Download Protocol for administration of Infliximab as a treatment in uveitis

Protocol for administration of Infliximab as a treatment in
uveitis
Pre-treatment Investigations
Prior to administration of the first infusion, the following
investigations should be performed:

Medical history to exclude TB

CRP, U+E, LFTs

ESR, FBC

dsDNA

Urinary pregnancy test as appropriate

CXR to exclude active TB
Mantoux testing is not helpful. False positive results may be
obtained in those previously vaccinated and false negatives may
also occur.
Administration and monitoring of Infliximab treatment
Dosage

5mg/kg of body weight as a single intravenous infusion.

Dosage may be repeated at 2 and 6 weeks following first
infusion, and then 6 weekly as required thereafter.
1
Reconstitution, dilution and administration
1. Calculate the dose required according to the patient’s body
weight (5mg/kg):

Weight =

Total dose required =

Volume of reconstituted solution required =

(Doses should be rounded up or down to nearest 5mg)

(Each reconstituted vial contains 100mg in 10ml ie 10mg/ml)
kg
mg
ml
2. Reconstitution of powder

Each vial should be reconstituted with 10ml for injectionsusing 21 gauge or smaller needle.

Remove flip-top from each vial and wipe with 70% alcohol
wipe.

Insert needle through centre of rubber stopper and direct
stream of water onto glass wall of vial.

Swirl the vial to dissolve the powder- DO NOT SHAKE.

If foaming of the solution occurs, allow to stand for 5 minutes.

The solution should be colourless/light yellow and opalescent.

As infliximab is a protein, the solution may contain a few fine
translucent particles.

Do not use the solution if it is discoloured or contains opaque
or other foreign particles.
3. Dilution

Dilute the solution to a total volume of 250ml with NaCl 0.9%
w/v infusion solution ie withdrawn from the bag a volume
equivalent to the total volume of reconstituted solution to be
added.

Add the reconstituted solution slowly to the infusion bag,
gently mix
and
inspect
the
solution
for
particulate
contamination.

Any remaining solution should be discarded.
2
4. Administration

Infuse over a period of not less than 2 hours (ie not more than
2ml/minute) using an infusion set with an inline filter pore size
of 1.2 micrometer or less).

The infusion rate should be calculated by counting the drip
rate and not controlled by the use of an infusion pump.
DO NOT USE PUMP AS TUBING IS NOT DEFORMABLE
5. The infusion must be started within 3 hours of reconstitution of
the powder and must not be given concomitantly in the same
intravenous line with other agents.
3
Monitoring of Treatment

The patient should be given the Patient Information Leaflet
and asked to report any adverse effects that may occur during
or in the 2 hours after completion of the infusion.

The patient should be made aware of the possibility of delayed
adverse reactions and should be advised to report any
symptoms which may give them cause for concern.

The risk of development of hypersensitivity reactions may be
greater with second and subsequent treatments.
Supervision of Infusions and Routine Observations

The first infusion must be supervised by a doctor at the
patient’s bedside for the first 15 minutes of treatment.

Temperature, pulse and blood pressure should be checked
prior to commencing each infusion and monitored every 15
minutes for the first hour of treatment.

These observations should be continued every 30 minutes for
the remaining duration of the infusion and for 2 hours after
completion. A doctor must be available for immediate
assistance should any infusion reaction develop.

Emergency resuscitation equipment and appropriate drug
treatment should be immediately available.

The rate of infusion may be reduced or the infusion
temporarily stopped should the patient experience any milder
adverse reactions such as nausea and vomiting, headache and
mild abdominal pain.
Post-treatment follow-up

Patients should be followed up after each treatment.

At each follow up visit, the patient’s U+E, FBC, CRP, ESR
and LFTs should be rechecked.
4