• Remicade Dose:
    (will be diluted to a final volume of 250 mL)

  • mg/kg

  • mg
  • .

  • weeks (refills x 1 year)

  • .

  • NOTE: Test for latent tuberculosis (TB) should be performed prior to initiating therapy

  • Pre-Medication Orders:

  • mg PO x 1 dose

  • mg IV x 1 dose

  • mg PO x 1 dose

  • mg IV x 1 dose

    • Geneva Woods nurse to infuse Remicade over at least two hours via peripheral or central access. If no central intravenous access,
    Geneva Woods nurse to insert peripheral IV per Geneva Woods Pharmacy protocol.
    • Initiate first dose therapy at (1) 10 mL/hour x 15 minutes, (2) increase to 20 mL/hour x 15 minutes, (3) increase to 40 mL/hour x 15
    minutes, (4) increase to 80 mL/hour x 15 minutes, (5) increase to 150 mL/hour x 30 minutes, (6) increase to 250 mL/hour until infusion is complete.
    • Geneva Woods nurse to obtain baseline vital signs prior to the start of each Remicade infusion. For the first infusion, obtain
    additional vital signs with each rate increase, then every 30 minutes thereafter. For the second and subsequent infusions, obtain additional vital signs every 30 minutes until infusion is complete.
    • Once infusion is complete, the patient may be discharged to home if no side effects are noted.
  • Adverse Side Effect Orders:
    • For Remicade reaction: Stop infusion, initiate hypersensitivity protocol, and contact prescriber. Re-challenge at 50% prior infusion
    rate only by order of the prescriber.
  • • Acetaminophen 650 mg PO q4 hours PRN fever, chills, headache
    • Diphenhydramine 20 – 50 mg IV q4 hours PRN urticaria, pruritis, SOB
    • Oxygen by nasal cannula at 2 – 4 LPM as needed for chest pain, SOB
  • •Solu-Medrol 125 mg IV x 1 dose PRN urticaria, pruritis, SOB
    • Epinephrine 0.2 mg – 0.5 mg IV x 1 dose for anaphylaxis
    CALL PRESCRIBER if second dose is needed
  • Please fax completed form to Geneva Woods Infusion Pharmacy