When You Can't Find Neupogen, Alternatives Exist

If you've been prescribed Neupogen and can't find it at your pharmacy, the situation can feel urgent — and it is. Neupogen plays a critical role in protecting your immune system during chemotherapy. Skipping doses isn't an option.

The good news is that Neupogen isn't your only choice. There are several FDA-approved alternatives that work the same way and may be easier to find — or more affordable. In this guide, we'll walk you through what Neupogen does, how it works, and the alternatives worth discussing with your doctor.

What Is Neupogen and What Does It Do?

Neupogen is the brand name for Filgrastim, a man-made version of a protein your body naturally produces called granulocyte colony-stimulating factor (G-CSF). This protein tells your bone marrow to make more white blood cells — specifically neutrophils, the cells that fight bacterial infections.

Neupogen is prescribed for:

• Chemotherapy-induced neutropenia — the most common use, to help your immune system recover after cancer treatment
• Bone marrow transplant recovery
• Peripheral blood progenitor cell mobilization — preparing stem cells for collection
• Severe chronic neutropenia — a long-term condition where the body doesn't produce enough neutrophils

For a full overview, see our post on what Neupogen is and how it's used.

How Does Neupogen Work?

Neupogen works by binding to receptors on the surface of neutrophil precursor cells in your bone marrow. This signals those cells to multiply, mature, and become active neutrophils faster than they would on their own.

In practical terms, Neupogen:

• Speeds up white blood cell recovery after chemotherapy
• Reduces the number of days you spend with dangerously low neutrophil counts
• Lowers your risk of developing febrile neutropenia (fever with low white blood cells), which can be life-threatening

Learn more in our detailed explainer on how Neupogen works.

FDA-Approved Alternatives to Neupogen

All of the alternatives below are approved by the FDA for the same or similar uses as Neupogen. They all work by stimulating the production of neutrophils. Talk to your oncologist before switching — they'll confirm which option is right for your specific situation.

1. Zarxio (Filgrastim-sndz)

Zarxio was the first FDA-approved biosimilar to Neupogen, approved in 2015 and manufactured by Sandoz. A biosimilar is a medication that is highly similar to the original biologic with no clinically meaningful differences in safety or effectiveness.

• How it's given: Subcutaneous injection or IV infusion, same as Neupogen
• Dosing: Same doses as Neupogen (typically 5 mcg/kg/day)
• Cost: Generally 15–30% less expensive than brand Neupogen, with cash prices around $200–$350 per injection
• Availability: Widely available through specialty and retail pharmacies

Because Zarxio contains the same active ingredient (Filgrastim) and has been thoroughly tested, many oncologists consider it interchangeable with Neupogen.

2. Nivestym (Filgrastim-aafi)

Nivestym is another Filgrastim biosimilar, manufactured by Pfizer (Hospira) and approved in 2018.

• How it's given: Subcutaneous injection or IV infusion
• Dosing: Same as Neupogen
• Cost: Comparable to Zarxio, typically $200–$350 per injection
• Availability: Available through specialty pharmacies and some oncology clinics

Nivestym offers another option when brand Neupogen or Zarxio are unavailable.

3. Neulasta (Pegfilgrastim)

Neulasta is a long-acting form of Filgrastim. The key difference? Instead of daily injections, Neulasta requires just one injection per chemotherapy cycle — typically given 24 hours after chemo.

• How it's given: Single subcutaneous injection, or via the Neulasta Onpro on-body injector (which automatically delivers the dose about 27 hours after it's applied)
• Dosing: 6 mg once per chemotherapy cycle
• Cost: Higher per-dose cost (around $3,000–$6,000 per injection at cash price), but you only need one shot per cycle instead of daily shots
• Availability: Neulasta also has its own biosimilars (Udenyca, Nyvepria, Fylnetra, Stimufend), which may improve availability

Neulasta can be a great option if daily injections are burdensome, or if the daily Filgrastim products are all out of stock. However, it's not appropriate for all situations — your doctor will advise.

4. Granix (Tbo-filgrastim)

Granix is a short-acting G-CSF manufactured by Teva. It's approved for reducing the duration of severe neutropenia in patients with nonmyeloid cancers receiving myelosuppressive chemotherapy.

• How it's given: Subcutaneous injection
• Dosing: 5 mcg/kg/day
• Cost: Similar to Filgrastim biosimilars
• Availability: Available through specialty pharmacies

While Granix is technically a different product (not a biosimilar to Neupogen), it works through the same G-CSF mechanism and serves the same purpose.

How to Decide Which Alternative Is Right for You

The choice between these alternatives depends on several factors:

• Availability: Which products are actually in stock near you? Use Medfinder to check.
• Insurance coverage: Your plan may prefer or require a specific biosimilar. Check with your insurer about formulary coverage and prior authorization requirements.
• Convenience: If daily injections are difficult, Neulasta's once-per-cycle dosing may be appealing.
• Cost: Biosimilars are generally cheaper than brand Neupogen. If you're paying out of pocket, this matters. See our guide to saving money on Neupogen.
• Your doctor's recommendation: Your oncologist knows your treatment protocol and can guide the best choice.

A Note About Switching Medications

Switching between Filgrastim products (Neupogen, Zarxio, Nivestym, Releuko, Nypozi) is generally straightforward because they all contain the same active molecule. Switching to Neulasta or Granix involves a different product and dosing schedule, so your doctor will need to adjust your treatment plan.

Never switch medications on your own. Always work with your oncologist to make changes safely.

Final Thoughts

Not being able to find Neupogen is stressful, but you have real alternatives. Multiple biosimilars offer the same medication at a lower cost, and long-acting options like Neulasta can simplify your treatment. The most important thing is to talk to your oncologist quickly so you don't miss doses that protect your immune system.

Use Medfinder to search for Neupogen and its alternatives at pharmacies near you. And for more tips on navigating the shortage, read our guide on how to find Neupogen in stock.