MIRIKIZUMAB (OMVOH) FOR ULCERATIVE COLITIS – FOR CLINIC USE ONLY		version 8/17/2026		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Urgency of Scheduling: Routine Appointment requests for induction doses.	1 time a week	S	4 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment requests for induction doses.		
	☑	Referral to IV Infusion Room Urgency of Scheduling: Routine Appointment requests for maintenance doses.	Every 2 weeks	S+28	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment requests for maintenance doses.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Hepatic function panel	Once	S	1 treatment	
		Routine, Normal, Clinic Collect
	Prior to initiation of therapy.		
	☐	Hepatic function panel	Day 1 of every 3 months	S	 treatments	
		Routine, Normal, Clinic Collect
	For at least 24 weeks of treatment, then, as needed.		
	☐	Bilirubin, total and direct	Once	S	1 treatment	
		Routine, Normal, Clinic Collect
	Prior to initiation of therapy.		
	☐	TB Skin Test	Once	S	1 treatment	
		Evaluate for Tuberculosis (TB Infection). 
	Prior to initiation of therapy.		

Treatment Conditions 	

	
	Interval	Defer Until	Duration	
	☐	Treatment conditions	1 time a week	S	 treatments	
		For Ulcerative Colitis:
	Induction IV: 300mg at weeks 0,4, and 8.
	 
	Maintenance: Note Transition to maintenance dose in patients who respond to induction dose; continued dosing is based on clinical endpoints.
	 
	Subcutaneous: 200mg at week 12, then every 4 weeks thereafter.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Day 1 of every 1 month	S	 treatments	
		Monitor for signs and symptoms of TB disease for entire duration of treatment.		
	☐	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	
		At start of infusion: obtain vital signs every 15 minutes x 4, then every 30 minutes.		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for any signs of infusion reaction.  For MINOR INFUSION REACTIONS (fever, chills, pruritis, uticaria, chest pain, mild hypotension, hypertension, or mild dyspnea) stop or slow infusion rate by 50%. If symptoms do not resolve within 5-10 minutes give Benadryl as ordered. Notify MD if symptoms do not resolve within 5-10 minutes. With MD approval, give Solu-medrol as ordered. When symptoms resolve, restart medication at 25% of the original rate. After 15-30 minutes gently increase rate and monitor patient closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	Until discont'd	
		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, Notify physician and administer Benadryl as ordered, Monitor vital signs, Administer  Epinephrine as ordered. Consult MD 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		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once, Starting when released
	ONLY IF PATIENT HAS PORTACATH: Flush portacath before removing needle from portacath.		
	☐	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	
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Once	S	1 treatment	
		25 mg, intravenous, Starting when released
	Or PO		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	Once	S	1 treatment	
		25 mg, oral, Starting when released
	Or IV		
	☐	acetaminophen (TYLENOL) tablet 650 mg	Once	S	1 treatment	
		650 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).		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Once	S	1 treatment	
		40 mg, intravenous, once, Starting when released		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	mirikizumab-mrkz (Omvoh) 300 mg in sodium chloride 0.9% 250 mL (1.2 mg/mL) IVPB	Every 4 weeks	S	3 treatments	
		300 mg, intravenous, Administer over: 30 Minutes, once, Starting when released
	Do not mix or infuse with other medications. At the end of the infusion, flush the line with NS or D5W. Solution should be clear to opalescent, colorless to slightly yellow/brown and free of visible particles; do not use if cloudy or particles are visible.		

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).		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for mild to moderate 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		
	☐	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		
	☐	ondansetron (ZOFRAN) IV 4 mg	PRN	S	Until discont'd	
		4 mg, intravenous, once PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	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