NHSL Guidelines
Administration: Intravenous infusion
Dose: Dose and dose frequency varies depending on condition being treated.
Time to response: Up to 6 weeks
Indications:
- Vasculitis.
- Severe Systemic Lupus Erythematosis and Other Connective Tissue Diseases.
Contraindications:
- Pregnancy & breast feeding.
- Active infection.
- Haemorrhagic cystitis.
Cautions: Impaired liver function & moderate/severe renal impairment.
Monitoring:
- FBC, U&E, LFT, ESR, CRP will be checked prior to infusion.
- Please check FBC 10 days post infusion.
Vaccinations:
- Avoid live attenuated vaccines.
- Offer annual influenza vaccination.
- In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
- Assuming no contraindications before starting treatment:
- Patients >50 should undergo vaccination against HZV.
- Those who are varicella zoster negative should be offered varicella vaccination.
Ensure:
- Adequate contraception whilst on CYCLOPHOSPHAMIDE and for 3 months after stopping it.
- Young patients are aware of infertility risk.
In the event of:
- Nausea – give anti-emetics.
- Sore throat/fever/bruising/pallor – check FBC.
- Infection – CYCLOPHOSPHAMIDE infusion will be withheld.
- New haematuria unrelated to underlying rheumatic disease – discuss with urology.
- Increasing dyspnoea –arrange CXR.
Please inform the rheumatology department if:
- WBC < 3.5 x109/L
- Neutrophils < 2.0 x 109/l
- Platelets < 100 x 109/l