My Premedication Regimen for Biologic Treatments

My Premedication Regimen for Biologic Treatments
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Colitis therapy request, premedication

Premedication for Biologic Treatment with Crohn's Disease and IBD

Crohn’s disease management often requires the use of biologic medications. Premedication is used to help prevent adverse reactions from these treatments.

To prepare for any medication, reducing medication reactions and the risk of anti-drug antibodies is always of high importance to prevent adverse effects. In this column, I discuss the premedications sometimes needed to lessen the intensity of side effects caused by biologics.

Premedication for Biologic Treatment with Crohn's Disease and IBD
Mary Horsley, getting Entyvio (vedolizumab) infusions. (Courtesy of Mary Horsley)

These biologic medications, like any other medication, come with allergic reactions risks, or drug toxicity may occur.

Premedication for Biologic Treatment with Crohn's Disease and IBD
Mary Horsley’s premedication for Stelara (ustekinumab). (Photo by Mary Horsley)
Biologics, such as Humira (adalimumab), Remicade (infliximab), Entyvio (vedolizumab), Stelara (ustekinumab), and Cimzia (certolizumab pegol), all come with risks of adverse reactions and vulnerability to infections. Biologics can prevent inflammation in the digestive system, but it does this by suppressing the immune system. Because of these risks, biologics have the potential to cause more damage than good.
Now, you may not be able to avoid all reactions, but preventing the mild and moderate side effects can be important to the success of biologic medication use because it affects patient compliance.

I have taken almost all of the available biologics. Unfortunately, I suffer side effects easily. I always get nausea and migraines, and sometimes joint pain and insomnia.

Premedication for Biologic Treatment with Crohn's Disease and IBD
Mary Horsley receives a Stelara infusion. (Courtesy of Mary Horsley)
I know I will inevitably suffer some of the listed potential side effects when beginning a new medication, so preparation is essential. With each new medication, my care team and I have had to come up with a new treatment regime. Premedication adjustments are often needed based on the medication given and my body’s reaction history.
Following are some of the premedications that my care team and I have found helpful.

Tylenol, Benadryl, and saline

  • With almost every intravenous (IV) biologic medication I have been given, there has always been a medication cocktail that includes Tylenol, Benadryl, and usually a saline IV drip to help maintain hydration. Benadryl with Tylenol before biologics helps prevent fever, nausea, and other minor reactions to medication.

    Premedication for Biologic Treatment with Crohn's Disease and IBD
    Mary Horsley self-injecting Humira. (Courtesy of Mary Horsley)

Hydrocortisone

  • Hydrocortisone weakens the antibodies fighting the biological medications. Hydrocortisone is given intravenously before administering biologic medications.

Sumatriptan

  • Imitrex (sumatriptan) and other triptan medications can prevent migraines. Some biologic medications may induce migraines, so adding these medications to a premedication list could be wise. I even wear glasses made specifically to help prevent migraines.
Premedication for Biologic Treatment with Crohn's Disease and IBD
(Courtesy of Mary Horsley)

Promethazine

  • Phenergan (promethazine) and other medications of the like are used for anti-nausea and vomiting. Phenergan is a drug I take daily — especially before biologic medications. These premedications prevent nausea and vomiting, as well as allergy-related symptoms.

It is important to note that medication reactions can occur immediately or be delayed, even a few days after dosage. It is important that you immediately notify your care team of any and all medication reactions, whether mild or severe.

Premedication for Biologic Treatment with Crohn's Disease and IBD
My Stelara injections. (Photo by Mary Horsley)

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