OCRELIZUMAB (OCREVUS) 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	2 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 request for subsequent doses.	Every 180 days	S+180	 treatments	
		Status: Future, Expected: S, Expires: S+365
	Urgency of Scheduling: Routine
	Appointment request for subsequent doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Hepatitis B surface antigen	Once	S	1 treatment	
		Routine, Normal, Clinic Collect		
	☐	Hepatitis B core antibody total	Once	S	1 treatment	
		Routine, 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		
	☐	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	
		Monitor for infusion reactions during infusion and observe for at least one hour after infusion is complete. If infusion reaction occurs, interrupt infusion, discontinue or decrease the rate, depending on the severity of the reaction.		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Administer 30 to 60 minutes prior to infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 100 mg	Every visit	S	Until discont'd	
		100 mg, intravenous, once, Starting when released
	Administer 30 minutes prior to infusion.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Administer 30 to 60 minutes prior to 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	
	☐	ocrelizumab (OCREVUS) 300 mg in sodium chloride 0.9% 250 mL IVPB (RESTRICTED)	Every 2 weeks	S	2 treatments	
		300 mg, intravenous, once, Starting when released
	Initiate at 30 mL per hour, and increase by an additional 30 mL/hour every 30 minutes if previous rate tolerated.  Maximum rate: 180 mL/hr
	
	Use a dedicated line with an infusion set containing a 0.2 or 0.22 micron filter.
	
	Observe patients throughout the infusion and 1 hour post-infusion. If mild to moderate infusion-related reactions occurs, reduce infusion rate by half. If severe infusion related reactions occur then interrupt infusion, provide appropriate supportive care and once symptoms resolved resume at half the initial infusion rate. If no improvement in symptoms or serious or life-threatening infusion-related reaction occurs, discontinue infusion permanently.
	
	Send infusion set with 0.2 of 0.22 micron filter from Pharmacy.		
	☐	ocrelizumab (OCREVUS) 600 mg in sodium chloride 0.9% 500 mL IVPB (RESTRICTED)	Every 180 days	S+180	 treatments	
		600 mg, intravenous, once, Starting when released
	Initiate at 40 mL per hour, and increase by an additional 40 mL/hour every 30 minutes if previous rate tolerated.  Maximum rate: 200 mL/hr
	
	Use a dedicated line with an infusion set containing a 0.2 or 0.22 micron filter.
	
	Observe patients throughout the infusion and 1 hour post-infusion. If mild to moderate infusion-related reactions occurs, reduce infusion rate by half. If severe infusion related reactions occur then interrupt infusion, provide appropriate supportive care and once symptoms resolved resume at half the initial infusion rate. If no improvement in symptoms or serious or life-threatening infusion-related reaction occurs, discontinue infusion permanently.
	
	Send infusion set with 0.2 of 0.22 micron filter from Pharmacy.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		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	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, Minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, Severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	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		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued		
	☐	meperidine (DEMEROL) injection (RESTRICTED) 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Formulary approved non-pain management indication(s) : Drug-induced rigors