle cell disorder.
  • have kidney problems.
  • are receiving radiation therapy.
  • are pregnant or plan to become pregnant. It is not known if NIVESTYM will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if NIVESTYM 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.

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How will I receive NIVESTYM?

  • NIVESTYM injections can be given by a healthcare provider by intravenous (IV) infusion or under your skin (subcutaneous injection). Your healthcare provider may decide subcutaneous injections can be given at home by you...

How will I receive NIVESTYM?

  • NIVESTYM injections can be given by a healthcare provider by intravenous (IV) infusion or under your skin (subcutaneous injection). Your healthcare provider may decide subcutaneous injections can be given at home by you or your caregiver. If NIVESTYM is given at home, see the detailed "Instructions for Use" that comes with your NIVESTYM for information on how to prepare and inject a dose of NIVESTYM.
  • You and your caregiver should be shown how to prepare and inject NIVESTYM before you use it, by your healthcare provider.
  • You should not try to inject a dose of NIVESTYM less than 0.3 mL (180 mcg) from a NIVESTYM prefilled syringe. A dose less than 0.3 mL cannot be accurately measured using the NIVESTYM prefilled syringe.
  • Your healthcare provider will tell you how much NIVESTYM to inject and when to inject it. Do not change your dose or stop NIVESTYM unless your healthcare provider tells you to.
  • If you are receiving NIVESTYM because you are also receiving chemotherapy, your dose of NIVESTYM should be injected at least 24 hours before or 24 hours after your dose of chemotherapy. Your healthcare provider will do blood tests to monitor your white blood cell count, and if necessary, adjust your NIVESTYM dose.
  • If you miss a dose of NIVESTYM, talk to your healthcare provider about when you should give your next dose.
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What are the possible side effects of NIVESTYM?

NIVESTYM may cause serious side effects, including:

  • Spleen rupture. Your spleen may become enlarged and can rupture. A ruptured spleen can cause death. Call your...

What are the possible side effects of NIVESTYM?

NIVESTYM 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 (abdomen) area or your left shoulder.
  • A serious lung problem called acute respiratory distress syndrome (ARDS). Call your healthcare provider or get emergency medical help right away if you have shortness of breath with or without a fever, trouble breathing, or a fast rate of breathing.
  • Serious allergic reactions. NIVESTYM 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 NIVESTYM and call your healthcare provider or get emergency medical help right away.
  • Sickle cell crises. You may have a serious sickle cell crisis, which could lead to death, if you have a sickle cell disorder and receive NIVESTYM. Call your healthcare provider right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.
  • Kidney injury (glomerulonephritis). NIVESTYM 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
  • Capillary leak syndrome. NIVESTYM 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
  • Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).
    • NIVESTYM may increase the risk of developing a precancerous condition called MDS or a type of blood cancer called AML in people who were born with low white blood cell counts (congenital neutropenia).
    • If you have breast cancer or lung cancer, when NIVESTYM is used with chemotherapy and radiation therapy, or with radiation therapy only, you may have an increased risk of developing MDS or AML.
    • Symptoms of MDS and AML may include tiredness, fever, and easy bruising or bleeding.
    • Call your healthcare provider if you develop any of these symptoms during treatment with NIVESTYM.
  • Decreased platelet count (thrombocytopenia). Your healthcare provider will check your blood during treatment with NIVESTYM. Tell your healthcare provider if you have unusual bleeding or bruising during treatment with NIVESTYM. This could be a sign of decreased platelet counts, which may reduce the ability of your blood to clot.
  • Increased white blood cell count (leukocytosis). Your healthcare provider will check your blood during treatment with NIVESTYM.
  • Inflammation of your blood vessels (cutaneous vasculitis). Tell your healthcare provider right away if you develop purple spots or redness of your skin.
  • Inflammation of the aorta (aortitis). Inflammation of the aorta (the large blood vessel which transports blood from the heart to the body) has been reported in patients who received NIVESTYM. Symptoms may include fever, abdominal pain, feeling tired, and back pain. Call your healthcare provider if you experience these symptoms.

The most common side effects experienced in patients receiving NIVESTYM include:

  • Patients with cancer receiving chemotherapy: fever, pain, rash, cough, and shortness of breath
  • Patients with acute myeloid leukemia receiving chemotherapy: pain, nose bleed, and rash
  • Patients with cancer receiving chemotherapy followed by bone marrow transplant: rash
  • Patients who are having their own blood cells collected: bone pain, fever, and headache
  • Patients with severe chronic neutropenia: pain, decreased red blood cells, nose bleed, diarrhea, reduced sensation, and hair loss

These are not all the possible side effects of NIVESTYM. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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How should I store NIVESTYM?

  • Store NIVESTYM in the refrigerator between 36°F to 46°F (2°C to 8°C).
  • Do not freeze.
  • Keep NIVESTYM in the original carton to protect from light or physical damage. Do not leave NIVESTYM in direct sunlight.
  • Do not...

How should I store NIVESTYM?

  • Store NIVESTYM in the refrigerator between 36°F to 46°F (2°C to 8°C).
  • Do not freeze.
  • Keep NIVESTYM in the original carton to protect from light or physical damage. Do not leave NIVESTYM in direct sunlight.
  • Do not shake NIVESTYM.
  • Take NIVESTYM out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection.
  • Throw away (dispose of) any NIVESTYM that has been left at room temperature for longer than 24 hours.
  • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the vials or prefilled syringes. Do not save unused NIVESTYM in the vials or prefilled syringes for later use.

Keep NIVESTYM out of the reach of children.

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General information about the safe and effective use of NIVESTYM.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use NIVESTYM for a condition for which it was not prescribed. Do not give NIVESTYM to other people, even if...

General information about the safe and effective use of NIVESTYM.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use NIVESTYM for a condition for which it was not prescribed. Do not give NIVESTYM 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 NIVESTYM that is written for healthcare professionals.

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What are the ingredients in NIVESTYM?

Active ingredient: (filgrastim-aafi)

Inactive ingredients: acetate, polysorbate 80, sodium, sorbitol, and water for Injection

...

What are the ingredients in NIVESTYM?

Active ingredient: (filgrastim-aafi)

Inactive ingredients: acetate, polysorbate 80, sodium, sorbitol, and water for Injection

Manufactured by Hospira, Inc., a Pfizer Company, Lake Forest, IL 60045 USA
US License No. 1974

LAB-0935-2.0
For more information go to www.pfizer.com or call 1-800-438-1985.

Logo

Instructions for Use
NIVESTYM (Neye-ves-tim)
(filgrastim-aafi)
injection
Single-Dose Prefilled Syringe

Important

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

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

Storing your prefilled syringe
  • Store the NIVESTYM prefilled syringe in the refrigerator between 36˚F to 46˚F (2˚C to 8˚C).
  • Do not freeze.
  • Keep the NIVESTYM 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.
  • The NIVESTYM prefilled syringe may be allowed to reach room temperature for up to 24 hours. Throw away (dispose of) any NIVESTYM prefilled syringe that has been left at room temperature for longer than 24 hours.
  • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the prefilled syringe. Do not save unused NIVESTYM in the prefilled syringe for later use.
  • Keep NIVESTYM and all medicines out of the reach of children.
Using your 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.
  • You should not inject a dose of NIVESTYM less than 0.3 mL (180 mcg) from a NIVESTYM prefilled syringe. A dose less than 0.3 mL cannot be accurately measured using the NIVESTYM prefilled syringe.
  • Make sure the name NIVESTYM appears on the carton and prefilled syringe label.
  • Do not use a NIVESTYM prefilled syringe after the expiration date on the label.
  • Do not shake the NIVESTYM prefilled syringe.
  • The prefilled syringe has a needle guard that needs to be activated to cover the needle after the injection is given. The needle guard will help prevent needle stick injuries to anyone who handles the prefilled syringe.
  • Do not remove the needle cover from the prefilled syringe until you are ready to inject.
  • Do not use the NIVESTYM prefilled syringe if the needle cover is missing.
  • 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.

Call your healthcare provider if you have any questions.

About the NIVESTYM prefilled syringe
  • NIVESTYM prefilled syringes come in two strengths. Depending on your prescription, you will receive NIVESTYM prefilled syringes that contain 300 mcg/0.5mL or 480 mcg/0.8mL of medicine. Your healthcare provider will determine the dose in milliliters (mL) that you will need to give based on your body weight.
  • When you receive your NIVESTYM prefilled syringes, always check to see that the:
    • name NIVESTYM appears on the carton and prefilled syringe label.
    • expiration date on the prefilled syringe label has not passed. You should not use a prefilled syringe after the date on the label.
    • strength of NIVESTYM (number of micrograms on the carton containing the prefilled syringe) is the same as what your healthcare provider prescribed.

NIVESTYM prefilled syringe parts (see Figure A

Figure A

What you need for your injection

Included in the carton:

  • 1 new NIVESTYM prefilled syringe

Not included in the carton (see Figure B

Figure B

Figure C shows a needle guard that has not yet been activated. The prefilled syringe is ready for use. This is what the prefilled syringe looks like before use.

Figure C

Figure C

Figure D shows a needle guard that has been activated. This is what the prefilled syringe looks like after use.

Figure D

Figure D
Preparing the NIVESTYM prefilled syringe
Step 1:Find a clean, well-lit flat work surface.
Step 2:Take the carton containing the NIVESTYM prefilled syringe out of the refrigerator and leave it unopened on your work surface for at least 30 minutes so that it reaches room temperature. Put the original carton with any unused prefilled syringes back in the refrigerator.
  • Do not shake the prefilled syringe.
  • Do not leave the prefilled syringe in direct sunlight.
Step 3:Wash your hands with soap and water.
Step 4:Remove the prefilled syringe from the carton. Check to make sure that the needle guard is covering the barrel of the prefilled syringe. Do not push the needle guard over the needle cover before the injection. This may activate or lock the needle guard. See Figure E
Figure E
  • Choose a different site for each injection of NIVESTYM.
  • Do not inject into areas where the skin is tender, bruised, red, or hard. Avoid injecting into areas with scars or stretch marks.
  • Step 8: Clean your injection site with an alcohol wipe. See Figure FFigure F
    Step 9: Hold the prefilled syringe by the needle guard with the needle cover pointing up. Carefully pull the needle cover straight off and away from your body. Throw away the needle cover. Do not recap the needle. See Figure G

    Figure G

    Your healthcare provider has prescribed either a "full" syringe dose or a "partial" syringe dose.

    • If you are prescribed a partial dose of NIVESTYM, follow Steps 10 through 18.
    • If you are prescribed a full dose, you will inject all of the medicine from your prefilled syringe. For a full dose, skip Steps 10 and 11, and follow Steps 12 through 18.
    Partial dosing
    Step 10:Point the needle up and tap gently until the air rises to the top. See Figure H

    Figure H

    Step 11:Holding the prefilled syringe as shown, slowly push up on the plunger rod to push out the extra air and medicine until the end of the conical base (edge) of the plunger stopper lines up with the syringe marking for your prescribed dose. See Figure I

    Figure I

    Administering the NIVESTYM prefilled syringe
    Step 12:With one hand, gently pinch a fold of skin at the injection site. Hold the pinch. See Figure J

    Figure J

    Step 13:With your other hand, hold the prefilled syringe like you would hold a pencil. Use a quick "dart-like" motion to insert the needle at a 45 to 90 degree angle into the skin as shown. See

    Figure K

    Figure K
    Step 14:Using slow and constant pressure, press down on the plunger rod as far as it will go. Keep the plunger rod fully pressed down while you hold the prefilled syringe in place for 5 seconds. See Figure L

    Figure L

    Step 15:Keep the plunger rod fully pressed down while you carefully pull the needle straight out from the injection site. See Figure M

    Figure M

    Step 16: As you let go of the plunger rod, the needle guard will automatically slide over the needle until the needle is completely covered and the needle guard locks into place. Do not recap the needle. See Figure N

    Figure N

    Step 17:There may be a small amount of blood at the injection site. You can press a cotton ball or gauze over the injection site and hold it for 10 seconds. Do not rub the injection site. You may cover the injection site with a small adhesive bandage, if needed. See Figure O

    Figure O

    Step 18:Throw away (dispose of) the syringe as instructed by your healthcare provider or by following the instructions below. See Figure P

    Figure P

    Disposing of (throw away) used NIVESTYM prefilled syringes
    • Put the used prefilled syringe in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) prefilled syringes in your 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 dispose of your used sharps container in your household trash unless your community guidelines permit this. Do not recycle your used sharps disposal container.

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

    Manufactured by:
    Hospira, Inc.,
    a Pfizer Company
    Lake Forest, IL 60045 USA
    US License No. 1974

    Logo

    LAB-0938-1.0
    For more information go to www.pfizer.com or call 1-800-438-1985.

    Issued: July 2018


    Instructions for Use NIVESTYM
    (Neye-ves-tim)
    (filgrastim-aafi)
    injection
    Single-Dose Vial

    Important

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

    Before you use a NIVESTYM vial, read this important information:

    Storing your NIVESTYM vial

    • Store the vial in the refrigerator between 36˚F to 46˚F (2˚C to 8˚C).
    • Do not freeze.
    • Keep the vial in the original carton to protect from light or physical damage.
    • Take the vial out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection.
    • Throw away (dispose of) any vial that has been left at room temperature for longer than 24 hours.
    • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the vial. Do not save unused NIVESTYM in the vial for later use.

    Keep NIVESTYM and all medicines out of the reach of children.

    Using your vial

    • 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 NIVESTYM appears on the carton and vial label.
    • Only use the vial 1 time. Discard (throw away) the vial with any remaining NIVESTYM liquid.
    • Do not use a vial after the expiration date on the label.
    • Do not shake the vial.
    • Do not use the vial if the medicine is cloudy or discolored or contains flakes or particles.

    Call your healthcare provider if you have any questions.

    Step 1: Prepare

    A
    Remove the vial from the refrigerator.
    Find a clean, well-lit, flat work surface. Place the vial on your clean work surface for 30 minutes and allow it to reach room temperature before you give an injection.
    • Do not try to warm the vial by using a heat source such as hot water or microwave.
    • Do not leave the vial in direct sunlight.
    • Do not shake the vial.
    • Use the vial only 1 time.
    B
    Inspect the vial.
    Make sure the medicine in the vial is clear and colorless.
    • Do not use the vial if:
      • The medicine is cloudy or discolored or contains flakes or particles.
      • The expiration date printed on the label has passed.
    • In all cases, use a new vial and call your healthcare provider.
    C
    Gather all materials needed for your injection.
    Wash your hands thoroughly with soap and water. On your clean, well-lit, flat work surface, place:
    • 1 Vial
    • 1 Disposable syringe and needle
    • 2 Alcohol wipes
    • 1 Cotton ball or gauze pad
    • 1 Adhesive bandage
    • Sharps disposal container

      Figure

    • Only use the disposable syringes and needles that your healthcare provider prescribes.
    • Only use the syringes and needles 1 time. Throw away (dispose of) any used syringes and needles. See Step 5: Finish
      S
      Dispose of (throw away) the used needle and syringe.
      Figure
      • Put your used needles and syringes in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) loose needles, and syringes in your household trash.
      • If you do not have an 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 dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. Do not recycle your used sharps disposal container.
      T
      Examine the injection site.
      If there is blood, press a cotton ball or gauze pad on your 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:
      Hospira, Inc.,
      a Pfizer Company
      Lake Forest, IL 60045 USA
      US License No. 1974

      Logo

      LAB-0937-1.0
      For more information go to www.pfizer.com or call 1-800-438-1985.

      Issued: July 2018

    Did you find an answer to your question? Yes No

    Full Patient Information

    ...

    Full Patient Information

    17 PATIENT COUNSELING INFORMATION

    Advise the patient to read the FDA-approved patient labeling (Patient Information and Instructions for Use). Review the steps for direct patient administration with patients and caregivers. Training by the healthcare provider should aim to ensure that patients and caregivers can successfully perform all of the steps in the Instructions for Use of NIVESTYM vial and prefilled syringe, including showing the patient or caregiver how to measure the required dose, particularly if a patient is on a dose other than the entire prefilled syringe. If a patient or caregiver is not able to demonstrate that they can measure the dose and administer the product successfully, you should consider whether the patient is an appropriate candidate for self-administration of NIVESTYM or whether the patient would benefit from a different NIVESTYM presentation. Advise patients of the following risks and potential risks with NIVESTYM:

    • Rupture or enlargement of the spleen may occur. Symptoms include left upper quadrant abdominal pain or left shoulder pain. Advise patients to report pain in these areas to their physician immediately [see
      This Patient Information has been approved by the U.S. Food and Drug AdministrationRevised: April 2021

      Patient Information
      NIVESTYM
      (Neye-ves-tim)
      (filgrastim-aafi)
      injection

      What is NIVESTYM?

      NIVESTYM 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.

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

      Before you take NIVESTYM, tell your healthcare provider about all of your medical conditions, including if you:

      • have a sickle cell disorder.
      • have kidney problems.
      • are receiving radiation therapy.
      • are pregnant or plan to become pregnant. It is not known if NIVESTYM will harm your unborn baby.
      • are breastfeeding or plan to breastfeed. It is not known if NIVESTYM 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 NIVESTYM?

      • NIVESTYM injections can be given by a healthcare provider by intravenous (IV) infusion or under your skin (subcutaneous injection). Your healthcare provider may decide subcutaneous injections can be given at home by you or your caregiver. If NIVESTYM is given at home, see the detailed " What are the possible side effects of NIVESTYM?

        NIVESTYM 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 (abdomen) area or your left shoulder.
        • A serious lung problem called acute respiratory distress syndrome (ARDS). Call your healthcare provider or get emergency medical help right away if you have shortness of breath with or without a fever, trouble breathing, or a fast rate of breathing.
        • Serious allergic reactions. NIVESTYM 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 NIVESTYM and call your healthcare provider or get emergency medical help right away.
        • Sickle cell crises. You may have a serious sickle cell crisis, which could lead to death, if you have a sickle cell disorder and receive NIVESTYM. Call your healthcare provider right away if you have symptoms of sickle cell crisis such as pain or difficulty breathing.
        • Kidney injury (glomerulonephritis). NIVESTYM 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
        • Capillary leak syndrome. NIVESTYM 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
        • Myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).
          • NIVESTYM may increase the risk of developing a precancerous condition called MDS or a type of blood cancer called AML in people who were born with low white blood cell counts (congenital neutropenia).
          • If you have breast cancer or lung cancer, when NIVESTYM is used with chemotherapy and radiation therapy, or with radiation therapy only, you may have an increased risk of developing MDS or AML.
          • Symptoms of MDS and AML may include tiredness, fever, and easy bruising or bleeding.
          • Call your healthcare provider if you develop any of these symptoms during treatment with NIVESTYM.
        • Decreased platelet count (thrombocytopenia). Your healthcare provider will check your blood during treatment with NIVESTYM. Tell your healthcare provider if you have unusual bleeding or bruising during treatment with NIVESTYM. This could be a sign of decreased platelet counts, which may reduce the ability of your blood to clot.
        • Increased white blood cell count (leukocytosis). Your healthcare provider will check your blood during treatment with NIVESTYM.
        • Inflammation of your blood vessels (cutaneous vasculitis). Tell your healthcare provider right away if you develop purple spots or redness of your skin.
        • Inflammation of the aorta (aortitis). Inflammation of the aorta (the large blood vessel which transports blood from the heart to the body) has been reported in patients who received NIVESTYM. Symptoms may include fever, abdominal pain, feeling tired, and back pain. Call your healthcare provider if you experience these symptoms.

        The most common side effects experienced in patients receiving NIVESTYM include:

        • Patients with cancer receiving chemotherapy: fever, pain, rash, cough, and shortness of breath
        • Patients with acute myeloid leukemia receiving chemotherapy: pain, nose bleed, and rash
        • Patients with cancer receiving chemotherapy followed by bone marrow transplant: rash
        • Patients who are having their own blood cells collected: bone pain, fever, and headache
        • Patients with severe chronic neutropenia: pain, decreased red blood cells, nose bleed, diarrhea, reduced sensation, and hair loss

        These are not all the possible side effects of NIVESTYM. 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 NIVESTYM?

      • Store NIVESTYM in the refrigerator between 36°F to 46°F (2°C to 8°C).
      • Do not freeze.
      • Keep NIVESTYM in the original carton to protect from light or physical damage. Do not leave NIVESTYM in direct sunlight.
      • Do not shake NIVESTYM.
      • Take NIVESTYM out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection.
      • Throw away (dispose of) any NIVESTYM that has been left at room temperature for longer than 24 hours.
      • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the vials or prefilled syringes. Do not save unused NIVESTYM in the vials or prefilled syringes for later use.

      Keep NIVESTYM out of the reach of children.

      General information about the safe and effective use of NIVESTYM.

      Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use NIVESTYM for a condition for which it was not prescribed. Do not give NIVESTYM 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 NIVESTYM that is written for healthcare professionals.

      What are the ingredients in NIVESTYM?

      Active ingredient: (filgrastim-aafi)

      Inactive ingredients: acetate, polysorbate 80, sodium, sorbitol, and water for Injection

      Manufactured by Hospira, Inc., a Pfizer Company, Lake Forest, IL 60045 USA
      US License No. 1974

      LAB-0935-2.0
      For more information go to www.pfizer.com or call 1-800-438-1985.

      Logo

    Instructions for Use
    NIVESTYM (Neye-ves-tim)
    (filgrastim-aafi)
    injection
    Single-Dose Prefilled Syringe

    Important

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

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

    Storing your prefilled syringe
    • Store the NIVESTYM prefilled syringe in the refrigerator between 36˚F to 46˚F (2˚C to 8˚C).
    • Do not freeze.
    • Keep the NIVESTYM 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.
    • The NIVESTYM prefilled syringe may be allowed to reach room temperature for up to 24 hours. Throw away (dispose of) any NIVESTYM prefilled syringe that has been left at room temperature for longer than 24 hours.
    • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the prefilled syringe. Do not save unused NIVESTYM in the prefilled syringe for later use.
    • Keep NIVESTYM and all medicines out of the reach of children.
    Using your 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.
    • You should not inject a dose of NIVESTYM less than 0.3 mL (180 mcg) from a NIVESTYM prefilled syringe. A dose less than 0.3 mL cannot be accurately measured using the NIVESTYM prefilled syringe.
    • Make sure the name NIVESTYM appears on the carton and prefilled syringe label.
    • Do not use a NIVESTYM prefilled syringe after the expiration date on the label.
    • Do not shake the NIVESTYM prefilled syringe.
    • The prefilled syringe has a needle guard that needs to be activated to cover the needle after the injection is given. The needle guard will help prevent needle stick injuries to anyone who handles the prefilled syringe.
    • Do not remove the needle cover from the prefilled syringe until you are ready to inject.
    • Do not use the NIVESTYM prefilled syringe if the needle cover is missing.
    • 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.

    Call your healthcare provider if you have any questions.

    About the NIVESTYM prefilled syringe
    • NIVESTYM prefilled syringes come in two strengths. Depending on your prescription, you will receive NIVESTYM prefilled syringes that contain 300 mcg/0.5mL or 480 mcg/0.8mL of medicine. Your healthcare provider will determine the dose in milliliters (mL) that you will need to give based on your body weight.
    • When you receive your NIVESTYM prefilled syringes, always check to see that the:
      • name NIVESTYM appears on the carton and prefilled syringe label.
      • expiration date on the prefilled syringe label has not passed. You should not use a prefilled syringe after the date on the label.
      • strength of NIVESTYM (number of micrograms on the carton containing the prefilled syringe) is the same as what your healthcare provider prescribed.

    NIVESTYM prefilled syringe parts (see Figure A

    Figure A

    What you need for your injection

    Included in the carton:

    • 1 new NIVESTYM prefilled syringe

    Not included in the carton (see Figure B

    Figure B

    Figure C shows a needle guard that has not yet been activated. The prefilled syringe is ready for use. This is what the prefilled syringe looks like before use.

    Figure C

    Figure C

    Figure D shows a needle guard that has been activated. This is what the prefilled syringe looks like after use.

    Figure D

    Figure D
    Preparing the NIVESTYM prefilled syringe
    Step 1:Find a clean, well-lit flat work surface.
    Step 2:Take the carton containing the NIVESTYM prefilled syringe out of the refrigerator and leave it unopened on your work surface for at least 30 minutes so that it reaches room temperature. Put the original carton with any unused prefilled syringes back in the refrigerator.
    • Do not shake the prefilled syringe.
    • Do not leave the prefilled syringe in direct sunlight.
    Step 3:Wash your hands with soap and water.
    Step 4:Remove the prefilled syringe from the carton. Check to make sure that the needle guard is covering the barrel of the prefilled syringe. Do not push the needle guard over the needle cover before the injection. This may activate or lock the needle guard. See Figure E
    Figure E
  • Choose a different site for each injection of NIVESTYM.
  • Do not inject into areas where the skin is tender, bruised, red, or hard. Avoid injecting into areas with scars or stretch marks.
  • Step 8: Clean your injection site with an alcohol wipe. See Figure FFigure F
    Step 9: Hold the prefilled syringe by the needle guard with the needle cover pointing up. Carefully pull the needle cover straight off and away from your body. Throw away the needle cover. Do not recap the needle. See Figure G

    Figure G

    Your healthcare provider has prescribed either a "full" syringe dose or a "partial" syringe dose.

    • If you are prescribed a partial dose of NIVESTYM, follow Steps 10 through 18.
    • If you are prescribed a full dose, you will inject all of the medicine from your prefilled syringe. For a full dose, skip Steps 10 and 11, and follow Steps 12 through 18.
    Partial dosing
    Step 10:Point the needle up and tap gently until the air rises to the top. See Figure H

    Figure H

    Step 11:Holding the prefilled syringe as shown, slowly push up on the plunger rod to push out the extra air and medicine until the end of the conical base (edge) of the plunger stopper lines up with the syringe marking for your prescribed dose. See Figure I

    Figure I

    Administering the NIVESTYM prefilled syringe
    Step 12:With one hand, gently pinch a fold of skin at the injection site. Hold the pinch. See Figure J

    Figure J

    Step 13:With your other hand, hold the prefilled syringe like you would hold a pencil. Use a quick "dart-like" motion to insert the needle at a 45 to 90 degree angle into the skin as shown. See

    Figure K

    Figure K
    Step 14:Using slow and constant pressure, press down on the plunger rod as far as it will go. Keep the plunger rod fully pressed down while you hold the prefilled syringe in place for 5 seconds. See Figure L

    Figure L

    Step 15:Keep the plunger rod fully pressed down while you carefully pull the needle straight out from the injection site. See Figure M

    Figure M

    Step 16: As you let go of the plunger rod, the needle guard will automatically slide over the needle until the needle is completely covered and the needle guard locks into place. Do not recap the needle. See Figure N

    Figure N

    Step 17:There may be a small amount of blood at the injection site. You can press a cotton ball or gauze over the injection site and hold it for 10 seconds. Do not rub the injection site. You may cover the injection site with a small adhesive bandage, if needed. See Figure O

    Figure O

    Step 18:Throw away (dispose of) the syringe as instructed by your healthcare provider or by following the instructions below. See Figure P

    Figure P

    Disposing of (throw away) used NIVESTYM prefilled syringes
    • Put the used prefilled syringe in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) prefilled syringes in your 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 dispose of your used sharps container in your household trash unless your community guidelines permit this. Do not recycle your used sharps disposal container.

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

    Manufactured by:
    Hospira, Inc.,
    a Pfizer Company
    Lake Forest, IL 60045 USA
    US License No. 1974

    Logo

    LAB-0938-1.0
    For more information go to www.pfizer.com or call 1-800-438-1985.

    Issued: July 2018


    Instructions for Use NIVESTYM
    (Neye-ves-tim)
    (filgrastim-aafi)
    injection
    Single-Dose Vial

    Important

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

    Before you use a NIVESTYM vial, read this important information:

    Storing your NIVESTYM vial

    • Store the vial in the refrigerator between 36˚F to 46˚F (2˚C to 8˚C).
    • Do not freeze.
    • Keep the vial in the original carton to protect from light or physical damage.
    • Take the vial out of the refrigerator 30 minutes before use and allow it to reach room temperature before preparing an injection.
    • Throw away (dispose of) any vial that has been left at room temperature for longer than 24 hours.
    • After you inject your dose, throw away (dispose of) any unused NIVESTYM left in the vial. Do not save unused NIVESTYM in the vial for later use.

    Keep NIVESTYM and all medicines out of the reach of children.

    Using your vial

    • 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 NIVESTYM appears on the carton and vial label.
    • Only use the vial 1 time. Discard (throw away) the vial with any remaining NIVESTYM liquid.
    • Do not use a vial after the expiration date on the label.
    • Do not shake the vial.
    • Do not use the vial if the medicine is cloudy or discolored or contains flakes or particles.

    Call your healthcare provider if you have any questions.

    Step 1: Prepare

    A
    Remove the vial from the refrigerator.
    Find a clean, well-lit, flat work surface. Place the vial on your clean work surface for 30 minutes and allow it to reach room temperature before you give an injection.
    • Do not try to warm the vial by using a heat source such as hot water or microwave.
    • Do not leave the vial in direct sunlight.
    • Do not shake the vial.
    • Use the vial only 1 time.
    B
    Inspect the vial.
    Make sure the medicine in the vial is clear and colorless.
    • Do not use the vial if:
      • The medicine is cloudy or discolored or contains flakes or particles.
      • The expiration date printed on the label has passed.
    • In all cases, use a new vial and call your healthcare provider.
    C
    Gather all materials needed for your injection.
    Wash your hands thoroughly with soap and water. On your clean, well-lit, flat work surface, place:
    • 1 Vial
    • 1 Disposable syringe and needle
    • 2 Alcohol wipes
    • 1 Cotton ball or gauze pad
    • 1 Adhesive bandage
    • Sharps disposal container

      Figure

    • Only use the disposable syringes and needles that your healthcare provider prescribes.
    • Only use the syringes and needles 1 time. Throw away (dispose of) any used syringes and needles. See Step 5: Finish
      S
      Dispose of (throw away) the used needle and syringe.
      Figure
      • Put your used needles and syringes in a FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) loose needles, and syringes in your household trash.
      • If you do not have an 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 dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. Do not recycle your used sharps disposal container.
      T
      Examine the injection site.
      If there is blood, press a cotton ball or gauze pad on your 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:
      Hospira, Inc.,
      a Pfizer Company
      Lake Forest, IL 60045 USA
      US License No. 1974

      Logo

      LAB-0937-1.0
      For more information go to www.pfizer.com or call 1-800-438-1985.

      Issued: July 2018

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    Resources

    Pfizer enCompass™
    Pfizer enCompass™ is a resource available to patients on NIVESTYM therapy. Support includes assistance for eligible uninsured and insured patients who cannot afford their out-of-pocket costs. To learn more, call Pfizer enCompass to talk to an Access Counselor at (844) 722-6672 or visit the Pfizer enCompass website.
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