FERUMOXYTOL (FERAHEME) 510 MG INFUSION		version 2/18/2026		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	1 time a week	S	2 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Ferritin level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Total iron binding capacity, percent transferrin saturation, and iron level	Once	S	1 treatment	
		Routine, Normal, Clinic Collect		
	☐	Iron level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	 treatments	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	 treatments	
		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 *MILD INFUSION REACTION*: flushing, headache, metallic taste, mild myalgias, chills, pruritis, urticaria, chest pain, mild hypotension or hypertension, or mild dyspnea, nausea.
	·For mild infusion reaction take the following steps:
	·STOP iron infusion for at least 15 minutes and observe, obtain vital signs and notify supervising physician, and watch for symptom progression or resolution. If unstable or symptoms worsen in 5- 10 minutes, notify physician and treat as moderate to severe reaction. With physician approval, give Solu-medrol as ordered. If patient remains stable after 15 minutes of total observation, consider completing infusion rate at 50% of previous rate. Observe for at least 1 hour after infusion.		
	☐	Nursing communication: Monitor patient for any signs of MODERATE INFUSION REACTION	Every visit	S	 treatments	
		·Monitor patient for signs of *MODERATE INFUSION REACTION*: transient cough, flushing, tachycardia, hypotension, chest tightness, dyspnea, nausea / vomiting 
	·For moderate infusion reaction take the following steps:
	·STOP iron infusion and notify supervising physician, obtain vital signs, and watch for symptom progression or resolution. Consider oxygen for hypoxia. Consider 500mL NS and IV Solu-Medrol as ordered with physician approval.  If unstable or symptoms worsen, treat as severe reaction. Rechallenge with physician approval. Observe for at least 1 hour after infusion.		
	☐	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. Initiate immediate rapid response or Code Blue protocol. Notify physician immediately and administer IV solumedrol. Monitor vital signs. Administer Epinephrine as ordered. Consult physician for further orders.		
	☐	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	 treatments	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	 treatments	
		No details available for preview		
	☐	For new patients, patients requiring pre-medication, and patients with previous reactions to IV iron, monitor 30 minutes following infusion for shortness of breath, wheezing, hypotension, tachycardia, or hives.	Every visit	S	 treatments	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	 treatments	
		Consider pre-medications in patients with a history of multiple drug allergies, moderate to severe asthma or immune-mediated diseases, or a prior reaction to another IV iron formulation.		
	☐	fexofenadine (ALLEGRA) tablet 180 mg	Every visit	S	 treatments	
		180 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	Every visit	S	 treatments	
		125 mg, intravenous, once, Starting when released		
	☐	famotidine (PEPCID) injection 20 mg	Every visit	S	 treatments	
		20 mg, intravenous, once, Starting when released
	Administer 30 minutes before infusion.  Not covered for Medicare patients.  Dilute with 10 mL of 0.9% sodium chloride injection.  Administer IV push over at least 2 minutes.  Use only assigned diluent for reconstitution.  Do NOT use saline flush for reconstitution or dilution.
	Indication(s) for H2 Receptor Antagonist (H2RA) Therapy: Hypersensitivity Prophylaxis		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	ferumoxytol (FERAHEME) 510 mg in dextrose 5% 67 mL IVPB (RESTRICTED for therapy plans)	1 time a week	S	2 treatments	
		510 mg, intravenous, Administer over: 15 Minutes, once, Starting when released
	Administer over a MINIMUM of 15 minutes. Stable at room temperature for 4 hours.		

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).		
	☐	cetirizine (ZyrTEC) tablet 10 mg	PRN	S	 treatments	
		10 mg, oral, once PRN, itching, Starting when released, for 1 dose		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL	PRN	S	Until discont'd	
		0.5 mg, 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, once PRN, for infusion reaction, Starting when released, Until Discontinued
	Administer over 5 minutes.		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued