Infusions

Our center focuses on treatments for MS and other immune disorders. Our expert clinical team includes physicians, physician assistants, nurses, and medical assistants. The center was designed specifically with patient needs in mind. We recently underwent a renovation and we are now located in room 815. Large windows allow bright natural light. We now have large comfortable reclining infusion chairs. Receiving IV treatment will never be fun, but at the Infusion Center we strive to make it as convenient and stress-free as possible. The Infusion Center also offers room for one family member or friend. Please refrain from bringing any child under age 16 into our infusion center as we are protecting their safety. The Infusion Center also offers Wifi for your electronic device. Outlets are available if you require electricity for your device. If you are experiencing any change in your condition such as weakness, confusion, speech change, visual change, or any symptoms of an infection, we ask that you contact us before coming in, so we can decide if your treatment schedule should be adjusted. Anytime you are scheduled for an infusion, we ask that you first check in at the front registration desk (Room 810) where you will be provided with labels required for your infusion.


Infusion Medications


Tysabri

What is Tysabri and how do I get started?

Tysabri is a medication approved to help control MS. Once the doctor and you decide that Tysabri is the right treatment for you, you will sign the Tysabri start form and a UPMC consent. You should allow approximately 4-6 weeks for approval of the medication by your insurance, delivery of the medication to our office, and scheduling of your first infusion.

How is this medication given?

Tysabri is given intravenously (IV, in your vein through a catheter) in our infusion center every 4 to 5 weeks. Due to the possibility of allergic reactions and a mandated risk management program called TOUCH, Tysabri is never given at home. Tysabri is only to be administered by infusion centers that are certified to give this agent.

Where do I get the medication?

The medication is dispensed from a specialty pharmacy and shipped directly to our center. You will never have to worry about transporting it. The infusion nurses will arrange for the delivery of medicine from your pharmacy but you may need to give permission to the pharmacy to dispense it. Often this is required so that you can first pay your copayment to your pharmacy.

How will I be able to afford Tysabri?

Although there are several costs in our center associated with Tysabri (medication and infusion charges), there are also opportunities for financial assistance available which are provided by BIOGEN. These include copay assistance, infusion assistance, free drug programs, and charitable organizations, which provide additional funding. Please do not be embarrassed to ask for assistance as we find many people are eligible for some assistance. Call BIOGEN directly at 1800-456-2255 to see if you may qualify. Many patients in our center do qualify for this assistance program as the financial qualifications are very generous.

What happens when I come for treatment?

When you come in for your infusion, we will first check your vital signs (blood pressure, pulse, and temperature). The nurse will ask a series of questions to determine whether your infusion should be given as scheduled. It is essential to let our nurses know if you have experienced any worsening of your neurologic symptoms or function since your last visit. A change in your medical condition may necessitate a visit with the doctor or physician assistant. We ask if you have experienced a change in your condition that you preschedule an appointment on the day of your visit or on a day prior to your next infusion visit. Once you are medically cleared and ready for treatment, we then place your IV and prepare your medicine, which will be administered through an IV pump. The typical infusion lasts for one hour. When your infusion is finished, we will again check your vital signs. For your first six infusions, you will be required to remain in the infusion center for an additional hour for observation (you will need to be here at least 2 hours) to ensure that side effects such as allergic reactions do not occur. If you are symptom free after later treatments, beginning with dose number 7, you may leave after your 1 hour infusion is complete. We will remove the catheter from your vein prior to your departure and arrange for your appointment for the following month.

What are the most common side effects of Tysabri?

Generally, Tysabri is a well-tolerated medication with few side effects. Some people mention that they feel slightly more tired than usual for a day or two following their infusion while others report feeling more energetic. Additional side effects can include headache, urinary tract and/or lung infection, pain in arms and/or legs, and hives. There are other side effects associated with PML (see Tysabri education booklet).

What about PML?

PML or progressive multifocal leukoencephalopathy is an infection of the brain by a virus known as the JC virus or the John Cunningham virus. Many people carry this virus without having any difficulty. However, once an individual's immune system is already impaired as a result of an illness or immunosuppressive medication, the virus becomes activated. When the virus reaches the brain, it attacks the brain's white matter as well as the cells that create myelin, a coating that covers and shields nerve cells. This infection can be highly debilitating and possibly fatal. Before and while you're on Tysabri we will check your blood every 6 months to see if you carry this virus. If you carry this virus, you have an increased risk of getting this brain infection. Your risk of this infection is also higher if you have previously received immunosuppressive medicines such as chemotherapeutic drugs like cyclophosphamide (Cytoxan), methotrexate, Imuran (azathioprine), mycophenolate mofetil (CellCept), Fingolimod (Gilenya), teriflunomide (Aubagio), or others. The risk of this infection is also considered higher in patients who have received a medicine for more than a year and a half. Please review the information given to you prior to starting Tysabri and address any concerns you have about PML with our nurses or doctors.

Should I still receive Tysabri if I am sick?

Because Tysabri is a medication that suppresses parts of your immune system, we ask that you please call us to reschedule your infusion appointment if you are not feeling well or have any indication of a possible infection. Some indications of possible infection include elevated temperature, symptoms of a bladder infection (cloudy or foul smelling urine or pain with urination), diarrhea, vomiting, cough, and/or nasal congestion. If you are not sure if you should cancel your infusion due to how you are feeling, please call us at (412) 692-4331 or alert us though MyUPMC, if possible at least 24-48 hours before your infusion.

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IVIG

What is IVIG and when might it be used?

IVIG stands for intravenous immune globulin and is made by combining antibodies which have been removed from the blood of multiple human donors. IVIG works to help control the immune system of people with a variety of autoimmune diseases. It is FDA-approved for some neurologic disorders including Guillain-Barre syndrome and chronic inflammatory demyelinating polyradiculopathy (CIDP). IVIG is also sometimes used “off label” for other conditions, including MS.

Where do I get the medication?

The medication is dispensed from a specialty pharmacy and delivered directly to our infusion center. You will never have to worry about transporting it. The infusion nurses will arrange for the delivery of medicine but you may need to give permission to the pharmacy so they will dispense it. You may be required to pay for a portion of the medication (copayment) before it can be shipped to our center.

How is this medication given?

IVIG is given intravenously in the infusion center. The frequency of infusions is based on your doctor’s order. The dosage and scheduling of treatment varies from patient to patient and is dependent on body weight and the diagnosis being treated. When this medication is used for treatment of MS, it is typically given every 4 to 5 weeks and takes between 2 and 3 hours for administration of each dose. If IVIG is used for treatment of other neurological conditions, it may be ordered for up to 4 consecutive days each month and treatments last for up to 5 hours.

How do I prepare for my treatment?

Since the dose of this medication is often based on your body weight, please let us know before your arrival if you've had a significant change in your weight. Because this medication affects the immune system, please contact us about rescheduling if you are having any signs of infection, such as fever. We find it is best for patients to arrive having consumed their normal meals and hydrated. Drinking extra fluids may allow your body to better handle the protein load that occurs with administration of this medicine. Because we give medication (to help people tolerate this medicine) that may cause drowsiness, it will be necessary for you to have another person drive you home following your treatment.

What happens when I come for treatment?

When you come in for your infusion, we will check your blood pressure, pulse, and temperature. A catheter will be placed in your vein. We will then give you medications before we start your infusion, typically diphenhydramine (Benadryl), ibuprofen (Motrin), and/or acetaminophen (Tylenol). These medications are given to decrease potential side effects that may occur during the infusion. Your infusion will be started at a slow rate and increased if you are tolerating it adequately. We will monitor your blood pressure and pulse periodically as you receive your infusion. When your infusion is finished, we will remove the catheter from your vein and arrange for your next appointment.

What are the most common side effects of IVIG?

Generally, IVIG is a well-tolerated medication. The medications taken before your infusion (mentioned above) often lessen or prevent side effects. Should you develop side effects, we will either decrease the rate of infusion or stop the infusion. Examples of some adverse effects which may occur include headache, flushing, chills, nausea, back pain, and joint pains. Some patients may experience rashes following IVIG administration. Neck stiffness and headache associated with aseptic (not infectious) meningitis may also occur. The amount of fluid and protein given with these treatments can be large in patients with significant heart or lung disease and may require special cautions. Please let us know if you experience any shortness of breath during or after these treatments. Some swelling of the feet or hands may also occur. This medicine has been reported to be associated with increased risk for blood clots. Please let us and your family physician know if you experience any limb redness, swelling, or pain. The site of the intravenous catheter may become inflamed, irritated, or even infected. Please let our nurses know if you experience any difficulty with the IV site.

Can IVIG change how immunizations work for me?

Because IVIG does affect the immune system, it may prevent immunizations from working completely. If you are due for or require any vaccinations, please discuss them with your physician.

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Rituxan

What is Rituxan and when might it be used?

Rituxan (rituximab) is a medication that destroys a certain group of immune cells called B lymphocytes. It belongs to a group of medicines known as monoclonal antibodies. Rituximab was first FDA-approved for lymphoma, but it may be used for people with a variety of autoimmune conditions. There are studies of Rituxan for MS and related disorders; however, it is currently considered an “off label” use for MS and other neurologic immune disorders. Approval often requires special permission from a medical insurance company.

Where do I get the medication?

This medication is dispensed from a specialty pharmacy and mailed directly to our infusion center. The infusion nurses will arrange for the delivery of medicine, but you may need to give permission to the pharmacy before they will dispense it, as a copayment may be required.

How is this medication given?

Rituxan is given intravenously in our infusion center. The frequency of infusions varies depending on your physician’s order. The medication may be given as frequently as twice a month and then again six months later, or it may be given every 3 months. Each Rituxan infusion lasts at least 5 hours. Therefore, you should plan to be in our infusion center for at least 5 hours. You may want to bring snacks or an activity.

Rituxan authorization takes approximately 8 -12 weeks.

Thus, you will need to discuss with your provider what disease modifying medication you should be taking during this time frame.

What happens when I come for treatment?

On the day of your infusion, please check in at the front desk, Room 810, and proceed to the infusion suite with your paperwork and labels. Once seated, you will be asked questions to screen for infections or other new medical issues. We will check your blood pressure, pulse, and temperature and then place a catheter into your vein. The nurses will then give you medications before starting your treatment, typically diphenhydramine (Benadryl) and acetaminophen (Tylenol) pills and intravenous methylprednisolone (Solumedrol). Your Rituxan infusion will be started after your Solumedrol infusion. The Rituxan administration rate is initially very slow; however, if it is being adequately tolerated, the rate is increased. We will monitor your blood pressure and pulse intermittently during the infusion. During the infusion you should report any new or unusual symptoms to the nurses, particularly any itching or other symptoms of allergic reaction. When the infusion is complete, we will remove the catheter from your vein and arrange for your next appointment.

What are the most common side effects of Rituxan?

Rituxan is well-tolerated by most patients, but some common examples of side effects include infusion-related reactions with flushing, fever, chills, muscle or body aches, and headaches. You may experience hives, itching, or other allergic reactions (tell your nurse immediately). Rarely, reactions can be severe including more severe allergic reactions or blood pressure changes. Please let the nurses know immediately if you feel dizzy, weak, light-headed, or short of breath; if you are wheezing; or if you have chest pain, a new cough, irregular heartbeats, or any other new symptoms.

What are some of the risks of Rituxan?

Infusion reactions including allergic reactions are described above. Infusion reactions are usually more severe in patients being treated with Rituxan for lymphoma. These reactions, however, can be severe or even life-threatening and may involve heart or lung changes. Occasionally, severe skin or mouth reactions may occur. As Rituxan does decrease immune functions, the risk of infections is higher in patients taking Rituxan. These may include normal type infections such as urinary tract infections, bronchitis, or pneumonia as well as unusual infections related to immune suppression including shingles (zoster) and a brain infection by the JC virus called progressive multifocal leukoencephalopathy (PML). Pre-existing infections such as hepatitis B may be reactivated. Report any new health problems you experience while on this medicine to both us and your personal physician. Make sure all of your physicians are aware you are receiving Rituxan, as it does not appear on normal medication lists.

What about vaccinations or immunizations?

As Rituxan does decrease immune functions, it may impair the ability of your body to respond appropriately to immunizations. You should not receive any live vaccines while on this medicine. Please see our separate information describing immunizations and MS.

How long do the effects of Rituxan last?

The immune effects of Rituxan will last for many months and likely persist for greater than one year. We may monitor the number of B cells in your blood to help determine when your next dose may be given. Your doctor will determine the frequency and duration of necessary treatment.

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Solu-Medrol (methylprednisolone)

What is Solumedrol and why might it be given?

Solumedrol (methylprednisolone) is a potent type of steroid (corticosteroid) medication. It may be given to speed recovery from attacks of multiple sclerosis (MS) or other immune diseases. It may also be given as intermittent scheduled doses to help control MS disease activity.

How is Solumedrol given?

Solumedrol is usually given by an intravenous (IV, in the vein) and fusion. Most infusions are given over 45-60 minutes, although some patients do better with a slower infusion rate. The IV catheter may be left in place for the daily infusions. If it is normally difficult for you to have blood draws or IV infusions, please let our nurses know in advance. We often find it easier to start IVs for infusions if patients arrive well hydrated.

What happens when I come in for treatment?

When you come in for your infusion, we will first check your blood pressure, pulse, and temperature. We will place a catheter in your vein, mix the medication, and administer it. We encourage you to bring some chewing gum or hard candy as a metallic taste in the mouth is a common side effect of Solumedrol.

Are there other options instead of IV solumedrol?

Although Solumedrol is traditionally given by the IV route, there are occasional instances when the doctors may prescribe a different injectable medicine known as ACTH or oral steroid medications (either a high dose of Prednisone pills or Solumedrol that has been made into a capsule).

Will I need to take additional steroids following my IV?

After your course of Solumedrol is complete, your doctor may order oral Prednisone tablets that you will take over a course of approximately 2 weeks. If your doctor ordered prednisone after your IV therapy, the nurses will notify you and ensure that the prescription is sent to your pharmacy. It is to begin the morning after your last IV infusion.

What are the most common side effects of Solumedrol?

Corticosteroid medicines are very potent and, while they can have benefits, they may also have significant side effects. Below is a list of some of the side effects.

Mood changes- You may have mood changes while on this medication. You may feel very energetic or depressed. Excessive physical activity may not be healthy immediately following an MS exacerbation. You may also become overly optimistic and make impulsive decisions. We advise not making major financial or personal decisions while your mood is up or down from the steroids. Please call us immediately day or night for any serious mood changes, especially any thoughts of harming yourself or others.

Energy boost- Even if you get a desired energy boost, please try to not overdo physical activity. Excessive physical activity may not be healthy immediately following an MS exacerbation. Taking on large projects may increase your overall fatigue.

Insomnia- You may notice that you have difficulty falling asleep or staying asleep. Taking your medication early in the day may decrease this effect. You may use over-the-counter Benadryl (diphenhydramine) for sleep. If this is not effective, you may require prescription medication to help you sleep. Please let our nurses know if insomnia is an issue for you.

Stomach irritation- This medication can cause irritation to the stomach lining and increase production of stomach acid. Please let us know if you are having active stomach issues. Many patients benefit by using over-the-counter Zantac (ranitidine) or Pepcid (famotidine) if you are not on an acid blocking medication. If you are taking steroids by mouth, please take them with food. Let us know if significant stomach pain irritation or other symptoms develop while you're on steroids or if they developed with prior courses of steroids.

Increased appetite- This medication can stimulate your appetite, in particular, an increase in desire for carbohydrates and salty foods. To lessen weight gain, we encourage you to have healthier snacks (vegetables and fruit) and those which contain fiber to help you feel fuller longer.

Increased blood sugar- It is common for the blood sugar level to increase while on this medication. If you have diabetes, you must notify your family doctor as blood sugar levels may increase and will need to be monitored closely. If you notice clamminess of your skin, increased thirst, increase in urination, dizziness, or visual changes, please notify your medical doctor.

Water and sodium retention, blood pressure chain- Steroid medication can cause your body to retain sodium and water. You may notice some swelling in your hands and feet while on this medication and for a short period of time afterwards. Following a low salt diet (no processed foods) can limit retention. When your body retains sodium, you lose potassium. We recommend that you increase your intake of potassium-rich foods like bananas, oranges, nuts, fresh vegetables, and baked or sweet potatoes with skin.

Lower resistance to infection- Steroids can worsen an existing infection or lower your resistance to infection. We will often screen your urine for infection before treating you with steroids. If you notice any new symptoms of infection, please report these to you medical doctor and to the infusion nurses.

Skin- Steroids may temporarily cause acne, rashes, or redness. If you have to go out in the sun during this period, it is important that you use appropriate sunscreen as your skin may be more likely to sunburn.

Osteoporosis- Frequent use of steroid medications can lead to bone thinning (osteopenia or osteoporosis). Usually, this happens over a prolonged time period, but you should report any hip or shoulder pain or broken bones to us, especially if you have received several treatments with steroids for your condition. Regular intake of calcium and vitamin D as well as weight-bearing exercise may help prevent osteoporosis.

Osteonecrosis- Another condition that may arise from repeated steroid use is osteonecrosis. This is a process where the blood supply to the bones, most commonly hip bones, becomes impaired, causing the bone to degenerate. This is the reason we commonly seek to avoid repeated steroid courses unless medically necessary.

Eye problems- Steroid use may increase the risk of cataracts or aggravate glaucoma. Please keep up with regular eye exams and let us know if you experience new visual blurring. Blurred vision may also be a symptom of high blood sugar related to steroids.

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Lemtrada

Lemtrada is a medication directed at CD52, which is a protein on the surface of immune cells. It is approved by the FDA for the treatment of patients with relapsing forms of MS. Because of Lemtrada’s safety profile, the FDA recommends that this medication generally be reserved for people who have had an inadequate response to two or more MS therapies.

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Ocrevus​

What is Ocrevus and when might it be used?

Ocrevus (ocrelizumab) is a medication that destroys a certain group of immune cells called B lymphocytes, which contribute to nerve damage in MS.

Where do I get the medication?

This medication is dispensed from a specialty pharmacy and mailed directly to our infusion center. The infusion nurses will arrange for the delivery of medicine, but you may need to give permission to the pharmacy before they will dispense it, as a copayment may be required.

How is this medication given?

Ocrevus is given intravenously in our infusion center. The dosing regime is as follows: the first and second doses are 300 mg infusions two weeks apart, the next dose is 600 mg scheduled approximately 6 months later, and subsequent doses are every 6 months thereafter. Alternately, it may be given every 3 months. The frequency of infusions varies depending on your physician’s order. Each Ocrevus infusion lasts at least 5 hours. Therefore, you should plan to be in our infusion center for approximately 4 to 6 hours depending on dose and tolerance. You may want to bring snacks or an activity while you are receiving this in our infusion suite.

​Ocrevus authorizations may take 8-12 weeks because it is a new medication.

Thus, you will need to discuss with your provider what disease modifying medication you should be taking during this time frame.

What happens when I come for treatment?

On the day of your infusion, please check in at the front desk, Room 810, and proceed to the infusion suite with your paperwork and labels. Once seated, you will be asked questions to screen for infections or other new medical issues. We will check your blood pressure, pulse, and temperature and then place a catheter into your vein. The nurses will then give you medications before starting your treatment, typically diphenhydramine (Benadryl) and acetaminophen (Tylenol) pills and intravenous methylprednisolone (Solumedrol). Your Ocrevus infusion will be started after your Solumedrol infusion. The Ocrevus ;administration rate is initially very slow; however, if it is being adequately tolerated, the rate is increased. We will monitor your blood pressure and pulse intermittently during the infusion. During the infusion you should report any new or unusual symptoms to the nurses, particularly any itching or other symptoms of allergic reaction. When the infusion is complete, we will remove the catheter from your vein and arrange for your next appointment.

What are the most common side effects of Ocrevus?

The most common timeframe for reaction is during the infusion and for at least one hour after completion of the infusion. In some cases, infusion reactions can occur up to 24 hours afterwards. Ocrevus is well-tolerated by most patients, but some common examples of side effects include the following infusion-related reactions: flushing or redness of the skin; itching, rash, or urticaria (hives); bronchospasm or shortness of breath; throat irritation, pain, or edema; fever; hypotension (low blood pressure); rapid heart rate; headache; dizziness/nausea; and fatigue.

If you experience hives, itching, or other allergic reactions during or after infusion, tell your nurse immediately. Also, please let the nurses know immediately if you feel dizzy, weak, light-headed, or short of breath, or if you are wheezing, have chest pain, a new cough, irregular heartbeats, or any other new symptoms.

What are some of the risks of Ocrevus?

Infusion reactions including allergic reactions as described above. As Ocrevus does decrease immune functions, the risk of infections is higher in patients taking Ocrevus. Ocrevus is known to increase the risk for upper respiratory tract infections (URI), lower respiratory tract infections, skin infections, and herpes-related infections. This medication is not associated with increased risk of serious or life-threatening infections in MS patients. Pre-existing infections such as hepatitis B may be reactivated, so your doctor will test you for this before you receive your first infusion. Report any new health problems you experience while on this medicine to both us and your personal physician. Make sure all of your physicians are aware you are receiving Ocrevus, as it does not appear on normal medication lists.

Progressive Multifocal Leukoencephalopathy (PML) was not identified in the medication's clinical trials, and at this time, no cases of PML have been reported with patients taking Ocrevus. Your doctor will still test you for the John Cunningham virus (JC virus), as PML has been associated with other MS therapies similar to Ocrevus.

What about vaccinations or immunizations?

As Ocrevus does decrease immune functions, it may impair the ability of your body to respond appropriately to immunizations. You should NOT receive any “live vaccines” while on this medicine. Please see our separate information describing immunizations and MS.

How long do the effects of Ocrevus last?

Typically, the first infusion and second infusion are separated by 2 weeks, then the next infusion will be at 6 months. Regular infusions will take place every 5-6 months. The immune effects of Ocrevus will last for many months and will likely persist for greater than one year. We may monitor the number of B cells in your blood to help determine when your next dose may be given. Your doctor will determine the frequency and duration of necessary treatment.

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