DONANEMAB (KISUNLA) TITRATED DOSING INFUSION		version 8/8/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☐	Referral to IV Infusion Room Appointment requests for initial doses.	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365
	Urgency of Scheduling: Routine
	Appointment requests for initial doses.		
	☐	Referral to IV Infusion Room Appointment requests for week 4	Once	S+28	1 treatment	
		Status: Future, Expected: S, Expires: S+365
	Urgency of Scheduling: Routine
	Appointment requests for week 4		
	☐	Referral to IV Infusion Room Appointment requests for week 8	Once	S+56	1 treatment	
		Status: Future, Expected: S, Expires: S+365
	Urgency of Scheduling: Routine
	Appointment requests for week 8		
	☐	Referral to IV Infusion Room Appointment requests for week 12 and thereafter	Every 28 days	S+84	 treatments	
		Status: Future, Expected: S, Expires: S+365
	Urgency of Scheduling: Routine
	Appointment requests for week 12 and thereafter		

Imaging 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Day 1 of every 1 month	S	 treatments	
		Clinic Performed, Normal
	Magnetic Resonance Imaging (MRI) should be performed at baseline, and prior to the 2nd, 3rd, 4th and 7th infusions		
	☐	PET/CT Amyloid	Day 1 of every 1 month	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Routine, Ancillary Performed
	Amyloid Positron Emission Tomography (PET) at months 6 and 12		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Day 1 of every 1 month	S	 treatments	
		Treatment conditions: Alzheimer's Disease with mild to moderate cognitive impairment or mild dementia		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	 treatments	
		Routine, Until discontinued Starting when released Until Specified		
	☐	Nursing communication	Every visit	S	 treatments	
		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	 treatments	
		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	 treatments	
		Routine, Until discontinued Starting when released Until Specified		

Line Flush 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	 treatments	
		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	 treatments	
		250 mL, intravenous, PRN, Flush bag, Starting when released, Until Discontinued		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	donanemab-azbt (KISUNLA) 350 mg in sodium chloride 0.9% 50 mL (7 mg/mL)	Once	S	1 treatment	
		350 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Week 0		
	☐	donanemab (KISUNLA) 700 mg/100 mL IVPB infusion (RESTRICTED)	Once	S+28	1 treatment	
		700 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Week 4		
	☐	donanemab-azbt (KISUNLA) 1,050 mg in sodium chloride 0.9% 250 mL (4.2 mg/mL)	Once	S+56	1 treatment	
		1,050 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Week 8		
	☐	donanemab-azbt (KISUNLA) 1,400 mg in sodium chloride 0.9% 250 mL (5.6 mg/mL)	Every 28 days	S+84	 treatments	
		1,400 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Week 12 and thereafter		

Delayed infusion reactions 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	PRN	S	 treatments	
		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 KISUNLA 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	 treatments	
		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				
		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				
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg				
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg				
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.5 mg				
		0.5 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg				
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg				
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	0.9%  NaCl solution				
		250 mL, intravenous, once PRN, for hydration, Starting when released, Until Discontinued		

Discharge Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9% flush 10 mL	PRN	S	 treatments	
		10 mL, intravenous, PRN, line care, Starting when released, Until Discontinued
	Flush IV line at the end of donanemab (Kisunla) infusion. 		
	☐	Discontinue IV	Every visit	S	 treatments	
		Routine, Once Starting when released