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Zarxio (filgrastim-sndz) is biosimilar product used to treat neutropenia associated with chemotherapy. Includes Zarxio side effects, interactions and indications.
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Drug Information:
The United States Food and Drug Administration (FDA) has approved Zarxio (filgrastim-sndz), a leukocyte growth factor biosimilar to the reference product Neupogen. It is indicated for the treatment of neutropenia associated with chemotherapy and all other indications included in the reference product's label. Read this Patient Information before you start treatment and each time you get a refill. 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. Learn more

Zarxio Side Effects

Zarxio Side Effects

Note: This document contains side effect information about filgrastim. Some of the dosage forms listed on this page may not apply to the brand name Zarxio.

For the Consumer

Applies to filgrastim: injection solution

Along with its needed effects, filgrastim (the active ingredient contained in Zarxio) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking filgrastim:

More common

  • Bleeding gums
  • bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
  • blood in the urine or stools
  • bloody nose
  • chills
  • cough
  • coughing up blood
  • diarrhea
  • difficult or labored breathing
  • difficulty with swallowing
  • dizziness
  • facial swelling
  • feeling of fullness
  • fever
  • headache
  • increased menstrual flow or vaginal bleeding
  • lower back or side pain
  • nausea
  • nosebleeds
  • pain in the back, ribs, arms, or legs
  • pain spreading to the left shoulder
  • painful or difficult urination
  • pale skin
  • paralysis
  • pinpoint red or purple spots on the skin
  • prolonged bleeding from cuts
  • red or black, tarry stools
  • red or dark brown urine
  • skin rash
  • sore throat
  • sores, ulcers, or white spots on the lips, tongue, or inside the mouth
  • stomach pain
  • tightness in the chest
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting

Less common

  • Blurred vision
  • chest pain
  • nervousness
  • pounding in the ears
  • slow or fast heartbeat

Incidence not known

  • Blisters on the skin
  • blue lips, fingernails, or skin
  • difficult or fast breathing
  • sores on the skin

Some side effects of filgrastim may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Bone, joint, or muscle pain
  • hair loss or thinning of the hair
  • loss of appetite
  • weight loss

Less common

  • Cracked lips
  • difficulty having a bowel movement
  • swelling or inflammation of the mouth

For Healthcare Professionals

Applies to filgrastim: injectable solution


Very common (10% or more): Decreased platelet counts (up to 97%), increase in white blood cell counts between 10 x 10(9)/L and 70 x 10(9)/L (up to 88%), decreased hemoglobin (up to 65%), mild to moderate decreases in hemoglobin (up to 59%), leukocytosis (up to 41%), thrombocytopenia (up to 38%), transient thrombocytopenia (up to 35%), palpable splenomegaly (up to 30%), splenomegaly (up to 30%), anemia (up to 10%)

Common (1% to 10%): Spleen disorder, splenic rupture/fatal splenic rupture

Uncommon (0.1% to 1%): Sickle cell anemia with crisis/sickle cell crisis

Rare (0.01% to 0.1%): Cytopenia

Postmarketing reports: Sickle cell disorders


Very common (10% or more): Mild to moderate musculoskeletal symptoms (up to 44%), medullary bone pain (up to 38%), mild to moderate bone pain (up to 33%), bone pain (up to 30%), back pain (up to 15%), musculoskeletal pain (up to 14%), flank pain (up to 12%), myalgia (up to 12%)

Common (1% to 10%): Arthralgia, extremity pain, muscle spasms, osteoporosis, severe musculoskeletal pain

Uncommon (0.1% to 1%): Pseudogout/chondrocalcinosis pyrophosphate, rheumatoid arthritis exacerbation

Rare (0.01% to 0.1%): Decreased bone density

Frequency not reported: Musculoskeletal chest pain, neck pain


Very common (10% or more): Pyrexia (up to 48%), fatigue (up to 20%), pain (up to 12%)

Common (1% to 10%): Asthenia, generalized weakness, malaise, mucosal inflammation, mucositis


Very common (10% or more): Epistaxis (up to 15%), cough (up to 14%), dyspnea (up to 13%)

Common (1% to 10%): Bronchitis, hemoptysis, sore throat, upper respiratory tract infection

Uncommon (0.1% to 1%): Acute respiratory distress syndrome (ARDS), hypoxia, interstitial lung disease, pulmonary edema, pulmonary hemorrhage, pulmonary infiltrates/lung infiltration, respiratory failure

Very rare (less than 0.01%): Pulmonary adverse events

Frequency not reported: Interstitial pneumonia, serious pulmonary adverse events

Postmarketing reports: Alveolar hemorrhage


Very common (10% or more): Spontaneously reversible elevations in lactate dehydrogenase (up to 56%), spontaneously reversible elevations in uric acid (up to 56%)

Common (1% to 10%): Anorexia, blood glucose decreased, blood lactate dehydrogenase increased, blood uric acid increased, decreased appetite, hyperuricemia

Uncommon (0.1% to 1%): Fluid volume disturbances


Very common (10% or more): Spontaneously reversible elevations in alkaline phosphatase (up to 56%), blood alkaline phosphatase increased (up to 11%)

Common (1% to 10%): Gamma glutamyltransferase increased, hepatomegaly

Uncommon (0.1% to 1%): AST increased


Very common (10% or more): Nausea (up to 43%), abdominal pain (up to 12%)

Common (1% to 10%): Constipation, diarrhea, oral pain, oropharyngeal pain, pharyngolaryngeal pain, vomiting

Frequency not reported: Stomatitis

Nervous system

Very common (10% or more): Dizziness (up to 14%), headache (up to 10%)

Common (1% to 10%): Hypoesthesia, paresthesia


Very common (10% or more): Rash/skin rash (up to 14%)

Common (1% to 10%): Alopecia, cutaneous/leukocytoclastic vasculitis, erythema

Uncommon (0.1% to 1%): Acute febrile neutrophilic dermatosis/Sweet's syndrome, maculopapular rash, pre-existing skin disorder exacerbation, psoriasis exacerbation

Frequency not reported: Urticaria


Very common (10% or more): Chest pain (up to 13%)

Common (1% to 10%): Hypertension, hypotension, peripheral edema

Uncommon (0.1% to 1%): Capillary leak syndrome, veno-occlusive disease

Rare (0.01% to 0.1%): Aortitis, vascular disorder


Common (1% to 10%): Dysuria, hematuria, urinary tract infection

Uncommon (0.1% to 1%): Proteinuria,

Rare (0.01% to 0.1%): Urine abnormality


Common (1% to 10%): Injection site pain, injection site reaction, transfusion reaction


Common (1% to 10%): Antibody formation, sepsis

Uncommon (0.1% to 1%): Graft versus Host Disease (GvHD)/fatal GvHD


Common (1% to 10%): Drug hypersensitivity

Uncommon (0.1% to 1%): Anaphylactic reaction, hypersensitivity/hypersensitivity reactions, severe allergic reaction

Very rare (less than 0.01%): Allergic reaction

Frequency not reported: Anaphylaxis, angioedema


Common (1% to 10%): Glomerulonephritis


Common (1% to 10%): Insomnia


Frequency not reported: cytogenetic abnormalities, transformation to myelodysplastic syndromes (MDS), transformation to acute myeloid leukemia (AML)

Transformation to MDS/AML and cytogenetic abnormalities appeared to be confined to patients with congenital neutropenia. The cumulative risk in this population in the eighth year of treatment was predicted to be 16.5%, or approximately 2% per year.

Editorial References and Review

Medically reviewed by BestRx Medical Team Last updated on 1/1/2020.

Source: Drugs.com Zarxio