TOCILIZUMAB-AAZG (TYENNE) INFUSION FOR RHEUMATOLOGY		version 5/20/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Appointment request for initial dose.	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for initial dose.		
	☑	Referral to IV Infusion Room Appointment request for subsequent doses.	Every 4 weeks	S+27	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for subsequent doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	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		

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 signs of minor infusion reaction; fever, chills, pruritis, uticaria, 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 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 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 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, catheter 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	
	☐	acetaminophen (TYLENOL) tablet 500 mg	1 time a week	S	1 treatment	
		500 mg, oral, once, Starting when released
	Give 30 minutes prior to start of Actemra infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	acetaminophen (TYLENOL) tablet 500 mg	Every 4 weeks	S+27	Until discont'd	
		500 mg, oral, once, Starting when released
	Give 30 minutes prior to start of Actemra infusion.
	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	
	☐	tocilizumab-aazg (TYENNE) 4 mg/kg in sodium chloride 0.9% 100 mL IVPB (RESTRICTED)	Once	S	1 treatment	
		4 mg/kg, intravenous, Administer over: 60 Minutes, once, Starting when released
	Do not infuse tocilizumab concomitantly in the same intravenous line with other drugs.
	DO NOT EXCEED 800 mg PER DOSE, Protect from light.		
	☐	TOCILIZUMAB-AAZG (TYENNE) 8 OR 6 MG/KG (S) ONCE (MAX 800 MG)				
	◎	tocilizumab-aazg (TYENNE) 8 mg/kg in sodium chloride 0.9% 100 mL IVPB (RESTRICTED)	Every 4 weeks	S+27	 treatments	
		8 mg/kg, intravenous, Administer over: 60 Minutes, once, Starting when released
	Do not infuse tocilizumab concomitantly in the same intravenous line with other drugs. 
	Administer on week 4 and every 4 weeks thereafter. 
	DO NOT EXCEED 800 mg PER DOSE, Protect from light.		
	◎	tocilizumab-aazg (TYENNE) 6 mg/kg in sodium chloride 0.9% 100 mL IVPB (RESTRICTED)	Every 4 weeks	S+27	 treatments	
		6 mg/kg, intravenous, Administer over: 60 Minutes, once, Starting when released
	Do not infuse tocilizumab concomitantly in the same intravenous line with other drugs. 
	Administer on week 4 and every 4 weeks thereafter. 
	DO NOT EXCEED 800 mg PER DOSE, Protect from light.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, headaches, fever, myalgia, Starting when released, Until Discontinued
	Give 325-650 mg for headache, fever, myalgia
	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, for allergic reaction symptoms, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 1 mg	PRN	S	Until discont'd	
		1 mg, intravenous, once PRN, anaphylaxis, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for anaphylactic reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 50 mg	PRN	S	Until discont'd	
		50 mg, oral, every 4 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	Give 25-50 mg every 4-6 hours for nausea/vomiting		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued