Entyvio 300 mg infused intravenously over 30 minutes
Prior to initiating treatment with Entyvio, all patients should be brought up-to-date with all immunizations according to current
immunization guidelines. Consider screening for tuberculosis (TB) according to the local practice.
If NO , Begin with infusions at Week 0, 2, & 6 and then continue every 8 week 14
(refills x 1 year)
NOTE: Discontinue therapy in patients who show no evidence of therapeutic benefit by Week 14.
Optional Pre-Medication Orders:
(consider prescribing if patient has
previously had a reaction to Entyvio)
Please fax completed form to Geneva Woods Infusion Pharmacy