Step 1: Inquire for contraindications (known hypersensitivity to mouse proteins or other components of the product). Stop if present.
Step 2: Weigh the patient and calculate the dose at 5 mg/kg. Prepare the infusion solution with a final volume of 250 mL.
Step 3: Start an IV with a "Y" connection between isotonic saline and the infliximab solution.
Step 4: Give premedication.
(4a) If this is the first infusion, then no premedication is usually needed.
(4b) If the patient has received a previous infusion without reaction, then consider one of the following:
(4b1) diphenhydramine 25-50 mg po or IV
(4b2) acetaminophen 650 mg po
(4c) If the patient has had a reaction to a previous infusion, then give one or more of the following:
(4c1) diphenhydramine 25-50 mg po or IV
(4c2) acetaminophen 650 mg po
(4c3) prednisone 40 mg po or methylprednisone 100 mg IV
Step 5: Start infusing the infliximab solution and monitor the patient every 15 minutes. The infusion should be stopped if significant symptoms develop.
Infusion rate titration schedule:
(a) 10 mL/hr over 15 minutes (2.5 mL)
(b) 20 mL/hr over 15 minutes (5.0 mL)
(c) 40 mL/hr over 15 minutes (10 mL)
(d) 80 mL/hr over 15 minutes (20 mL)
(e) 150 mL/hr over 30 minutes (75 mL)
(f) 250 mL/hr over 33 minutes (137.5 mL) for total 250 mL
An alternative approach is to administer the infliximab solution as a slow infusion of 2 mL per minute.
Step 6: Monitor vital signs for 30 minutes after the infusion is completed. Ask the patient if there are any symptoms to note.
