LEQEMBI 10 MG/KG INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☐	Referral to IV Infusion Room	Every 14 days	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Additional Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Every visit	S	Until discont'd	
		Clinic Performed, Normal
	MRls should be performed at baseline & prior to the 5th, 7th, and 14th infusion		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Routine, Until discontinued Until Specified		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Clinic Performed, Normal
	Obtain vital signs (temperature, blood pressure, respiratory rate, and pulse) upon arrival, upon start of infusion, upon discontinuation of infusion and prior to discharge. If history of an acute infusion reaction, monitor vitals every 10 minutes for 30 minutes then every 30 minutes and for 30 minutes after infusion.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Clinic Performed, Normal
	*Monitor patient for 3 hours after infusion 1 , and 2 hours after infusion 2 and 3 
	* Monitor patient for 30 minutes on infusions 4 and onward.		

IV Maintenance 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		Routine, Until discontinued Until Specified		

Line Flush 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		

IV Fluids 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9 % infusion	Every visit	S	Until discont'd	
		250 mL, intravenous, PRN, Flush bag, Starting when released, Until Discontinued		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☑	Acetaminophen 650,Diphenhydramine 25,Hydrocortisone 100				
	☑	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, once
	Administer 15 - 30 minutes prior to START OF THE INFUSION
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Administer via slow IV push 15 - 30 minutes prior to START OF THE INFUSION.		
	☑	diphenhydrAMINE (BENADRYL) tablet 25 mg	Every visit	S	Until discont'd	
		25 mg, oral, once
	Administer 15 - 30 minutes prior to START OF THE INFUSION.		
	☐	fexofenadine (ALLEGRA) tablet 180 mg	Every visit	S	Until discont'd	
		180 mg, oral, once, Starting when released		
	☐	loratadine (CLARITIN) tablet 10 mg	Every visit	S	Until discont'd	
		10 mg, oral, once, Starting when released		
	☐	cetirizine (ZyrTEC) tablet 10 mg	Every visit	S	Until discont'd	
		10 mg, oral, once, Starting when released		
	☑	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	Every visit	S	Until discont'd	
		125 mg, intravenous, Starting when released		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Every visit	S	Until discont'd	
		100 mg, intravenous, once
	Administer via slow IV push 15 - 30 minutes prior to START OF THE INFUSION.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	lecanemab-irmb (LEQEMBI) 10 mg/kg in sodium chloride 0.9% 250 mL infusion	Every 14 days	S	Until discont'd	
		10 mg/kg, intravenous, Administer over: 60 Minutes, every 14 days, Starting S As Scheduled, Until Discontinued
	Protect from light. Do not shake. Administer immediately with a binding 0.2 micron in-line filter.
	If not administered immediately, may be kept refrigerated or at room temperature for no more than 4 hours		

Delayed infusion reactions 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	PRN	S	Until discont'd	
		Clinic Performed, Normal
	MINOR INFUSION REACTIONS may include any of the following: headache, nausea, itching, Flushing, fever, or chills. Initiate the following:
	1.     STOP infusion.
	2.     If symptoms do not resolve within 5-10 minutes, administer diphenhydramine 25 mg/IV.When symptoms resolve, restart Leqembi at 50% previous rate then gently increase over 15 minutes and monitor closely. 1.      You may pre medicate with Allegra 180 mg PO or Zyrtec 10 mg PO, or loratadine 10 mg PO, or Benadryl 25 mg PO for subsequent infusions.
	3.     Call MD to notify of the reactions and treatment plan administered.
	4.     Patient should be called later in the day to assure no delayed or returned reactions		
	☐	Nursing communication	PRN	S	Until discont'd	
		Clinic Performed, Normal
	SEVERE INFUSION REACTIONS may include any of the following: marked hypotension/hypertension, urticaria, chest pain, severe, dyspnea, wheezing, stridor, angioedema, changes in skin color, flushing or purple hue. Initiate the following STAT:
	1.       STOP Infusion and initiate normal saline at appropriate rate for reaction.
	2.       Call Cert team. If patient is unstable
	3.       INITIATE contact with MD. (STAY WITH PATIENT. ENGAGE STAFF TO CALL MD OFFICE.)
	4.       Administer Diphenhydramine (Benadryl®) 50 mg IVP followed by Solu-medrol 125 mg IVP
	5        Administer Epinephrine 0.3-0.5 mg of 1:1000 strength IM if any anaphylaxis      
	6.       Communicate all treatments and status with MD.
	7.       Patient should be called later in the day to assure no delayed or returned reactions.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.5 mg	PRN	S	Until discont'd	
		0.5 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	0.9%  NaCl solution	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, for hydration, Starting when released, Until Discontinued		

Discharge Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 20 mL	PRN	S	Until discont'd	
		20 mL, intravenous, PRN, line care, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		Routine, Once