USTEKINUMAB (STELARA) SUBCUTANEOUS INJECTION FOR PSORIASIS		version 4/7/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Appointment requests for initial doses.	Every 4 weeks	S	2 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment requests for initial doses.		
	☑	Referral to IV Infusion Room Appointment requests for subsequent doses.	Every 12 weeks	S+112	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment requests for subsequent doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		Normal, Clinic Collect
	Labs to be drawn at Physicians office unless otherwise noted: for first 3 visits on new starts then every 4 months.		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		Normal, Clinic Collect
	Labs to be drawn at Physicians office unless otherwise noted: for first 3 visits on new starts then every 4 months.		
	☐	Sedimentation rate	Every visit	S	Until discont'd	
		Normal, Clinic Collect
	Labs to be drawn at Physicians office unless otherwise noted: for first 3 visits on new starts then every 4 months.		
	☐	C-reactive protein	Every visit	S	Until discont'd	
		Normal, Clinic Collect
	Labs to be drawn at Physicians office unless otherwise noted: for first 3 visits on new starts then every 4 months.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Obtain vitals prior to injection and then every 15 minutes for 30 minutes.  Instruct patient to report symptoms of chills, fever, or pain.		

Weight Less Than or Equal to 100 kg 	

	
	Interval	Defer Until	Duration	
	☐	ustekinumab (STELARA) injection 45 mg	Every 4 weeks	S	2 treatments	
		45 mg, subcutaneous, once, Starting when released
	Administer by subcutaneous injection into the top of the thigh, abdomen, upper arms, or buttocks. Rotate sites. Do not inject into tender, bruised, erythematous, or indurated skin. Avoid areas of skin where psoriasis is present. Discard any unused portion.		
	☐	ustekinumab (STELARA) injection 45 mg	Every 12 weeks	S+112	Until discont'd	
		45 mg, subcutaneous
	Administer by subcutaneous injection into the top of the thigh, abdomen, upper arms, or buttocks. Rotate sites. Do not inject into tender, bruised, erythematous, or indurated skin. Avoid areas of skin where psoriasis is present. Discard any unused portion.		

Weight Greater Than 100 kg 	

	
	Interval	Defer Until	Duration	
	☐	ustekinumab (STELARA) injection 90 mg	Every 4 weeks	S	2 treatments	
		90 mg, subcutaneous, once, Starting when released
	Administer by subcutaneous injection into the top of the thigh, abdomen, upper arms, or buttocks. Rotate sites. Do not inject into tender, bruised, erythematous, or indurated skin. Avoid areas of skin where psoriasis is present. Discard any unused portion.		
	☐	ustekinumab (STELARA) injection 90 mg	Every 12 weeks	S+112	Until discont'd	
		90 mg, subcutaneous, once, Starting when released
	Administer by subcutaneous injection into the top of the thigh, abdomen, upper arms, or buttocks. Rotate sites. Do not inject into tender, bruised, erythematous, or indurated skin. Avoid areas of skin where psoriasis is present. Discard any unused portion.		

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, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, 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, for 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