AXATILIMAB (NIKTIMVOTM) INFUSION		version 2/6/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		
	☑	Nursing communication	Every visit	S	Until discont'd	
		Please continue to schedule subsequent infusion appointments manually as appropriate.		

Treatment Conditions 	

	
	Interval	Defer Until	Duration	
	☐	Treatment conditions	Every visit	S	 treatments	
		HOLD and notify provider for
	o AST or ALT GREATER than 3x ULN and
	o Total bilirubin GREATER than 2x ULN.
	
	o Serum CPK GREATER than 5x ULN or
	o Serum amylase GREATER than 2x ULN or
	o Serum lipase GREATER than 2x ULN.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	 treatments	
		10 mL, intravenous, PRN, line care, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	 treatments	
		Monitor patient for signs of *MINOR INFUSION REACTION*: fever, chills, pruritis, urticaria, periorbital edema, chest pain, mild hypotension, hypertension, or mild dyspnea. 
	-  For minor infusion reaction take the following steps: stop or slow infusion rate by 50%. 
	-  If symptoms do not resolve within 5-10 minutes, give Benadryl and Tylenol as ordered. 
	-  Monitor vital signs until resolution of symptoms. 
	-  Notify MD if symptoms do not resolve within 5-10 minutes. With MD approval, give Solu-medrol as ordered. 
	-  When symptoms resolve, restart medication at 50% of the original rate. After 15-30 minutes gently increase rate and monitor patient closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	 treatments	
		Monitor patient for signs of *SEVERE INFUSION REACTION*: severe dyspnea, wheezing, stridor, angioedema, or marked hypotension. 
	-  For severe infusion reaction take the following steps: STOP Infusion and start normal saline solution. 
	-  Notify physician and administer Benadryl, Tylenol, Solu-medrol as ordered. 
	-  Monitor vital signs. Administer Epinephrine as ordered. 
	-  Consult MD for further orders.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Creatine kinase, total (CPK)	Every 2 weeks	S	2 treatments	
		STAT, Normal, Clinic Collect
	Every 2 weeks monitoring for the first 2 treatments.		
	☐	Creatine kinase, total (CPK)	Every 4 weeks	S	 treatments	
		STAT, Normal, Clinic Collect
	Start monthly monitoring after 3rd treatment.		
	☐	Amylase level	Every 2 weeks	S	2 treatments	
		STAT, Normal, Clinic Collect
	Every 2 weeks monitoring for the first 2 treatments.		
	☐	Amylase level	Every 4 weeks	S	 treatments	
		STAT, Normal, Clinic Collect
	Start monthly monitoring after 3rd treatment.		
	☐	Lipase level	Every 2 weeks	S	2 treatments	
		STAT, Normal, Clinic Collect
	Every 2 weeks monitoring for the first 2 treatments.		
	☐	Lipase level	Every 4 weeks	S	 treatments	
		STAT, Normal, Clinic Collect
	Start monthly monitoring after 3rd treatment.		
	☐	hCG qualitative, urine screen	Every 4 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Collect		
	☐	CBC with platelet and differential	Every 2 weeks	S	 treatments	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every 2 weeks	S	 treatments	
		STAT, Normal, Clinic Collect		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	 treatments	
		Please add pre-medication (diphenhydramine and antipyretic) and reduce subsequent infusion rate by 50% of the prior rate in patients with prior infusion-related reaction to axatilimab.		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every 2 weeks	S	 treatments	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued
	Administer 30 minutes prior to therapy.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every 2 weeks	S	 treatments	
		650 mg, oral, once, Starting when released
	Administer 30 minutes prior to therapy.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	axatilimab-csfr (NIKTIMVO) 0.3 mg/kg in sodium chloride 0.9% 50 mL	Every 2 weeks	S	 treatments	
		0.3 mg/kg, intravenous, Administer over: 30 Minutes, once, Starting when released
	HAZARDOUS - Handle with care.  Max dose = 35 mg
	Use 0.2 micron in line or polyether sulfone (PES filter). Do not shake or infuse concomitantly with other agents.  After administration, flush the line with 0.9% Sodium Chloride.		

Post-Medications 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	 treatments	
		10 mL, intravenous, once, Starting when released
	Flush IV line after completion of axatilimab.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	 treatments	
		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	 treatments	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	 treatments	
		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) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, 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		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued