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ALLERGIES/REACTIONS ________________________
2.
DIAGNOSIS:
3.
CURRENT MEDICATIONS:____________________________________________
4.
Do not initiate therapy in patient with unstable Heart Failure (HF). If a patient has a history of
HF, nurse is to assess and monitor patient for exacerbation of HF and notify provider of
changes.
5.
Verify TUBERCULOSIS TESTING (TB) has been done. If not done, conduct one of the following tests PRIOR
to initiating the first dose of infliximab (Remicade.)
7.
Height:
8.
CALCULATED DOSE:
9.
cm
Actual Weight:
kg
Other ____________________________
10.
OTHER MEDICATION :
PRN Medication:
Acetaminophen (Tylenol) 650 mg PO every 4 hours PRN aches or temperature change greater
than 1C LIMIT THE TOTAL DOSE OF ALL ACETAMINOPHEN CONTAINING PRODUCTS
TO 3,000 MG PER DAY Infusion Directions:
Final concentration to be between 0.4 mg/ml and
4 mg/ml Do not shake Include 1.2 micron (or smaller) in-line filter
Do not infuse other medication into the IV line with infliximab (Remicade).
Flush with saline before and after medication administration.
Infuse per the following infusion rate schedule or maximum tolerated by patient:
Time
(Minute)
0
15
30
45
60
90
120
DATETIME
PHYSICIANS SIGNATURE
Steroid dosing may be oral (prednisone 50 mg orally every 12 hours for 3 doses prior to infusion) or
intravenous (a single dose of hydrocortisone 100 mg or methylprednisolone 20 to 40 mg administered
20 minutes prior to the infusion).
On initiation of the infusion, begin with a test dose at 10 mL/hour of infliximab for 15 minutes.
Thereafter, the infusion may be increased at 15-minute intervals, as tolerated, to completion (initial
increase 20 mL/hour, then 40 mL/hour, then 80 mL/hour, etc).
A maximum rate of 125 mL/hour is recommended in patients who experienced prior mild-moderate
reactions and 100 mL/hour is recommended in patients who experienced prior severe reactions.
For delayed infusion reactions, premedication with acetaminophen and diphenhydramine 90 minutes
prior to infusion.
On initiation of the infusion, begin with a test dose at 10 mL/hour for 15 minutes.
Post infusion therapy with acetaminophen for 3 days and an antihistamine for 7 days is recommended.
Note: In a trial of pediatric patients, premedication with acetaminophen (20 mg/kg; maximum single
dose: 1000 mg) and cetirizine (0.3 mg/kg if <5 years, 10 mg if 5 years) did not significantly impact
incidence of infusion-related reactions; patients should be monitored closely.