GOLIMUMAB (SIMPONI ARIA) INFUSION		version 2/27/2025		

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 8 weeks	S+83	 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	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Sedimentation rate	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C-reactive protein	Every visit	S	Until discont'd	
		STAT, 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		
	☐	Nursing communication: Review lab results for Hep B, Hep C, and TB	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of infusion reaction. For MINOR INFUSION REACTIONS: fever, chills, pruritis, urticaria, chest pain, mild hypotension, hypertension, or mild dyspnea. Take the following steps: Stop or SLOW infusion rate by 50%. If symptoms do not resolve within 5-10 minutes, give supportive/emergency medications as ordered, and notify MD. When symptoms resolve, restart medication at 25% of the original rate. After 15-30 minutes gently increase rate and monitor closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of infusion reaction. For SEVERE INFUSION REACTIONS: severe dyspnea, wheezing, stridor, angioedema, or marked hypotension, Take the following steps: STOP INFUSION, and start Normal Saline IV bolus (as ordered), Notify physician and administer emergency medications (as ordered). Monitor vital signs. Consult physician for further orders.		
	☐	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		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 500 mg	Every visit	S	Until discont'd	
		500 mg, oral, once, Starting when released
	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, once, Starting when released		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	golimumab (SIMPONI ARIA) 2 mg/kg in sodium chloride 0.9% 100 mL IVPB	Every 4 weeks	S	2 treatments	
		2 mg/kg, intravenous, Administer over: 30 Minutes, once, Starting 30 minutes after treatment start time
	Use an infusion set with an in-line, sterile, non-pyrogenic filter (0.22 micrometer or less). Do not infuse other agents in the same IV line. Administer on Week 0 and 4.
	only Simponi Aria formulation may be administered intravenously		
	☐	golimumab (SIMPONI ARIA) 2 mg/kg in sodium chloride 0.9% 100 mL IVPB	Every 8 weeks	S+83	Until discont'd	
		2 mg/kg, intravenous, Administer over: 30 Minutes, once, Starting 30 minutes after treatment start time
	Use an infusion set with an in-line, sterile, non-pyrogenic filter (0.22 micrometer or less). Do not infuse other agents in the same IV line. Administer on Week 12 and every 8 weeks thereafter.
	only Simponi Aria formulation may be administered intravenously		

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