How to Give Yourself an Injection of Filgrastim (Neupogen®) or Pegfilgrastim (Neulasta®) Using a Prefilled Syringe

This information will teach you how to give yourself a subcutaneous (SUB-kyoo-TAY-nee-us) injection (shot) with filgrastim (Neupogen) or pegfilgrastim (Neulasta) using a prefilled syringe. A subcutaneous injection is an injection that is given under your skin. A prefilled syringe is a syringe that comes with medication inside.

Your healthcare provider will show you how to give yourself the injection. You can use the information in this resource to remember how to do it at home.

How to Store Your Prefilled Syringes

• Store your prefilled syringes in your refrigerator. Do not store them in your freezer.
  • If the medication inside a syringe freezes, place the syringe near the front of your refrigerator or on one of the shelves inside the refrigerator door. This will help it thaw.
  • If the medication inside a syringe freezes more than once, do not use it. Call your healthcare provider for instructions on what to do next.
• You can leave a prefilled syringe out at room temperature for up to 24 hours. Room temperature is 68 °F to 77 °F (20 °C to 25 °C). Do not leave it in direct sunlight.
  • Do not leave a prefilled syringe out at room temperature for longer than 24 hours. If you do not use it, put it back in your refrigerator.
  • If you leave a prefilled syringe out at room temperature for longer than 24 hours, do not use it. Call your healthcare provider for instructions on what to do next.
• If you have questions about how to store or carry your prefilled syringes when you travel, talk with your healthcare provider or pharmacist.

How to Give Yourself an Injection

Gather your supplies

Place your supplies on a clean, flat surface (such as a table or countertop). You can work in your bathroom if it is private and there is enough space. You will need:

• 1 prefilled syringe with a plastic safety guard attached
• 1 alcohol pad
• An empty, hard plastic container with a screw-top lid (such as a laundry detergent bottle) to throw away the syringe. For instructions on how to choose a plastic container, read How to Store and Get Rid of Your Home Medical Sharps (www.mskcc.org/pe/store_get_rid_sharps).
• 1 (2-inch x 2-inch) gauze pad or cotton ball
• 1 bandage (such as a Band-Aid^®)

Get the injection ready

1. Take the prefilled syringe out of your refrigerator 30 minutes before you plan to give yourself the injection. The medication should be at room temperature when you inject it.
2. Do not shake the syringe. Shaking it may damage the medication inside. If it has been shaken, the medication might look foamy and you should not use it.
3. Check the medication for the following:
   • Name – Make sure the name of the medication matches what your healthcare provider prescribed for you. The name is listed on the package or syringe label.
   • Expiration date – Make sure the expiration date on the syringe has not passed. If the date has passed, throw away the syringe in the plastic container.
   • Dose – Make sure the dose of the medication matches what your healthcare provider prescribed for you. The dose is listed on the colored dot on the package.
   • Color – Make sure the medication in the syringe is clear and colorless. Do not use it if it looks foamy, cloudy, has any color, or has crystals (solid pieces) in it.

Do not use the syringe if:

• The medication name or dose does not match what your healthcare provider prescribed.
• The medication is expired.
• The medication is foamy, cloudy, has any color, or has crystals (solid pieces) in it.

If you have another syringe, use that one instead. Then contact your healthcare provider or pharmacist to tell them what happened. You may be able to bring the unused syringe to your local pharmacy so they can replace it.

Choose an injection site

4. Choose an injection site (place on your body to give the injection) where you can pinch a 1 to 2-inch (2.5 to 5-centimeter) fold of skin. It is best to use one of the following areas (see Figure 1):
   • The front part of your upper arms
   • Your abdomen (belly), except for the 2-inch (5-centimeter) area around your belly button
   • The middle front or middle outside of your thighs
   • The upper areas of your buttocks (butt), only if someone else is giving you the injection
   • The back part of your upper arms, only if someone else is giving you the injection
   Choose a different injection site each time. It is helpful to use a notebook or calendar to keep track. Switching injection sites will help limit soreness and keep scar tissue from forming. Scar tissue can keep the medication from working like it is supposed to. It also makes it hard to put the needle into your skin.
   
   Do not inject into an area that is tender, red, bruised, hard, or that has scars or stretch marks.
5. Fold back any clothing covering the injection site.
6. Tear off any 3 edges on a sealed alcohol pad packet. Hold the packet at the edge you did not tear off. Carefully open the packet to expose the alcohol pad, but do not take the pad out. Set the open packet on your clean work area. You will use this alcohol pad to clean the skin at the injection site just before you give yourself the injection.

Give yourself the injection

It is best to give yourself the injection while standing up. If you are sitting or lying down, it may be hard to see the injection site. If you are more comfortable sitting or lying down, ask someone else to give you the injection, such as a caregiver. Make sure your healthcare provider shows this person how to give you the injection.

7. Wash your hands well with soap and water or use an alcohol-based hand sanitizer.
   • If you are washing your hands with soap and water, wet your hands with warm water and apply soap. Rub your hands together for at least 20 seconds, then rinse. Dry your hands with a paper towel. Use that same towel to turn off the faucet.
   • If you are using an alcohol-based hand sanitizer, be sure to cover all parts of your hands with it. Rub your hands together until they are dry.
8. Take the syringe out of its package.

9. 

   With your dominant hand (the hand you write with), hold the syringe around the middle, like a pen or dart. Carefully pull the needle cover straight off (see Figure 2) and throw it away in the plastic container. Once the needle cover is off, do not set the syringe down. Do not let anything, including your fingers, touch the needle. If anything touches the needle, throw away the syringe in the plastic container. Start over with a new syringe. After you give yourself the injection, contact your healthcare provider to tell them what happened.
10. Check the syringe for air bubbles. If you see any, hold the syringe with the needle pointing up. Gently tap the side of the syringe with your fingers until the air bubbles rise to the top, near the needle. Slowly push the plunger up to push the air bubbles out of the syringe. Be careful not to push out any medication.
11. Pick up the alcohol pad with your other hand. Using firm pressure, clean the skin at the injection site. Start at the center of the site and move outward in a circular motion. Let your skin air dry before giving yourself the injection. Do not fan or blow on the area to speed up the drying.
12. Make sure you are still holding the syringe around the middle, like a pen or dart. Use your other hand to pinch a 1 to 2-inch (2.5 to 5-centimeter) fold of skin at the injection site.

13. 

    Push the whole needle straight down into your pinched-up fold of skin in one smooth, quick motion (see Figure 3). Do not put your thumb on the plunger yet.
14. After the needle is inserted, let go of your skin. Use your thumb (whichever thumb is more comfortable) to slowly push the plunger all the way down. Push it until all the medication is injected (see Figure 4).

    

15. When the syringe is empty, pull it straight out of your skin. Place a cotton ball or gauze pad over the injection site and gently press down for a few seconds. If needed, put a bandage over the injection site. Do not rub or press hard on the injection site.
16. Depending on the medication you’re taking, your syringe will come with either an automatic safety guard or a manual safety guard. With an automatic safety guard, the safety guard will automatically slide over the needle and cover it. With a manual safety guard, you will use your hands to slide the safety guard over the needle to cover it.
    • If your syringe has an automatic safety guard: Slowly let go of the plunger. The safety guard will automatically slide over the needle until the needle is completely covered. You will hear the safety guard click into place.
    • If your syringe has a manual safety guard: Be careful to not poke yourself with the needle. Hold the clear plastic finger grips on the sides of the syringe with one hand. Hold the safety guard with your other hand. Slide the safety guard over the needle until the needle is completely covered (see Figure 5). You will hear the safety guard click into place.

    

17. Throw away the syringe in the plastic container. Do not use a prefilled syringe more than once.

How to Store and Get Rid of Your Used Syringes

Keep your plastic container in a safe place. Read How to Store and Get Rid of Your Home Medical Sharps (www.mskcc.org/pe/store_get_rid_sharps) for information about choosing a plastic container and getting rid of your used syringes and other home medical sharps.

When to Call Your Healthcare Provider

Call your healthcare provider if:

• The injection site will not stop bleeding
• You have very bad pain at the injection site
• You inject the medication into the wrong area
• You have a fever of 100.4 °F (38 °C) or higher
• You have signs of an allergic reaction, such as swelling, redness, itching, or a rash at the injection site or anywhere else on your body
• You cannot use a syringe because the medication is expired (the expiration date on the syringe has passed), foamy, cloudy, has any color, or has crystals (solid pieces) in it
• You cannot use a syringe because something touches the needle before the injection
• You have trouble giving yourself the injection
• You have questions about how to give yourself the injection correctly