BELIMUMAB (BENLYSTA) INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Appointment request for initial doses.	Every 2 weeks	S	3 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for initial doses.		
	☑	Referral to IV Infusion Room Appointment requests for subsequent doses.	Every 4 weeks	S+55	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment requests for subsequent doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Urinalysis, automated with microscopy	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Sedimentation rate	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C-reactive protein	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C3 complement component	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C4 complement component	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	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	Until discont'd	
		Monitor patient for any signs of infusion reaction. For MINOR INFUSION REACTIONS (fever, chills, pruritis, uticaria, chest pain, mild hypotension, hypertension, or mild dyspnea) stop or slow infusion rate by 50%. If symptoms do not resolve within 5-10 minutes give Benadryl as ordered. 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 25% 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	Until discont'd	
		Monitor patient for signs of SEVERE INFUSION REACTIONS: 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 as ordered, Monitor vital signs, Administer  Epinephrine as ordered. Consult MD for further orders.		
	☐	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		
	☐	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		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	Every visit	S	Until discont'd	
		25 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	acetaminophen (TYLENOL) tablet 500 mg	Every visit	S	Until discont'd	
		500 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Every visit	S	Until discont'd	
		100 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	belimumab (BENLYSTA) IVPB 10 mg/kg	Every 2 weeks	S	3 treatments	
		10 mg/kg, intravenous, once, Starting when released
	Administer on Weeks 0, 2, and 4.		
	☐	belimumab (BENLYSTA) IVPB 10 mg/kg	Every 4 weeks	S+55	Until discont'd	
		10 mg/kg, intravenous, once, Starting when released
	Administer on Week 8 and every 4 weeks thereafter.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 6 hours PRN, mild pain (score 1-3), headaches, fever, 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) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, PRN, for mild to moderate 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		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	PRN	S	Until discont'd	
		40 mg, intravenous, 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