BENRALIZUMAB (FASENRA) SQ EVERY 8 WEEKS (MAINTENANCE)		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 8 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Immunoglobulin E	Every 8 weeks	S	Until discont'd	
		Routine, Normal, Clinic Collect
	Serum		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Monitor	Every 8 weeks	S	Until discont'd	
		Clinic Performed, Normal
	For signs and symptoms of infection		
	☐	Nursing communication	Every 8 weeks	S	Until discont'd	
		Have patient report immediately regarding dizziness, passing out, or difficulty breathing.		
	☐	Patient education	Every 8 weeks	S	Until discont'd	
		Clinic Performed, Normal
	Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Ask patient to consult prescriber for additional questions.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Every 8 weeks	S	Until discont'd	
		Administer after three (3) every 4 week doses of benralizumab.		
	☐	benralizumab (FASENRA) injection (RESTRICTED) 30 mg	Every 8 weeks	S	Until discont'd	
		30 mg, subcutaneous, once, Starting when released
	Every 8 weeks for maintenance.  Administered subcutaneous injection by a healthcare professional at upper arm, thigh, or abdomen. Monitor patient for anaphylaxis, angioedema, urticaria, and rash for 2 hours following administration. Warm medication at room temperature for 30 minutes prior to administration. The solution should be clear to opalescent, colorless to slightly yellow solution.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	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	Every visit	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	Every visit	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	Every visit	S	Until discont'd	
		0.5 mg, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Every visit	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	Every visit	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	Every visit	S	Until discont'd	
		250 mL, intravenous, once PRN, for Hydration, Starting when released, Until Discontinued