Upon arrival
Our expert clinical team includes physicians, physician assistants, nurses, and medical assistants. The infusion center is located in Magee-Womens Hospital in Suite 4500, down the hall from the clinic exam rooms. The center focuses on intravenous treatments for MS and other neurological immune disease. Patients arriving for infusions should first check-in at the front registration desk. One of our infusion nurses will then meet you in the waiting room to direct you back to the infusion area. The nurse will verify your name and date of birth before applying an ID band to your wrist. This will ensure correct identification and medication administration. Parking violation is available from the front desk or in our Infusion Center.
If you are experiencing any change in your condition such as weakness, confusion, speech changes, visual changes, or any symptoms of an infection, we ask that you contact us before coming to your appointment, as your treatment may need to be rescheduled.
Please let us know in advance if your insurance changes so that we can reapply for infusion authorization for you. If your insurance changes and we do not know about it ahead of time, your infusion will need to be rescheduled.
Amenities
Receiving IV treatment will never be fun, but at our outpatient Infusion Center, we strive to make it as convenient and stress-free as possible. The center was designed specifically with patient needs in mind. Large windows allow bright natural light, and the room infusion chairs recline for your comfort. There is a small selection of beverages and snacks available for patients, but feel free to bring your own food to enjoy during your infusion. There are two handicap-accessible restrooms in the immediate vicinity. The Infusion Center also offers room for one family member or friend; additional visitors can wait in the MS Clinic waiting room, the cafeteria, or hospital lobby. Wi-Fi and power outlets are available for your electronic device.
*Note: Due to concerns of other patients, staff and per UPMC policy, we will allow service pets only in the infusion room. We will not allow emotional support pets into infusion (neither for clinical nor research patients).
To protect their safety, we cannot allow any child under the age of 16 into the Infusion Center.
Infusion Medications
Tysabri
What is Tysabri and how do I get started?
Prior to this medication you will be required to obtain “prestaging labs” to better estimate your potential risks of this or other medications.
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 both 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 your medication to our office, and scheduling of your first infusion. The TOUCH Program is a required risk management program for Tysabri and you will be enrolled.
How is this medication given?
Tysabri is given intravenously (IV, in your vein through a catheter) in our Infusion Center every 4 to 8weeks with each infusion lasting about 1 hourDue to the possibility of allergic reactions, Tysabri is never given at home or other infusion sites. Tysabri is administered only infusion centers that are certified to give this medication.
Where do I get the medication?
The medication is dispensed from Magee Pharmacy. When you arrive, the nurse will ask you a series of questions. If you are cleared to receive the medication, the nurse will request it from the pharmacy. The pharmacy will then deliver the Tysabri to the Infusion Center.
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 through BIOGEN. These include copay assistance, infusion assistance, free drug programs, and charitable organizations that 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 1-800-456-2255 to see if you may qualify. As the financial qualifications are very generous, many patients in our center do qualify for these assistance programs.
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 symptoms of your neurologic symptoms or function since your last visit. We will ask you to read the Tysabri Medication Guide, which is always available in the Infusion Center to review. A change in your medical condition may necessitate a visit with the doctor or Advanced Practice Provider. We ask if you have experienced a change in your condition that you pre-schedule 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 an IV catheter and request your medication from the pharmacy. The Tysabri will be administered through an IV pump. The typical infusion lasts for one hour. When your infusion is finished, we will check your vital signs again. 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 the seventh Tysabri infusion, you may leave after the infusion is complete. We will remove the catheter from your vein prior to your departure and arrange for your next infusion appointment.
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 upper respiratory infection, pain in arms and/or legs, and hives. There is a potential risk associated with PML (see Tysabri education booklet).
What about PML?
Progressive multifocal leukoencephalopathy (PML) is an infection of the brain by a virus known as the John Cunningham (JC) virus. Many people carry this virus without having any difficulty. However, once an individual's immune system is impaired because of an illness or immunosuppressive medication, the virus can become activated. If the virus proliferates in the 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.
To monitor this risk your provider will check your JC virus index before your infusion and every 6 months. If you remain JC virus negative, we will recheck this lab about every 6 months. Your initial MRI will be 6 months after the start of this therapy, then, usually yearly.
IF you are JC virus positive, your provider will discuss risk mediation possibilities including increasing the interval between your infusions, more frequent lab work and/or more frequent MRI studies vs discussing a change in therapy.
Your risk of PML infection is also higher if you have previously received immunosuppressive medicines such as chemotherapeutic drugs like ocrelizumab (Ocrevus), rituximab (Rituxan), ofatumumab (Kesimpta), cyclophosphamide (Cytoxan), methotrexate, azathioprine (Imuran), mycophenolate mofetil (CellCept), fingolimod (Gilenya), teriflunomide (Aubagio), or others. The risk of PML infection is also considered higher in patients who have received Tysabri 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.
“Rebound” risk with Tysabri:
When changing medication therapy from Tysabri (or any disease modifying medication in Multiple Sclerosis) patients are at risk of “relapse” (a new neurological deficit or worsening of established deficits >24 hours) usually related to a new or enlarging demyelinating lesion. This is an increased risk when stopping Tysabri OR if delaying Tysabri infusion greater than 8 weeks, and in some cases, rebound can be significant. The rate of rebound is not truly known; however, this risk is increased with in the first 6 months for stopping therapy. Your provider will discuss the reasons for discontinuing this medication and the risks/benefits associated with this recommendation. You are to contact our office with any new or worsening symptoms or any questions or concerns. There are treatment options available for rebound, however, response to treatment varies.
IVIG
What is IVIG and when might it be used?
Prior to this medication you will be required to obtain “prestaging labs” to better estimate your potential risks of this or other medications.
IVIG stands for intravenous immune globulin and is made by combining antibodies that 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 (Multiple Sclerosis), NMO (Neuromyelitis Optica) or MOGAD (Myelin Oligodendrocyte Glycoprotein).
Where do I get the medication?
The medication is dispensed from Magee pharmacy. When you arrive, the nurse will ask you a series of questions. If you are cleared to receive the medication, the nurse will request it from the pharmacy. The pharmacy will then deliver the IVIG to the Infusion 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. Your vital signs will be checked periodically during your infusion.
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 well hydrated and having consumed their normal meals. Drinking extra fluids may allow your body to better handle the protein load that occurs with administration of this medicine. Because we give pre-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 precautions. 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.
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Rituximab and Ocrelizumab
Prior to this medication you will be required to obtain “prestaging labs” to better estimate your potential risks of this or other medications.
Rituxan (rituximab) and Ocrevus (ocrelizumab) are both monoclonal antibodies to treat several neuroautoimmune conditions. Ocrevus is FDA approved forms and Rituxan is used “off label”. Generic forms of rituximab are also available for use (Ruxience, Truxima).
What is Rituximab and Ocrelizumab and when might they be used?
Rituximab (Rituxan) and Ocrelizumab (Ocrevus) are infusion medications that destroys a certain group of immune cells called B lymphocytes. They belong to a group of medicines known as monoclonal antibodies. Rituximab was first FDA-approved for lymphoma, in 1997,, but it may be used for people with a variety of autoimmune conditions. There are studies of Rituximab for MS and related disorders; however, it is currently considered an “off label” use for MS and other neurologic immune disorders. Ocrelizumab has been FDA approved since March of 2017. Approval of these medications often requires special permission from a health insurance company.
Where do I get the medication?
This medication is dispensed from the hospital pharmacy. When you arrive, the nurse will ask you a series of questions. If you are cleared to receive the medication, the nurse will request it from the pharmacy. The pharmacy will then prepare and deliver the medication to the Infusion Center.
How will I be able to afford this medication?
Although there are several costs in our center associated with Rituximab and Ocrelizumab (medication and infusion charges), there are also opportunities for financial assistance available through Genentech. These include copay assistance, infusion assistance, free drug programs, and charitable organizations that provide additional funding. Please do not be embarrassed to ask for assistance as we fine many people are eligible for some assistance. Call Genentech directly at 1-888-249-4918 to see if you may qualify.
How is this medication given?
Rituximab and Ocrelizumab are given intravenously in our infusion center. The frequency of infusions varies depending on your physician’s order. Each infusion can last anywhere from 2-5 hours depending on how well you tolerated previous infusions. You may want to bring snacks or an activity.
What happens when I come for treatment?
On the day of your infusion, please check in at the front desk at Suite 4500 and wait for a staff member to call your name and direct you to the infusion area. 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. Before starting your treatment, the nurses will give you pre-medications which typically include diphenhydramine (Benadryl) and acetaminophen (Tylenol) pills and intravenous methylprednisolone (Solumedrol). After the Solumedrol injection, your Rituximab or Ocrelizumab infusion will start. The infusion administration rate is initially very slow but will increase as you tolerate the medication. We will monitor your blood pressure and pulse intermittently during the infusion. During the infusion, you should report to the nurses any new or unusual symptoms such as itching, flushing, shortness of breath, rash, headache, or other symptoms of a 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 Rituximab and Ocrelizumab?
Both of these medications are typically well-tolerated by most patients, but some common examples of side effects include infusion-related reactions with flushing, itching, fever, chills, muscle or body aches, sore throat, 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 Rituximab and Ocrelizumab?
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 Rituximab and Ocrelizumab do decrease immune functions, the risk of general infections are higher in these patients. These may include normal type infections such as urinary tract infections, bronchitis, or pneumonia as well as unusual infections related to immune suppression including herpes zoster (shingles) and a brain infection by the John Cunningham virus (JCV) 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 primary care physician. Make sure all of your physicians are aware you are receiving Rituximab or Ocrelizumab, as it does not appear on normal medication lists.
How long do the effects of these medications last?
The immune effects of Rituximab and Ocrelizumab 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.
Solu-Medrol (methylprednisolone)
What is Solumedrol and why might it be given?
Methlyprednisolone (Solumedrol) is a potent type of steroid (corticosteroid) medication. It may be given to speed recovery from attacks of multiple sclerosis (MS), other immune diseases, or optic neuritis. 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 infusion. Most infusions are given over 20-45 minutes, although some patients do better with a slower infusion rate. The IV catheter may be left in place if your doctor recommends Solumedrol multiple days in a row. 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, receive the medication from the pharmacy department, 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.
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 or longer. 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. National Suicide Prevention Hotline: 1-800-273-8255. 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 omeprazole (Prilosec)) or famotidine (Pepcid) if you are not already 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 change- 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, mushrooms, dates, 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 must go out in the sun during this period, it is important that you use appropriate sunscreen as you may have a higher risk of sunburn. Steroids can also increase your risk of thrush (fungal (yeast) infection in your mouth/throat) or skin/vaginal yeast infection. This requires treatment.
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.
Lemtrada
Prior to this medication you will be required to obtain “prestaging labs” to better estimate your potential risks of this or other medications.
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.