NATALIZUMAB INFUSION EVERY 4 WEEKS		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 4 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

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		
	☐	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		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Notify MD for BP Less Than 90 / 60 mmHg or Above 160 / 100 mmHg; Pulse Less than or Equal to 50 or Greater than or Equal to 110.
	
	Notify MD of ANY unusual signs / symptoms of infection or hypersensitivity.		

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		
	☐	Hepatic function panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	JC virus, quantitative PCR	Every visit	S	Until discont'd	
		Routine, Normal, Clinic Collect		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	Until discont'd	
		REMS program: [US Boxed Warning]: Access is restricted through a REMS program called the TOUCH Prescribing Program; prescribers and pharmacies must be certified with the Tysabri Outreach Unified Commitment to Health (TOUCH) Prescribing Program. Patients must also be enrolled in the TOUCH Prescribing Program (800-456-2255) to receive natalizumab (MS-TOUCH for multiple sclerosis or CD-TOUCH for Crohn disease).		
	☐	natalizumab (TYSABRI) 300 mg in sodium chloride 0.9% 100 mL IVPB	Every 4 weeks	S	Until discont'd	
		300 mg, intravenous, Administer over: 1 Hours, once
	Infuse natalizumab 300 mg in 100 mL 0.9% sodium chloride and infuse over 1 hour (infusion rate approximately 5 mg per minute).  Do NOT administer natalizumab as an intravenous push or bolus injection.  After the infusion is complete, flush line with 0.9% sodium chloride.  Observe patients during the infusion and for one hour after the infusion is complete. Stable for 8 hours when refrigerated, warm to room temperature before administration.		

Post-Hydration 	

	
	Interval	Defer Until	Duration	
	☐	sodium chloride 0.9 % bolus 250 mL	Every 4 weeks	S	Until discont'd	
		250 mL, intravenous, Administer over: 60 Minutes, once, Starting when released
	To flush Tysabri tubing. Infuse over 1 hour.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.2 mg	PRN	S	Until discont'd	
		0.2 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued
	Add CALL MD		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, infusion reaction, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 500 mL	PRN	S	Until discont'd	
		500 mL, intravenous, once PRN, hypersensitivity reaction, Starting when released, Until Discontinued		

Supportive Care 	

	
	Interval	Defer Until	Duration	
	☐	ondansetron (ZOFRAN) IV 8 mg	PRN	S	Until discont'd	
		8 mg, intravenous, every 8 hours PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.