Lupus Infusion Therapy Everyone Must To Know About

In 1994, Dr. Stephen Paget, then Chief of Medicine at the Hospital for Special Surgery (HSS), created an Infusion Unit for people with Rheumatologic disorders. The infusion unit at HSS was the first in the country dedicated specifically to the care of people with Rheumatology related autoimmune mediated disorders and opened long before intravenous medications for lupus and arthritis were developed. A few years later, the field exploded with a variety of medications for arthritis, lupus and all Rheumatologic illnesses. In the ensuing years the “off label” use of biologic agents increased.In a presentation to the SLE workshop at HSS, Linda Leff, MPA, RN-BC, gave an overview of those drugs most frequently administered on the lupus infusion therapy unit to patients with lupus.

Medications for Lupus

Intravenous Medications for Lupus: Lupus infusion therapy refers to all medications that are administered intravenously, that is, through the vein or by IV.  These medications are generally administered in an infusion unit. Whenever an IV medication is prescribed, patients should discuss with their doctor the timing of treatment and how to prepare for administration. Precautions must be taken for all infusion medications. The patient must be in good health with no active infections. Infusion medications should not be administered prior to, or directly after, surgery including oral/dental surgery. Any procedures such as a colonoscopy that may lead to a biopsy also warrant postponement of infusion.

Side effects of Lupus Medications: One of the possible side effects of Solu-medrol is an increase in blood pressure. Patients should be sure to keep taking their blood pressure medication when receiving Solu-medrol by Lupus Infusion Therapy. Another side effect is a temporary increase in blood sugar. Unfortunately, steroids can also induce cravings for sugar and salt. Patients with diabetes must be especially vigilant about their sugar intake and all patients should be educated to watch their salt intake. In addition, steroids can cause weight gain and bloating. Intravenous steroids can cause patients to retain salt and fluid, leading to a gain of three to five pounds during a 3-5 day course of treatment. The increase in salt will also increase joint pain in patients for whom this is already an issue.

Side Effects of Cytoxan: Because Cytoxan may cause nausea and vomiting, medications such as Zofran (ondansetron) and Kytril (granistron) may be administered to control these side effects. To address complaints of “not feeling well” or not having an appetite, Ms. Leff recommends following a bland diet while receiving Cytoxan. Patients may also experience delayed nausea two days after receiving an infusion. If this occurs, patients should notify their doctor and who may change their protocol by adding steroids, along with their other anti-nausea medications. Patients will often experience fatigue two days after their infusion leading many to schedule their infusions on a Thursday or Friday in order to give themselves the weekend to recuperate.

The first Lupus Infusion Therapy lasts five hours and is titrated starting at a low rate with an increase every half hour. If a patient reacts well to the first infusion, the second infusion will begin at a higher rate and the infusion will take four hours. While on Rituxan, patients should not receive live vaccines.

Side Effects of Rituxan: Patients may experience mild to severe infusion reactions such as chills, itching, high temperature, hives, difficulty breathing, and chest pain. If patients experience any symptoms during the Lupus Infusion Therapy, it is very important to let the nurse know immediately.If a patient has a very strong reaction they may need to discontinue the infusion. Patients may not feel an improvement for the first 4 to 6 weeks after their second infusion of Rituxan, but this does not mean that the medication is not going to work. After their infusion, patients may experience fatigue, increased joint pain, and headaches; they are also at increased risk of infections. Patients on Rituxan are especially prone to sinus infections.

Side effects of Benlysta: The side effects for Benlysta include: headaches; stomach complaints such as nausea, diarrhea and pain; trouble sleeping; pain in extremities; inflammation in the nose and throat, which may feel like getting a cold; low white blood cell counts; and insomnia. The length of infusion varies significantly (anywhere from 2 to 10 hours) and is based on the dosage (total grams) and rate, as well as how the patient reacts to the infusion. The infusion rate begins slowly and is titrated (measured and adjusted) on an individual basis.

Side Effects of Intravenous Immune Globulin: Patients may experience infusion-related reactions to IVIG including: headaches, chills, fevers, shortness of breath, and chest pain. If any of these reactions occur, the rate of the infusion is lowered to lessen the effects. Other complaints or side effects are gastrointestinal upset and nausea. Patients may experience aseptic meningitis syndrome, which is a non-infectious inflammation of the meninges (membranes that line the brain and spinal cord) that causes headaches and a stiff neck, but this will go away with increasing fluid intake, rest and Tylenol.Source

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