The Long-Term Benefits of Receiving Ig Therapy at Home

Published on by Dr. Mark Alfonso, PharmD, BCMTMS

Individuals with chronic immune conditions typically require Ig therapy almost regularly for a long period to maintain their health and improve their quality of life.

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Initially, Ig therapy was only given in a hospital setting as a safety precaution to manage adverse effects if they occur. However, with recent advancements in medical technology, patients can now easily receive Ig therapy in the comfort of their homes without missing any scheduled infusions. 

In this article, we’ll review the long-term benefits of receiving Ig therapy at home and how it supports both ongoing health and an improved quality of life among Ig patients.

Understanding Ig Therapy

Ig therapy provides immunoglobulins (antibodies), which are obtained from healthy donors and either administered intravenously (IVIG) or subcutaneously (SCIG). These antibodies are used to strengthen the immune systems of people who either lack essential antibodies or have dysfunctional immune systems (i.e., immune systems that work abnormally). 

For these patients, Ig therapy becomes a life-long treatment that must be continued to maintain ongoing health and improve quality of life by preventing infections and managing disease-associated symptoms effectively.

Currently, Ig therapy can be delivered at different care sites, including physicians’ offices, outpatient departments of hospitals, and if well-tolerated, at patients’ homes. Most patients with life-long immune conditions preferred receiving Ig infusions in the comfort of their homes due to the potential long-term benefits, ranging from improved quality of life and physical well-being to reduced financial burden. 

Long-Term Benefits of Ig Therapy at Home

Some of the significant long-term benefits of receiving Ig therapy at home are as follows:

1. Enhanced Comfort and Convenience

Home-based Ig therapy provides enhanced comfort and convenience compared to traditional hospital-based infusions. Patients can easily incorporate the Ig treatment into their daily routine without worrying about spending hours traveling to and from hospitals regularly, which is particularly burdensome for individuals with mobility issues or those living far from healthcare centers. 

Moreover, the continuous support and love from family at home also help patients to relax in their own space and alleviate anxiety, which often impacts Ig patients in clinical settings. The home care approach of Ig therapy not only promotes a positive mindset but also enhances patient adherence to their treatment, contributing to their overall long-term health. 

2. Reduced Financial Burden

Home Ig therapy reduces the financial burden on patients and their caregivers because receiving Ig infusions at home is less expensive than receiving it in a hospital setting or infusion center. For instance, according to one observational study, a home Ig infusion cost was $1,452, which is 31% cheaper than an outpatient infusion. A single patient undergoing 13 to 18 home infusions a year can save an estimated $18,876 to $26,136 annually. 

The cost of Ig infusion at home may vary and may depend on the type of delivery method (IVIG or SCIG). For example, the cost-effectiveness of moving IVIG to the home environment and even switching patients from IVIG to SCIG has been demonstrated in numerous studies.

If you have a primary immunodeficiency (PI) disorder, you can enroll in a Medicare insurance program. Under the Consolidated Appropriations Act of 2023, Medicare now permanently covers home IVIG therapy with full support, including professional care and all the supplies you need. 

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3. Decreased Risk of Infections

Nurse standing next to an Ig therapy setup

Another long-term benefit of receiving Ig therapy at home is less exposure to potentially harmful pathogens and lower rates of hospital-acquired infections. Unlike the hospital or clinical settings, which are breeding grounds for harmful infections, patients with weak immune systems (e.g., primary or secondary immunodeficiency disorders) can receive their scheduled Ig doses at home in a safe and clean environment. 

A study reported that patients who received home-based infusion had significantly lower rates of bronchitis and pneumonia compared to the rates at an outpatient hospital. However, some patients may still experience infection if proper aseptic protocol is not followed. 

4. Improved Quality of Life

Beyond the comfort and convenience, patients who received Ig therapy at home for a long period reported significantly improved quality of life due to greater control over day-to-day activities. 

For example, with home infusions, patients no longer need to visit the hospital for Ig administration and can easily receive treatment at home at their scheduled time. This allows patients to engage in leisure and travel activities, which consequently improves their mental health and reduces stress. 

Furthermore, a study reported that patients who received consistent Ig therapy at home without missing any scheduled doses experienced better health outcomes and improved quality of life, including significantly improved symptoms, fewer infections, and fewer hospitalizations.  

5. Personalized Care

Home Ig therapy provides personalized care to support the patient’s ongoing health. In a personalized care approach, the treatment plan is tailored according to the needs of the patient throughout their life. Highly trained nurses regularly monitor the patient’s condition and infusion process and provide one-on-one care to address any concerns. 

Moreover, nurses educate patients or caregivers about safely infusing Ig doses and monitoring their conditions. This collaborative approach promotes better health outcomes and helps patients feel more in control of their condition.  

Eligibility of Receiving Ig Therapy at Home 

Not every patient is eligible or suitable for home Ig therapy. For instance, home Ig therapy is mainly recommended to patients with primary or secondary immunodeficiency or life-long neurological autoimmune disorders who require this therapy for the long term. Home Ig therapy is recommended to limit frequent hospital visits and save time, travel expenses, and healthcare costs. 

The decision to transition Ig treatment from hospital to home care is made collaboratively by healthcare providers and the patient based on the patient’s medical condition, stability, and ability to manage home therapy safely. 

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Conclusion

In summary, home Ig infusions offer various long-term benefits, such as providing comfort and personalized care, easing financial burden, and reducing hospital stays and risk of infections, making it an optimal choice for many Ig patients. These long-term benefits not only enhance patient care and quality of life but also promote a feeling of independence among Ig patients.

How To Spot Conflict of Interest in Healthcare

Published on by Dr. Robert Hakim, PharmD

Conflict of interest in healthcare has been a problem for decades. Conflict of interest (COI) is when a prescriber’s judgment is influenced by personal or financial gain rather than prioritizing the patient’s care and outcomes. The biased decisions of medical professionals because of financial or personal interests often misguide patients to take unsafe and inappropriate treatments or expensive medications that they might not actually need.  

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This does not mean every provider with financial ties to pharmaceutical companies or diagnostic facilities can’t be trusted. However, if patients recognize these conflicts, they can make informed decisions about their health and opt for appropriate medical treatment. 

This article aims to educate patients about conflict of interest in healthcare, its various forms, how to spot signs of conflicts, and what steps you can take to ensure your health remains the priority. 

What Is Conflict of Interest?

When a prescriber’s interest (personal or financial benefits) interferes with their professional responsibilities, and there is a chance that medical professionals will prioritize these interests above patient care and health, this situation is described as a “conflict of interest.”

To identify a conflict of interest in a prescriber’s recommendation, it is important for you to first learn about its various forms. Conflict of interest in healthcare can take many forms, which include: 

1. Direct Financial Interest or Financial Incentives

The direct financial interest may include pharmaceutical or medical device companies and dispensaries that may send payments to healthcare professionals to promote their new drugs or medical devices. 

2. Ownership Interests

In ownership interest, when healthcare providers own or manage treatment facilities, they refer patients to those facilities for financial gain. 

3. Indirect Financial Interests

In indirect financial interests, the prescriber’s close relationships, such as friends, family members, or associates, gain benefits when they promote or prescribe their services or products to patients. 

Other direct or indirect personal or professional interests may include training opportunities, personal relationships, enhancement to professional reputation, consultancy or speaker fees, or research benefits. 

How To Spot and Address Conflict of Interest in Prescriber Recommendations 

You can spot a conflict of interest in prescriber recommendations by noticing the following red flags:

Frequent Recommendation of Branded Medications Over Generics

Patient pouring prescription pills into their hand

Generic medications contain the same active ingredient as brand-name medications but are typically less expensive. If your healthcare professional receives financial compensation from a pharmaceutical manufacturer, they may recommend the use of a brand-name medication without a clear reason or explanation. This could be a red flag that the healthcare professional has a conflict of interest. 

If you notice this, you should consider asking the following questions:

  1. Can I take the generic version of the medication instead of the brand name since both have the same active ingredient?
  2. Why are you prescribing the brand name version when there are generic versions available? 

Discussing the answers to these questions with your prescriber can ensure that the recommendation is based on clinical evidence with your health outcomes as the priority, rather than financial incentives.

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Limited Discussions of Alternative Treatments

If your healthcare provider does not discuss alternative treatment options, such as non-medication therapies, over-the-counter medications, or lifestyle changes that may help improve your condition, consider asking why. 

Generally, healthcare providers who truly want to positively impact their patients’ health explore and discuss multiple effective alternative options before choosing the best one. 

Promotional Materials in the Clinic

Sometimes, prescribers in clinics or offices have promotional materials (such as posters, pens, or brochures) that advertise specific medications or newly launched medical devices. These advertising materials might indicate a close relationship between the prescribers and certain pharmaceutical companies. 

If you notice promotional materials, ask your prescriber about how effective the promoted products are and how they compare to alternative options.

Connection to Specific Pharmacies or Diagnostic Labs

Sometimes, medical professionals prescribe medications that are only available from a specific pharmacy or dispensary they recommend. They also may order lab tests (e.g., ultrasounds, CBC, or MRI) from a specific place only, even though they could also be done in other places. 

These red flags may suggest that the prescriber has a direct or indirect financial interest, such as receiving a commission or other benefits.

Pressure To Participate in Clinical Trials

Clinical trials are indeed essential for advancing medicine, but not all trials are appropriate for every patient. If you’re being pressured to join a trial without full disclosure of the risks and benefits, be sure to take time and ask more questions about it. 

The prescriber may be a part of the research team or may have a close connection to someone conducting that particular clinical trial. 

What are the Other Ways To Spot the Prescriber’s Potential Conflicts?

You can also spot the conflict of interest in your prescriber’s recommendations through the following ways:

Research the Prescriber’s Background 

In the U.S., an open payment database is available that tracks the payments made by pharmaceutical and medical device companies to healthcare providers. You can search your prescriber to see if they’ve received any significant compensation. 

Read Online Reviews

This is the best way to check the conflict of interest in your prescriber’s recommendation. Carefully read the reviews and feedback left by patients and see if any of them mentioned unnecessary treatment or expensive medication recommendations. 

Always Ask for a Second Opinion

Always get a second opinion from another healthcare provider when you feel your current prescriber is just promoting certain products. Most of the time, patients can receive recommendations for alternative options and more clarity through a second opinion. 

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Research Over-Prescribed Treatments

Before you get your monthly prescriptions from the pharmacy, you should always research the medication online. Sometimes, the medication recommended by prescribers has limited effectiveness in certain conditions but is hyped due to heavy marketing. 

Takeaway

Conflict of interest in healthcare does not mean that a prescriber is acting unethically, but they do warrant vigilance. As a patient, being proactive and asking the right questions can help you identify potential biases and ensure your care is guided by what’s best for your health.

IVIG for Rasmussen Encephalitis: A Comprehensive Guide to Its Use and Safety

Published on by Dr. Saba Rassouli, PharmD

Rasmussen encephalitis (RE) is a chronic and rare disease that causes inflammation in one side of the brain. RE mostly affects children aged 10 years and younger and can lead to seizures, memory loss, and paralysis on one side of the body. 

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IVIG, or intravenous immunoglobulin, delivers antibodies to the body that regulate the immune response and target the harmful autoantibodies that may be responsible for causing inflammation in the brain. IVIG may help slow down the progression of RE, but surgery is still the only permanent cure for seizures caused by Rasmussen encephalitis.

IVIG should not be given to patients with a history of hypersensitivity or allergic reactions to immunoglobulins. It is recommended to inform your doctor about your medical history and medication use before starting IVIG therapy.

In this article, we will discuss IVIG for Rasmussen encephalitis in detail, including its dosage, side effects, mechanism, precautions, and more.

What Is IVIG and How Does It Treat Rasmussen Encephalitis?  

IVIG, also known as intravenous immunoglobulin, is an injectable medication that contains concentrated antibodies. It is made from the blood of numerous healthy donors and is injected into a person’s vein to treat immune disorders and inflammatory conditions. 

IVIG treats Rasmussen encephalitis, a brain-related inflammatory disorder, by administering healthy antibodies to the body, which helps fight infection and inflammation. 

It also activates the immune system to reduce brain inflammation and fight the disease. IVIG is commonly administered to patients with concurrent corticosteroid therapy unless steroid use is contraindicated. 

IVIG can treat Rasmussen encephalitis by several mechanisms, including: 

Neutralizing Autoantibodies 

The exact cause of Rasmussen encephalitis is still unknown, but it is possible that autoantibodies are responsible for causing inflammation in the brain. 

IVIG delivers thousands of healthy antibodies to the body, which binds to the harmful autoantibodies and helps neutralize them.

Anti-Inflammatory Effects 

IVIG has anti-inflammatory effects that help reduce inflammation in the brain.

Stimulating Immune Functions 

Thousands of healthy antibodies are injected through IVIG, which activates immune functions and stimulates the activity of immune cells, such as T cells and B cells, to help fight the disease.

Symptoms of Rasmussen Encephalitis 

The common symptoms of Rasmussen encephalitis include: 

  • Paralysis on one side of the body
  • Body weakness 
  • Mental decline, including learning and intellectual disabilities
  • Speech difficulties 

How Successful Is IVIG for Treating Rasmussen Encephalitis? 

The efficacy of IVIG for Rasmussen encephalitis can vary from patient to patient, depending on their health condition and individual response to the drug. Various studies have reported the outcomes and success of IVIG: 

  • A study reported by Caraballo et al. suggests that IVIG may show poor response as a first-line treatment. However, when given in combination with steroids, IVIG helps improve seizure frequency and stabilizes brain damage. 
  • Another study published in the National Library of Medicine reported that early treatment with IVIG as soon as RE is diagnosed maximizes the effects of immunomodulation in treating seizures and controlling brain damage. 
  • Journal Neurology reported a case of a 27-year-old man with late-stage Rasmussen encephalitis and seizures. The administration of IVIG showed a dramatic improvement in seizure frequency, which was observed after a single dose. Monthly administration of IVIG completely stopped the occurrence of seizures and caused gradual improvement in brain and motor functions. However, stopping IVIG caused seizures to reoccur.  

These studies show that IVIG is effective in controlling seizures and reducing brain damage and is a promising treatment option for Rasmussen encephalitis. IVIG is approved for use in children, but sufficient research is not available on the efficacy of IVIG in children with Rasmussen encephalitis.

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How To Use IVIG 

  • IVIG will be administered by your healthcare provider through injection into your veins. 
  • IVIG is administered initially at the rate of 1 ml/kg/hour for 15 – 30 minutes. If no adverse reactions occur, the rate can be increased every 15 – 30 minutes.
  • The infusion rate should not be increased to more than 3 – 6 ml/kg/hour. 
  • The duration of IVIG use for Rasmussen encephalitis may vary depending on individual patient needs and response to treatment.
  • A visit to a neurologist is recommended after 6 months of treatment with IVIG for Rasmussen encephalitis.
  • IVIG should be stored in the refrigerator at 2 – 8 °C. Avoid freezing IVIG. The shelf life of IVIG is around 24 – 36 months from the manufacturing date.
  • IVIG should not be given to patients who are using blood thinners like warfarin, as it can increase the risk of bleeding.

Dose of IVIG for Rasmussen Encephalitis 

IVIG is given to treat Rasmussen encephalitis in two phases: 

  • IVIG is first administered as an induction dose at 2g/kg in divided doses for 2 – 5 days.
  • After the induction dose, IVIG is administered as a maintenance dose, which is 1g/kg in a single dose per month.

Safety Precautions 

IVIG is generally a safe and effective drug, but it is crucial to monitor the following parameters to avoid any adverse reactions or organ damage: 

  • Signs of Infections: While receiving IVIG, signs of infections, like fever, chills, and cough should be monitored throughout the therapy. 
  • Kidney Function: IVIG can alter kidney function and cause kidney damage. Hence, the renal panel, fluid status, and GFR of the patient should be checked every 3 months.
  • Blood Counts: IVIG can affect white blood cells and platelet count. A complete blood count profile should be monitored every 4 – 6 weeks in patients receiving long-term therapy with IVIG. 

IVIG Strength 

IVIG is available as an intravenous injection at the following strengths: 

  • 0.5 g
  • 1 g
  • 2.5 g
  • 5 g
  • 10 g

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Side Effects of IVIG 

Doctor meeting with child who has a headache as a side effect of IVIG

IVIG can cause the following side effects: 

  • Infection, like redness, irritation, or pain at the injection site
  • Nausea
  • Vomiting 
  • Headache
  • Chest pain
  • Back pain 
  • Fever or chills 
  • Flushing 
  • Rash
  • Shortness of breath 
  • High or low blood pressure 

The infusion should be stopped immediately if the side effects become severe or the following adverse effects appear: 

  • Reduced consciousness 
  • Tightening of the lungs with symptoms like wheezing and coughing
  • Vomiting or chest pain
  • Severe allergic reactions 
  • High blood pressure 
  • Joint stiffness

Doxil Explained: Everything You Need to Know About This Chemotherapy Drug

Published on by Dr. Christine Leduc, PharmD

Doxil, also known as liposomal doxorubicin, is a chemotherapy medicine used to treat different types of cancers. The drug is given through IV (intravenous) infusion.

Doxil is sometimes given in combination with other chemotherapy drugs, depending on the patient’s condition and medical history. Before starting this medication, it is crucial to inform your doctor about your allergies, medical history, and if you are pregnant or breastfeeding.

In this blog, we will discuss Doxil in detail, including how the treatment works, how it is administered, its side effects, drug interactions, contraindications, and more.

What Is Doxil and How Does It Work?

Doxil is an anticancer prescription drug that is primarily given in metastatic ovarian cancer, myeloma, and AIDS-related sarcoma. It is also used to treat breast cancer.

It belongs to the class of drugs known as anthracyclines and contains the active ingredient, doxorubicin, in its formulation.

The medication works by two mechanisms:

  • It interferes with DNA production and damages the DNA by inserting itself and blocking the enzyme topoisomerase 2. This slows or inhibits the growth of cancer cells.
  • It generates free radicals, which help damage the DNA.

What Does Doxil Do to the Body?

Doxil is an antineoplastic chemotherapy medication that inhibits the growth of rapidly dividing body cells.

By targeting the rapidly dividing cells, it can destroy both cancer and normal cells, which can cause unwanted side effects.

Due to its liposomal formulation, this treatment specifically targets cancerous cells while minimizing damage to healthy cells.

How Successful Is Doxil?

The success and response rate of Doxil can vary from person to person. The overall response rate has been reported to be around 16% – 20%.

  • For breast cancer, a study reported that response to treatment with Doxil was seen in 56.5% of women.
  • Another study reported a response rate of 9% – 16% as a second-line agent for ovarian cancer.

What Is the Chemotherapy Drug Doxil Used For?

Doxil is used to treat different types of cancers, including:

  • Ovarian cancer, when the tumor has recurred or progressed after platinum chemotherapy
  • AIDS-related Kaposi’s sarcoma
  • Multiple myeloma or acute myeloid leukemia. Doxil is given in combination with bortezomib to treat myeloma in patients who have not been prescribed bortezomib before and have received one prior chemotherapy.

How to Use Doxil

  • Doxil treatment is administered by a healthcare provider through intravenous (IV) infusion. The medication takes about 60 minutes to be completely injected into the body.
  • It is administered only through the IV route. Any other route, including intramuscular or subcutaneous routes, should be avoided.
  • It is administered at an initial rate of 1 mg/min, and the rate may be gradually increased if no infusion or allergic reactions occur.
  • The drug should not be given as an undiluted solution or bolus injection.
  • The medication is typically administered once every 21 to 28 days.
  • This medication is approved for use in adults only. It should not be administered to infants or children.
  • If you notice any signs of redness, swelling, or pain near the injection site, immediately inform your healthcare provider.

Doxil Dosage

The dosage of Doxil varies depending on the type of cancer and the patient’s condition.

Ovarian Cancer

For ovarian cancer, the dose is 50 mg/m2, given through intravenous infusion every 28 days.

Myeloma

The recommended Doxil dosage for multiple myeloma is 30 mg/m2, given intravenously every 4th day of a 21-day cycle for eight cycles or until any toxicity or disease progression occurs.

For AIDS-related sarcoma, the dose of Doxil chemotherapy medication is 20 mg/m2 intravenously every 21 days until any toxicity or disease progression occurs.

Strength

Doxil HCL injection is a translucent red liposomal dispersion that comes in single-use vials and is available in two strengths:

  • 20 mg/10 ml
  • 50 mg/30 ml

Doxil Side Effects

The side effects of Doxil can go away a few weeks after treatment as the body gets used to the drug. They also go away after ending the therapy.

If the side effects become severe or intolerable, it is recommended to inform your doctor or pharmacist.

The common side effects of Doxil include:

  • Diarrhea
  • Hair loss
  • Constipation
  • Loss of appetite
  • Nausea and vomiting
  • Mouth and throat irritation
  • Reddish-orange color (not blood) in urine, sweat, and tears. This side effect should not be confused with blood in urine.
A woman holding her chest in pain

The serious side effects of the chemotherapy medication Doxil that should be reported immediately include:

  • Chills
  • Fever
  • Itching
  • Flushing
  • Back pain
  • Wheezing
  • Headache
  • Chest pain
  • Passing out
  • Fast heartbeat
  • Blue or gray skin
  • Very bad dizziness
  • Swelling of the face
  • Shortness of breath
  • Chest or throat tightness

Doxil Cost

The overall cost of Doxil varies depending on the total number of doses prescribed and the pharmacy where you purchase your medication.

On average, the cost of Doxil intravenous dispersion treatment ranges from $347 – $469 for a quantity of 10 ml, depending on your location, drug manufacturer, and pharmacy.

Contraindications

Doxil should be avoided or more closely monitored when used under the following conditions:

  • Hypersensitivity or allergic reactions to the drug or any of its components
  • Any active infection
  • Recent myocardial infarction, heart failure, cardiomyopathy, or any heart condition
  • Severe hepatic impairment

It is recommended that you inform your doctor if you are using any medication or have any health conditions before starting Doxil.

How AmeriPharma® Specialty Pharmacy Can Help

At AmeriPharma® Specialty Pharmacy, we provide the essential resources and personalized care you need to navigate your treatment journey.

Our URAC-accredited specialty pharmacy offers home infusion therapies, hard-to-find medications, and comprehensive copay assistance across 40+ U.S. states and territories. Contact us today for compassionate, specialty care at home.

A Guide to Home Parenteral Nutrition for New Patients

Published on by Neil Marshall, DACM, BSN, LAc, RN, CRNI, NCCAOM®

Home parenteral nutrition (HPN) is an essential therapy for those who can’t meet their nutritional requirements through oral intake or enteral tube feeding. It allows patients to receive parenteral nutrition at home, offering convenience and a better quality of life.

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As the reliance on hospital visits decreases, understanding the intricacies of HPN becomes crucial. If you are a new patient embarking on this journey, this guide is for you.

We will provide valuable insights into this treatment’s side effects, management techniques, and more. Read on to learn what to expect when starting total parenteral nutrition at home.

What Is Home Parenteral Nutrition?

Home parenteral nutrition (HPN) is a medical therapy that delivers essential nutrients directly into the bloodstream via an intravenous (IV) catheter, bypassing the digestive system entirely. It’s recommended for those experiencing severe gastrointestinal dysfunction or malabsorption.

HPN is typically administered through a vascular access device: a central venous catheter, a peripherally inserted central catheter (PICC), a tunneled catheter, or an implanted port-a-cath. The treatment is ideal for conditions like short bowel syndrome, chronic intestinal failure, or severe Crohn’s disease, where oral or enteral feeding is not possible.

Studies show that parenteral nutrition offers a lower risk of mortality among malnourished patients when compared to tube feeding.

The Components of Home Parenteral Nutrition

Patients receiving parenteral nutrition at home rely on a carefully balanced mixture of nutrients to meet their daily requirements. The components of the parenteral solution are tailored to each patient’s unique needs. When all components of nutrition are used, this is known as total parenteral nutrition (TPN). Learners should be aware that ‘TPN’ and ‘HPN’ are commonly used as if they mean the same thing, but they actually refer to different components of care. TPN often means parenteral nutrition in general. Clinically speaking, the word TPN has become shorthand for any parenteral nutrition solution that is used.

Here is an overview of what these mixtures typically include:

  • Macronutrients: These compounds include carbohydrates, proteins, and fats that provide energy and support bodily functions.
  • Micronutrients: Essential vitamins and minerals necessary for metabolic processes and overall health.
  • Electrolytes: These are important for maintaining fluid balance and proper cellular function, and include sodium, potassium, and magnesium.
  • Fluids: Fluids ensure adequate hydration and help transport other nutrients throughout the body.
  • Medications: These may be included to address specific health needs or to prevent complications.

Who Needs Home Parenteral Nutrition?

HPN is often essential for individuals with specific medical conditions that compromise their ability to absorb nutrients through traditional means. Below are some of the most common conditions that may necessitate HPN.

Crohn’s Disease

Crohn’s disease is an inflammatory bowel condition that can severely affect nutrient absorption, making HPN a crucial source of nutrition for affected individuals.

Ulcerative Colitis

Like Crohn’s disease, ulcerative colitis can lead to malnutrition due to the inability to digest food properly. HPN can help compensate for this deficiency.

Short Bowel Syndrome

Patients with this condition have a reduced intestinal length, limiting their ability to absorb nutrients effectively. Home parenteral nutrition ensures they receive the necessary nutrition directly into the bloodstream.

Ischemic Bowel Disease

This condition restricts blood flow to the intestines, impairing nutrient absorption. At-home parenteral nutrition can provide a reliable source of nourishment while the digestive system heals.

Cancer

Many cancer patients experience significant weight loss and malnutrition as a side effect of chemotherapy. HPN can support their nutritional needs during treatment and recovery.

Preparing for HPN

A friendly nurse offering guidance to a patient

Transitioning to home parenteral nutrition involves careful preparation to ensure a smooth experience. Here are some essential steps to prepare you for HPN.

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Initial Assessment and Education

Before starting HPN, your healthcare team will conduct a comprehensive assessment to determine your nutritional needs and suitability for home treatment. This process involves evaluating your medical history, current health status, and the specific conditions necessitating HPN.

Afterward, your doctor will educate you on the benefits and potential challenges of HPN. The more you learn about the treatment, the better you can safely manage your therapy.

Setting Up a Home Environment

You must receive your home parenteral nutrition in a suitable environment. Dedicate a clean and organized space in your home for the preparation of infusions. Ensure this place is quiet and away from pets and food preparation areas.

This area should include all your essential supplies, such as sterile equipment, an IV pole, and storage for HPN bags. Keep these HPN bags in a dedicated refrigerator, ideally on the top shelf at the proper temperature.

Training for Patients and Caregivers

Proper training for patients and caregivers is vital for administering parenteral nutrition at home. The healthcare team will provide detailed instructions on handling, preparing, and administering parenteral nutrition solutions, along with guidelines for maintaining sterile techniques and identifying potential complications.

This knowledge helps build confidence in managing home parenteral nutrition infusions and enhances the overall care experience.

Importance of a Support System

Having a support system around you can help make infusion sessions easier. A reliable support network will alleviate stress and foster a sense of community. Friends and family members can provide emotional support and practical assistance.

Communicating openly with your healthcare providers is also essential. They can offer guidance and address any concerns that may arise.

How Is HPN Administered?

HPN is delivered through a central venous catheter (CVC) that allows nutrients to be infused directly into the bloodstream. The frequency of administration depends on individual needs. Each infusion cycle can take anywhere from 10 to 24 hours per day.

These are the basic steps for administering home parenteral nutrition:

  1. Prepare the Workspace: Clean a designated area with disinfectant wipes to maintain cleanliness.
  2. Gather Supplies: Collect equipment, including PN bags, syringes, alcohol wipes, IV flushes, and the infusion pump.
  3. Warm to Room Temperature: Remove the PN bag from the refrigerator at least an hour before preparation of the bag. Set the bag down on a clean area, away from the sun or a heat source.
  4. Check the PN Solution: Inspect the bag for discoloration, cloudiness, or particles.
  5. Wash Hands: Thoroughly wash your hands with soap and water before the preparation and administration of HPN.
  6. Prepare the Bag as Instructed. Multivitamins are often added to each solution bag.  
  7. Connect the IV Line: Carefully clean the IV connection, flush your line as directed, and attach the pump tubing to the IV line as instructed by your healthcare provider.
  8. Start the Infusion: Start the program on the infusion pump to administer TPN.
  9. Monitor the Infusion Rate: Regularly check for any redness or swelling around the catheter insertion area. Monitor the infusion pump and bag to make sure it is infusing properly.

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Potential Risks of Home Parenteral Nutrition

While HPN is a vital therapy, it’s not without risks. Some of the potential side effects of HPN that may arise during treatment include:

  • Infection at the Catheter Site: Caused by bacteria entering through the catheter.
  • Thrombosis: Formation of blood clots in the veins.
  • Electrolyte Imbalances: Disruptions in electrolyte levels due to clinical indications and TPN formulation.
  • Nutritional Deficiencies: Laboratory tests are frequently performed to ensure the formula/solution is adequate for the patient’s needs. 
  • Metabolic Complications: Liver damage or hyperglycemia may occur.

Contact your pharmacy or healthcare provider immediately if you experience any signs of infection, fever, or unusual symptoms during treatment. Prompt action can help prevent more serious complications of TPN.

Managing Life With Home Parenteral Nutrition

A happy woman preparing TPN supplies

Adjusting your life with HPN requires thoughtful planning and proactive management. Here are some key aspects for a smoother at-home total parenteral nutrition experience.

Daily Routines

Incorporating HPN into your daily routine may require some adjustments. Establish a consistent schedule for your infusions that fits your lifestyle. Whether during the day or overnight, administer each solution around the same hour every time.

Consider setting reminders for preparation and infusion. Plan your activities around these sessions. Make good hygiene and sterilization practices a part of your daily life.

All these commitments allow you to receive home parenteral nutrition safely and effectively.

Managing Side Effects

You may experience different side effects of TPN. However, there are effective strategies to minimize their impact and maintain a balanced life. Here are some tips to help you navigate these adverse effects:

  • Stay Hydrated: If you are able to consume orally, drink plenty of fluids or receive hydration intravenously, and monitor your hydration levels regularly.
  • Maintain a Healthy Diet: Adhere to the specific diet plan as ordered by your healthcare provider. If you are able to eat by mouth, keep track of your consumption of any food or fluids in order to report it to your healthcare provider. 
  • Stay Active: Incorporate low-impact exercises such as walking or biking to promote physical and mental health.
  • Practice Good Hygiene: Follow strict hygiene practices when administering home parenteral nutrition to minimize the risk of infection.
  • Follow Medication Plan: Take prescribed medications on time.
  • Monitor Symptoms: Keep track of any side effects and report them to your doctor or pharmacy provider.

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Regular Monitoring and Follow-Up

Follow-ups with healthcare providers are vital for people receiving total parenteral nutrition at home. Visit your healthcare team regularly to assess your nutritional status and adjust your TPN formulation if necessary.

Your doctor will order blood tests and monitor your weight to ensure your current formulation provides you with the necessary nutrients. They may also inspect the infusion site and provide tips for better administration of future home parenteral nutrition solutions.

Emotional and Psychological Considerations

Living with HPN comes with emotional challenges. To overcome these challenges, consider joining support groups. Connecting with people who have similar experiences can create a sense of understanding.

If you’re struggling with feelings of loneliness, depression, and anxiety, consider seeking professional counseling. Building a strong support network helps enhance emotional well-being and foster resilience throughout the treatment process.

Receive Total Parenteral Nutrition At Home With AmeriPharma® Specialty Pharmacy

Home parenteral nutrition can transform the lives of those who need nutritional support, providing a means to receive essential nutrients in a familiar setting. However, navigating life with HPN can be challenging for new patients.

By learning more about this therapy and its importance for your health, you can better manage your needs and actively participate in your care.

If you’re looking for reliable home infusion services, AmeriPharma® Specialty Pharmacy can help. Our URAC-accredited specialty pharmacy provides at-home total parenteral nutrition services in over 40 US states and territories.

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Self-Care Tips to Live Your Best Life With Crohn’s Disease

Published on by Dr. Samantha Kaeberlein, PharmD

Crohn’s disease can cause uncomfortable physical symptoms like abdominal pain, fatigue, and diarrhea. It can even affect your mental health and lead to depression. Having an established self-care routine can make life with Crohn’s disease easier.

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Studies show that those who practice self-care experience fewer symptoms and visit the hospital less often. Below, we will provide 14 tips to help you build a care plan for Crohn’s disease and navigate life with this condition.

Keep a Food Diary

Certain foods can trigger symptoms of Crohn’s disease and make your condition worse. Some of the most common triggering foods include:

  • Spicy foods
  • High-lactose products
  • High-fat foods
  • High-fiber foods
  • Caffeine
  • Alcohol
  • Artificial sweeteners
  • Cruciferous vegetables
  • Fried and processed foods

You might tolerate certain food groups better during remission. Some people eat several smaller meals throughout the day as part of their Crohn’s disease self-care routine to experience less severe symptoms.

Experiment with different foods and keep track of the ones exacerbating your symptoms in a diary.

Follow a Nutritious Diet

There is no specific diet recommended for Crohn’s disease. However, certain diets may help reduce flare-ups. Some nutritionists recommend following a low-FODMAP diet. FODMAP stands for:

  • Fermentable oligosaccharides
  • Disaccharides
  • Monosaccharides
  • Polyols

Consuming less of these carbohydrates may alleviate gastrointestinal symptoms such as bloating, gas, and diarrhea.

When creating a care plan for Crohn’s disease, focus on a balanced diet. Avoid trigger foods and eat more FODMAP friendly fruits, vegetables, whole grains, and lean proteins. Examples include carrots, pineapples, strawberries, hard cheeses, eggs, oats, and peanuts.

Consult a Dietician

The best way to optimize your diet for your Crohn’s disease self-care routine is to consult a professional nutritionist or dietician. They help you devise a personalized meal plan and suggest supplements to ensure you receive all the essential nutrients.

You might even need total parenteral nutrition (TPN) if you’re dealing with a more severe case of the disease. A dietician can assess your nutritional status and help your healthcare team make that decision.

Stay Hydrated

Staying well-hydrated is crucial for managing Crohn’s disease. Dehydration can worsen your symptoms and lead to further complications, such as:

  • Constipation
  • Kidney problems
  • Electrolyte imbalances
  • Fatigue and weakness
  • Increased risk of flare-ups

The disease can also cause diarrhea and lead to dehydration, making it essential to incorporate adequate fluid intake into your Crohn’s disease self-care routine. Try different hydration strategies and track your water intake to avoid further problems.

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Exercise Regularly

You may not always feel like exercising, especially during a flare. However, including exercises in your care plan for Crohn’s disease is one of the best ways to manage symptoms and improve your overall health.

Studies show lower disease activity in individuals who stay physically active despite their diagnosis. Your exercises don’t have to be extreme to be effective. Do as much as your body allows. Try low-impact activities such as swimming, biking, or even walking.

Before adding physical activities to your Crohn’s disease self-care routine, ask your doctor for recommendations on the best types of exercises. Rest when you’re feeling abdominal pain or bloating. Lastly, remember to drink enough water to stay hydrated and energized.

Quit Smoking and Limit Alcohol

Living with Crohn’s disease is less challenging for non-smokers. If you’ve been a smoker until now, it’s a great time to quit. Nicotine in any form, whether it’s a cigarette or a vape, can wreak havoc on your body.

According to recent studies, smoking increases the risks of complications and interacts with medications for Crohn’s. Additionally, some medications used in the management of Crohn’s may not be as effective in those who smoke.

In addition to nicotine, certain compounds found in alcoholic beverages can irritate your intestinal lining, aggravate your symptoms, and cause medication interactions.

It’s up to you if you want to include the occasional cocktail in your Crohn’s disease self-care routine, but check with your doctor beforehand and prepare for any consequences.

Prioritize Sleep

An effective care plan for Crohn’s disease prioritizes sleep. Studies show that those who don’t get enough sleep have higher disease activity and hospitalization rates.

A good night’s rest can enhance your mood and boost your immune system. Aiming for seven to nine hours of rest each night will give your body enough time to recover.

If you find it difficult to fall asleep, try adding a bedtime routine to your Crohn’s disease self-care plan. Avoid TV and phone screens, lower your bedroom’s temperature, and take a warm bath before hitting the mattress.

Go to bed at the same time each night to signal your body it’s time to sleep. Your internal clock will adjust in no time.

Practice Relaxation Techniques

A female therapist performing breathwork exercises on another woman

Being diagnosed with this type of inflammatory bowel disease (IBD) can be stressful and take a toll on your mental health. Studies show mindfulness-based therapy improves inflammatory biomarkers in those with Crohn’s disease and helps alleviate their symptoms.

Try adding different relaxation techniques to your Crohn’s disease self-care routine to calm your mind. Some of the most popular techniques include:

  • Yoga
  • Tai chi
  • Meditation
  • Breathing exercises

If these techniques aren’t effective, try other relaxing activities such as reading, writing, listening to music, painting, or gardening. Do what works for you.

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Take Your Medications

The most vital part of your care plan for Crohn’s disease is taking your medications on time. Your medications can help prevent flare-ups, alleviate symptoms, and reduce the risk of further complications.

According to studies, one-third of those who don’t adhere to their treatment plan experience relapses and a worsening of their condition.

Find a reliable specialty pharmacy to get your medications from. If you have difficulty remembering when to take them, set an alarm on your phone to remind you of the most important part of your Crohn’s disease self-care routine.

Track Your Symptoms

Monitoring your symptoms is crucial for managing your condition effectively. Keeping track helps you identify patterns that may reveal triggers or predict flare-ups.

This knowledge empowers you to adjust your daily activities and engage in more informed discussions with your healthcare providers, ultimately improving your care plan for Crohn’s disease.

Some of the symptoms you should watch out for include:

  • Gas
  • Bloating
  • Fever
  • Fatigue
  • Diarrhea
  • Weight loss
  • Bloody stools
  • Abdominal pain

Communicate With Friends and Family

Navigating life with Crohn’s disease can be challenging, but having your friends and family by your side can make a significant difference. Studies even show that those with a better support system have a higher quality of life.

Communicate openly with your loved ones and let them be part of your Crohn’s disease self-care journey. Surrounding yourself with trusted individuals provides emotional comfort while ensuring you have help when it matters most.

Join Support Groups

People comforting each other in a support group

Your friends and family can only support you so far. They can’t know what it’s like to live with this condition. For these difficult times when you feel alone and misunderstood, it’s great to have a support network of peers.

Look for support groups of people dealing with the same condition. They can share experiences, provide insights, give helpful tips for your Crohn’s disease self-care routine, and reassure you that you’re not alone.

You can ask your doctor to refer you to patient advocacy groups or look through the Crohn’s and Colitis Foundation’s support group directory to connect with others facing the same challenges.

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Be Prepared

A care plan for Crohn’s disease is incomplete without preparation for unexpected situations. Planning ahead will help you navigate these situations easier and enjoy a more active social life.

Familiarize yourself with restroom locations in the areas you’re visiting and keep essential supplies on hand. A well-stocked Crohn’s disease self-care kit can provide comfort and security during outings.

Here is what you can include in your emergency kit:

  • Baby wipes
  • Toilet paper
  • Spare clothes
  • Hand sanitizer
  • Gloves and sealable bags

Communicate With Your Doctor

Open communication with your healthcare team is essential for effectively managing your condition. Inform your doctor about all aspects of your health, especially medications and supplements.

You might be considering adding over-the-counter (OTC) medications to your Crohn’s disease self-care routine. While these medications may help relieve some symptoms, they can also pose risks. Always consult your doctor before trying any new OTC products.

Some of the other key points you can discuss with your doctor include:

  • Report persistent or new symptoms
  • Notify them of any medication changes
  • Ask about the safety of OTC supplements or herbal remedies
  • Inform them of any side effects from current medications
  • Seek advice for managing severe symptoms or flare-ups
  • Discuss mental health concerns, including anxiety or depression

Manage Crohn’s Disease At Home With AmeriPharma® Specialty Pharmacy

Self-care is an essential part of managing Crohn’s disease. With these tips, you can create your care plan for Crohn’s disease and live your best life with this debilitating condition.

AmeriPharma® Specialty Pharmacy is here to help you in that quest. Our ACHC and URAC-accredited specialty pharmacy provides specialty treatments for Crohn’s disease in over 40 US states and territories.

Contact us today to speak to a patient navigator and start receiving at-home specialty care with full-service coordination, 24/7/365 support, and copay assistance.

IVIG for Acute Disseminated Encephalomyelitis: How This Therapy Can Help When Other Treatments Fail

Published on by Dr. Samantha Kaeberlein, PharmD

IVIG for acute disseminated encephalomyelitis (ADEM) is an effective second-line treatment when corticosteroids fall short, or patients cannot take them due to some medical conditions. 

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A Quick Overview of Acute Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is a sudden and severe autoimmune disorder. It causes damage to the protective coating surrounding nerve fibers. 

The process in which the immune system damages the coating is known as demyelination. In people with ADEM, demyelination occurs in the brain and spinal cord. Rarely, the optic nerves (carrying signals from the retina of the eyes to the brain) may be affected. 

Demyelination typically occurs after a bacterial or viral infection. Children are more likely than adults to get this condition. 

ADEM is a rare condition. The National Organization of Rare Disorders (NORD) estimates 0.07 to 0.09 new cases per 100,000 children [1]. The number of new cases in the general population is unknown.  

Another name for this condition is post-infectious encephalomyelitis.

ADEM isn’t inherited, but genetic factors may make you more likely to get it. 

How Is Acute Disseminated Encephalomyelitis Managed?

There’s no universally accepted treatment for ADEM, and the U.S. FDA hasn’t approved any specific therapy to treat it. 

Your healthcare provider will typically start with high-dose intravenous corticosteroids and supportive care. Corticosteroids (the first-line treatment) can help reduce inflammation of the brain and spinal cord. 

Supportive care can include [2]:

  • Measures to manage airway (some patients may need a machine to breathe)
  • Antibiotics to help fight infections
  • Antiseizure medications
  • Maintenance of fluid and electrolyte balance
  • Medications to prevent blood clots in the leg

When corticosteroids don’t work as desired, your healthcare provider will treat you with either plasma exchange (plasmapheresis) or IVIG. 

IVIG for Acute Disseminated Encephalomyelitis: How Does It Work?

The exact mechanism is unknown. Health experts believe that IVIG may work in ADEM by:

  • Decreasing the production of proteins (immunoglobulins or antibodies) that damage the brain and spinal cord
  • Accelerating the breakdown of immunoglobulins
  • Preventing the immune system from forming harmful immune complexes (the binding of antibodies with disease-causing particles)

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When Should You Get IVIG for Acute Disseminated Encephalomyelitis?

IVIG isn’t the primary treatment for ADEM and may only be considered under certain conditions:

  • When intravenous corticosteroids fail to manage ADEM symptoms
  • When some patients cannot tolerate high-dose corticosteroids due to certain medical conditions
  • When corticosteroids might worsen the condition in ADEM patients who also have meningoencephalitis (inflammation of the brain and its coverings)
  • When plasma exchange (a second-line treatment) doesn’t work

IVIG for Disseminated Encephalomyelitis: How Effective Is It?

Man on bed at home receiving IVIG therapy

Several case reports suggest IVIG can be an effective alternative to corticosteroids. 

For example, in a 1995 case report, investigators described an 11-year-old boy with ADEM who responded within 24 hours to IVIG. The patient received 400 mg/kg IVIG daily for 5 days [3].

In addition, a 1999 study reported full recovery in two children (both younger than 10) who received 2 g/kg IVIG for 5 days [4].

Similarly, a 2019 case study reported a 30-year-old female who fully recovered after prompt treatment with high-dose corticosteroid and IVIG. The patient received 0.4 g/kg IVIG for 7 days [5].

According to the Australian National Blood Authority guidelines, which reviewed multiple case reports, second-line IVIG treatment can result in complete recovery in [6]:

  • Children with monophasic ADEM (occurring once in a lifetime)
  • Children with recurrent ADEM (more than one episode of the disease)
  • Children with relapsing ADEM originally treated with IVIG within the previous six months

The Canadian guidelines recommend IVIG for acute disseminating encephalomyelitis when steroid therapy fails. The IVIG doses mentioned in the guidelines are as follows [7]:

  • Induction: 2 g/kg adjusted body weight divided over 2 to 5 days
  • Maintenance (for recurrent ADEM only): 0.4 to 2 g/kg adjusted body weight every 4 to 6 weeks

Combining Corticosteroids and IVIG

Only in severe cases, a healthcare provider may recommend the combination of corticosteroids and IVIG. However, it’s unclear if doing so has any added advantage. 

There have also been reports of healthcare providers administering plasma exchange with high-dose corticosteroids in severe cases of ADEM. 

Other Second-Line Treatments

Patients with severe or steroid-resistant ADEM may receive other second-line treatments like cyclophosphamide or rituximab. 

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The Challenges of Using IVIG for Acute Disseminating Encephalomyelitis

Despite promising results in initial small studies, several challenges still limit IVIG use for acute disseminating encephalomyelitis, including:

  • A lack of large, controlled human trials
  • Timing of therapy (whether to start IVIG immediately or wait for corticosteroids to fail)
  • Dosing guidelines

While early findings suggest IVIG can enhance the pace of initial recovery, it’s unknown whether IVIG can affect the time to or extent of full recovery. 

Other factors that can limit the use of IVIG for acute disseminating encephalomyelitis include the high cost of IVIG therapy and access to IVIG. 

Plasma Exchange vs. IVIG for Acute Disseminating Encephalomyelitis

Both plasma exchange and IVIG are effective second-line treatments. Yet plasma exchange is often considered superior. 

Plasma exchange may pose fewer risks and a reduced rate of complications. Additionally, it is oftentimes more cost-effective for the patient.

Frequently Asked Questions

How do you treat acute disseminated encephalomyelitis?

Several treatment options for acute disseminated encephalomyelitis are available. These include high-dose intravenous corticosteroids, IVIG, and plasma exchange. 

What is the first-line treatment for ADEM?

High-dose intravenous corticosteroids are the first-line therapy for ADEM. 

What is the protocol for ADEM treatment?

The standard protocol of corticosteroid treatment for ADEM is intravenous methylprednisolone at 20 – 30 mg/kg/day (maximum 1 g/day) for 3 to 5 days, followed by tapering (gradually lowering the dosage) with oral prednisone for 4 to 6 weeks.

Camcevi: What You Need To Know About This FDA-Approved Prostate Cancer Treatment

Published on by Dr. Mark Alfonso, PharmD, BCMTMS

Camcevi is an FDA-approved cancer medication. It is used to treat advanced prostate cancer in adult males. Learn about Camcevi’s mechanism of action, dosage, side effects, cost, and more.

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Important Camcevi Warnings

Worsening of Symptoms

Camcevi is a drug that may worsen prostate cancer symptoms or cause additional symptoms during the first few weeks of treatment. Your healthcare provider will watch you closely during this period.

Camcevi can also worsen bone pain and cause difficulty passing urine. In some people, this medication can cause spinal cord compression, which may result in paralysis. Seek emergency medical care if you experience:

  • Loss of sensation in the feet
  • Weakness in the foot, causing a limp
  • Trouble with hand or leg coordination
  • Pain and stiffness in the neck or back
  • Numbness, cramping, or weakness in the arms, hands, or legs
  • Burning pain that spreads to your arms, buttocks, or down into the legs

Low Blood Sugar and Diabetes

Camcevi can make you more likely to develop diabetes. Your healthcare provider will check your blood sugar levels periodically during treatment.

Diseases of the Heart and Blood Vessels

Camcevi injections can increase the risk of heart attack, sudden death, and stroke. Your healthcare provider will monitor signs and symptoms suggestive of heart disease during treatment.

Irregular Heartbeat

Before prescribing Camcevi, a healthcare provider will determine whether the benefits of the drug outweigh the risks in people with existing heart rhythm problems, heart failure, or those who use medications that can cause irregular heartbeats.

Convulsions

Call your healthcare provider immediately if you have a seizure.

Before Taking Camcevi

Before you receive your first dose of Camcevi injection, inform your provider if you are allergic to this drug, any product component, or similar medications like goserelin (Zoladex), histrelin (Supprelin LA, Vantas), nafarelin (Synarel), or triptorelin (Triptodur, Trelstar).

Tell your provider if you have or ever had:

  • Seizures or epilepsy
  • A blood vessel disorder
  • A brain tumor or spinal cord injury
  • Depression, a mental disorder, or psychosis
  • Heart disease, such as heart failure or arrhythmia
  • Electrolyte imbalance (low blood levels of salts like potassium or magnesium)
  • Risk factors for bone loss (history of brittle bones, smoking, heavy drinking, long-term use of steroids or seizure medicines)

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Camcevi Introduction and Uses

Camcevi is a brand-name prescription medication. The active ingredient in this product is leuprolide, which is in a medication class called gonadotropin-releasing hormone (GnRH) agonists.

In 2021, the U.S. FDA approved Camcevi injections to treat adult males with advanced prostate cancer.

Camcevi Mechanism of Action

Camcevi causes your testes to produce less testosterone (androgen). Hence, this medication is also known as androgen deprivation therapy (ADT).

Camcevi Dosage

This medication comes as an off-white to pale yellow, viscous liquid in a single-dose, pre-filled syringe. Each Camcevi syringe contains 42 mg of the active drug.

A healthcare provider will inject Camcevi just under your skin. The common injection sites are the upper- or mid-abdominal areas with enough loose subcutaneous tissue.

The recommended Camcevi dosage is 42 mg leuprolide or one syringe every 6 months.

Camcevi Side Effects

Common Side Effects

Call your healthcare provider if the following symptoms worsen or don’t go away:

  • Hot flush
  • Joint pain
  • Dizziness
  • Tiredness
  • Frequent urination
  • Muscle or bone pain
  • Pain in the extremities
  • Increased urination at night
  • Infection of the upper airway
  • Decrease in the size of the testicles
  • Decrease in sexual ability or desire
  • Hypertension (elevated blood pressure)
  • Runny nose, cough, sore throat, or flu-like symptoms
  • Injection site reactions (pain, burning, bruising, redness)
A patient holding his knee in pain

Serious Side Effects

Call your healthcare provider immediately if you experience the following after receiving Camcevi:

  • Nausea
  • Vomiting
  • Seizures
  • Bone pain
  • Confusion
  • Dry mouth
  • Weakness
  • Blurred vision
  • Extreme thirst
  • Vision changes
  • Drooping eyelids
  • Blood in the urine
  • Sudden headache
  • Dizziness or fainting
  • Slow or difficult speech
  • Breath that smells fruity
  • Lowered consciousness
  • Difficulty moving the eyes
  • Painful, frequent, or difficult urination
  • Pain in your arms, back, chest, neck, or jaw
  • Weakness, numbness, or inability to move an arm or leg

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Allergic Reactions to Camcevi

Camcevi is a drug that may cause allergic reactions in some people. Seek emergency medical care if you experience:

  • Hives
  • Breathing difficulty
  • Swelling in the face or throat

Signs and Symptoms of Spinal Cord Compression

Seek emergency medical care if you experience the following after a Camcevi injection:

  • Loss of sensation in the feet
  • Weakness in the foot, causing a limp
  • Trouble with hand or leg coordination
  • Pain and stiffness in the neck, back, or lower back
  • Numbness, cramping, or weakness in the arms, hands, or legs
  • Burning pain that spreads to your arms, buttocks, or down into the legs

Use During Pregnancy and Lactation

Camcevi is FDA-approved for use only in adult men with advanced prostate cancer. However, other formulations of leuprolide may be used in children (boys and girls) to delay sexual development. Ask your pharmacist for more information.

Camcevi Cost

The cost of Camcevi can vary depending on your insurance plan, location, and pharmacy. Contact your insurance provider to find out if your plan covers this medication or if you need prior authorization.

Accord BioPharma, which is licensed to market the drug in the U.S. by Foresee Pharmaceuticals, offers support and resources to eligible patients.

You can also contact us if you are interested in receiving financial assistance.

Camcevi vs. Eligard

Both products contain the same active drug, leuprolide. Camcevi is a ready-to-use depot formulation, while Eligard requires mixing before administration. Also, Eligard is available in four different strengths and dosing schedules.

Camcevi vs. Lupron

Both Camcevi and Lupron injections contain the same active drug, leuprolide, but different salt forms. Moreover, the strengths, dosing schedules, and methods of administration differ.

Camcevi vs. Orgovyx

The active ingredient in Camcevi is leuprolide, while in Orgovyx, it is relugolix. Both products are used to treat advanced prostate cancer in men.

Unlike leuprolide, which is a gonadotropin-releasing hormone (GnRH) agonist, relugolix is a gonadotropin-releasing hormone (GnRH) antagonist.

How AmeriPharma® Specialty Pharmacy Can Help

Living with advanced prostate cancer can be challenging, but you don’t have to navigate it alone. AmeriPharma® Specialty Pharmacy offers personalized support for your treatment journey.

Our URAC-accredited specialty pharmacy provides access to essential medications like Camcevi. We also offer copay assistance and reliable 24/7 support across 40+ U.S. states and territories. Contact us today to talk to a specialist.

IVIG for Acquired Red Cell Aplasia: Key Benefits and Treatment Insights

Published on by Dr. Robert Hakim, PharmD

Acquired red cell aplasia or acquired pure red cell aplasia is a sub-type of pure red cell aplasia (PRCA), a rare blood disorder in which the bone marrow does not produce enough red blood cells (RBCs). When an individual with this disorder doesn’t have enough red blood cells in their body, they feel fatigued, breathless, lethargic, or weak due to severe anemia.  

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Intravenous immunoglobulin (IVIG) therapy has emerged as an effective treatment option for acquired red cell aplasia (aPRCA), especially in cases where this condition is triggered or caused by autoimmune disorders or viral infections. 

Let’s take a closer look at the basics of acquired red cell aplasia, how it occurs, and how IVIG therapy can help patients with this rare bone marrow disorder. 

What Is Acquired Red Cell Aplasia?

Acquired pure red cell aplasia is a rare blood condition characterized by severe anemia due to a significant drop in the production of red blood cells (also called erythrocytes) by the bone marrow. This drastic drop can happen due to erythropoiesis failure. 

Erythropoiesis is the process of red blood cell production in the bone marrow. Any problem with this process can lower the number of available immature red blood cells (also called reticulocytes). These cells are released from the bone marrow into the bloodstream and develop into mature red blood cells. 

A low red blood cell count can lead to severe anemia, which can cause symptoms like dizziness, fatigue, difficulty breathing, rapid heartbeat, weakness, or pale skin. 

What Causes Acquired Red Cell Aplasia?

Unlike inherited or congenital red cell aplasia, caused by a mutation (an error) in certain genes, acquired pure red cell aplasia is caused by various external factors. Based on the factors involved in the onset of acquired red cell aplasia, it is further categorized into primary and secondary acquired red cell aplasia: 

  • Primary Acquired Red Cell Aplasia: Primary: aPRCA is an autoimmune disease, meaning the immune system makes proteins, called auto-antibodies, that then attack blood-forming stem cells in the bone marrow. 
  • Secondary Acquired Red Cell Aplasia: Secondary aPRCA is thought to be caused either by other medical conditions, such as solid tumors (thymoma), autoimmune diseases (such as systemic lupus erythematosus, chronic lymphocytic leukemia, or rheumatoid arthritis), infections (mainly parvovirus B19), or by certain medications. 

It is thought that primary or secondary aPRCA can be treated by targeting the underlying cause (i.e., autoimmune disease, cancer, or infections). 

How IVIG Therapy Can Treat Acquired Red Cell Aplasia

Man in bed at home receiving IVIG therapy for acquired red cell aplasia

In general, IVIG therapy provides essential antibodies that help to regulate the immune system, either by weakening the overactive immune response or by boosting the immune system activity when necessary. 

For patients with aPRCA, IVIG therapy can help modulate the immune response by: 

  • Regulating Immune Cells: In the case of aPRCA caused by autoimmune conditions, IVIG therapy lessens the activity of certain immune cells, particularly T-cells, that may be involved in attacking the red blood cell precursors. Hence, further damage to the bone marrow can be prevented with the help of IVIG treatment.  
  • Blocking Autoantibodies: In autoimmune disorders, the immune system produces autoantibodies that mistakenly target red blood cells or their precursors, which results in low red blood cell count. IVIG blocks these autoantibodies by binding to them and preventing them from destroying red blood cells in the bloodstream or their precursors in the bone marrow. 

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  • Boosting Immune Response Against Infections: In some cases, acquired red cell aplasia is caused by a viral infection, such as human parvovirus B19. The virus infects the human erythroid progenitors, which are the cells involved in the process of red blood cell production. IVIG helps to boost the immune response in people with weak immune systems by providing essential antibodies. These antibodies target and kill the virus, thus preventing them from attacking erythroid progenitors.  In fact, a research study involving 133 patients with HPV-B19 PRCA showed that 93% of patients experienced an improvement in their hemoglobin levels after the first course of IVIG. This study further suggested that IVIG therapy is effective in treating HPV-B19 PRCA in immunocompromised patients. 
  • Exerting Anti-Inflammatory Effects: During an overactive immune response, inflammation can occur in the bone marrow, which may affect the production of red blood cells. Since IVIG has anti-inflammatory properties, it helps to reduce the inflammation in the bone marrow, creating a more favorable environment for red blood cell production.

What Is the Standard Dose of IVIG for Acquired Red Cell Aplasia?

The dosage of IVIG can vary widely among people. It is typically based on the type of underlying condition causing the aPRCA. For instance, several case studies suggested that a high dose of IVIG (2 g/kg), usually divided over 5 days (400 mg/kg/day), is most effective in treating PRCA associated with parvovirus B19 infection in immunocompromised patients. 

However, for people who experience a relapse (severe anemia) after 3 months, a maintenance dose of 1 g/kg of IVIG over 2 days is recommended. 

It is important to consult your healthcare provider to understand your IVIG treatment period and frequency of doses. 

How Does IVIG Benefit Patients with Acquired Red Cell Aplasia?

IVIG therapy offers several potential benefits to those with acquired red cell aplasia:

  • IVIG rapidly modulates the immune system, which makes it a valuable option for patients who need immediate treatment. 
  • IVIG is a non-invasive treatment that has fewer risks compared to bone marrow transplantation. 
  • IVIG is a versatile therapy due to its multiple modes of action. For patients with aPRCA , it can treat both autoimmune and infection-related causes associated with this condition.

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What To Expect During IVIG Treatment

IVIG treatment is given as a slow infusion into the veins (intravenous or IV). While you receive IVIG treatment, it is possible to experience some mild side effects such as headache, nausea, low-grade fever, or muscle or joint pain. Depending on your situation, you might receive IVIG in a healthcare setting (e.g., an infusion center or a healthcare provider’s office) or at home.

Conclusion

IVIG therapy appears to be an effective option in treating aPRCA, particularly in cases where the cause is a viral infection or an autoimmune condition. However, IVIG therapy can cause some mild effects that should be considered before initiating therapy. Your healthcare provider can discuss the risks and benefits of using IVIG to treat aPRCA based on your clinical situation.

Afstyla: The First Single-Chain Factor VIII Therapy for Patients With Hemophilia A

Published on by Dr. Saba Rassouli, PharmD

Hemophilia A patients tend to bleed longer than healthy individuals since their body lacks a blood clotting factor called factor VIII (FVIII).

If you or your loved one has been experiencing spontaneous and frequent bleeds without any obvious cause, you may want to consider using Afstyla after consulting with your doctor.

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Afstyla is more effective at preventing and treating bleeding episodes in patients with severe hemophilia A than other available blood clotting factor VIII products. Afstyla is the first and only FDA-approved single-chain factor VIII therapy that provides long-lasting protection from bleeds.

In this guide, we will discuss Afstyla and how it can help patients with hemophilia A. We will also take a look at its standard dosage and administration process, potential side effects, estimated costs, and much more.

What Is Afstyla, and What Is It Used For?

Afstyla, also known by its generic name, antihemophilic factor (recombinant), single-chain, is a recombinant product that contains a lab-made form of factor VIII protein.

This artificial form of factor VIII temporarily replaces the missing coagulation factor VIII and helps to clot blood and stop bleeding in patients with hemophilia A (a bleeding disorder that occurs due to a deficiency of clotting factor VIII protein). Hemophilia A is also known as congenital Factor VIII deficiency.

The drug is typically prescribed to adults and children with hemophilia A and is used under the following circumstances:

  • To prevent or reduce the frequency of bleeding episodes (used as a prophylactic agent)
  • To control active bleeds occurring due to accidental injury/trauma (used as an on-demand treatment)
  • To prevent and manage spontaneous bleeds occurring during surgery (perioperative management).

It should be noted that recombinant Afstyla is not approved for use in treating von Willebrand disease.

How Does Afstyla Work and Help Patients With Hemophilia A?

Afstyla contains an active component, lonoctocog alfa, which is a short version of naturally occurring human clotting factor VIII.

The active component in Afstyla works like human factor VIII and becomes activated in the bloodstream when bleeding episodes occur. Once activated, it helps form a clot by working with other proteins in the blood to stop the bleeding.

Moreover, the single-chain structure of the drug is a unique feature that allows it to bind more tightly to the von Willebrand factor (VWF). This protein stabilizes factor VIII in the blood for a long period.

Hence, by binding to VWF, Afstyla does not break down quickly, stays active longer, and works more effectively than traditional blood clotting factor VIII drugs.

What Is the Standard Dose of Afstyla for Hemophilia A Patients?

The standard dosage and frequency of Afstyla are determined based on the severity of factor VIII deficiency, the extent, location, type of bleeding, patient’s clinical condition, and body weight (kg).

1. Dosage for Routine Prophylaxis

The recommended dosing range of this hemophilia medication for adults and children (≥12 years of age) is 20 to 50 IU per kg of Afstyla, which should be given 2 to 3 times a week.

For children under age 12, a dose of 30 to 50 IU per kg is administered 2 to 3 times a week.

2. Dosage for On-Demand Treatment and Control of Bleeding Episodes

For on-demand treatment, Afstyla is given to maintain the factor VIII activity levels within the target range:

  • For minor bleeding (e.g., joint bleeds, minor muscle bleeds, or oral bleeding), Afstyla is administered every 12 to 24 hours to achieve FVIII levels of 20 to 40 IU/dL until the bleeding stops.
  • In cases of moderate bleeding (e.g., muscle and joint bleeds or mild trauma), the medication is administered every 12 to 24 hours to keep FVIII activity levels between 30 to 60 IU/dL until the issue is resolved.
  • For severe or potentially fatal bleeding (e.g., deep muscle and brain hemorrhages, fractures, or head trauma), therapy is administered every 8 to 24 hours to reach FVIII levels of 60 to 100 IU/dL until the bleeding stops.

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3. Dosage for Perioperative Management of Bleeding

During minor and major surgical procedures, Afstyla is used to maintain the FVIII activity levels at or above the target range, which are as follows:

  • During minor surgical procedures (e.g., tooth extraction), to keep FVIII activity levels between 30 and 60 IU/dL, the drug is administered every 24 hours for at least a day until healing is complete.
  • During major surgical procedures (e.g., hip replacement surgery or brain surgery), to keep FVIII activity levels between 80 and 100 IU/dL, the drug is administered every 8 to 24 hours until recovery is complete. The treatment should be administered for at least another 7 days to keep FVIII activity levels between 30 and 60 IU/dL.
A doctor pointing to a blood sample tube with his pen

How Is Afstyla Administered?

Afstyla is administered intravenously (injected into the vein). This drug comes in single-dose vials as a white or slightly yellow dried powder that must be reconstituted (diluted) in sterile water or diluent provided in the kit.

The following are the available color-coded dosing strengths of Afstyla factor VIII therapy:

  • Orange: 250 IU per vial
  • Blue: 500 IU per vial
  • Green: 1,000 IU per vial
  • Turquoise: 1,500 IU per vial
  • Purple: 2,000 IU per vial
  • Cool Grey: 2,500 IU per vial
  • Yellow: 3,000 IU per vial

It is recommended to always check the strength of your prescribed dose printed on the label before using it.

Administration Process

After receiving the appropriate instruction from a qualified healthcare professional, Afstyla can be administered by a caregiver or the patient. Here are some useful tips that can be followed to administer this drug safely.

  • Make sure you follow an aseptic technique when injecting the drug to avoid the risk of injection site-related infections.
  • Do not combine Afstyla with other medications.
  • Always use intravenous injection to administer the medication.
  • The drug should be administered within 4 hours of reconstitution at room temperature.
  • It should only be taken once. After administration, properly dispose of all administration supplies and any leftover solution.

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Side Effects

Afstyla has fewer side effects compared to other available factor VIII medications.

The drug’s safety profile was evaluated in one of the largest FVIII clinical trial programs, including 258 hemophilia A participants. Approximately 14 out of 258 reported the following side effects during clinical trials:

  • Allergic (hypersensitivity) reactions (seen in up to 1 in 10 people)
  • Dizziness (seen in 0.8% of people)

These side effects are temporary and subside after taking medications prescribed by a healthcare provider.

What Precautions Should You Take Before Using Afstyla?

Always consult your healthcare provider before using Afstyla if you:

  • Are pregnant or planning to become pregnant
  • Are breastfeeding
  • Have been told you have FVIII inhibitors (because this medicine may not work for you if you have inhibitors to factor VIII)
  • Are allergic to hamster proteins (because Afstyla is manufactured using this protein)
  • Are using any over-the-counter medications, supplements, or herbal products
  • Have or have had any medical problems

Afstyla Cost

The cost for Afstyla recombinant intravenous powder for injection is around $12 for a supply of 1 powder, depending on the pharmacy you visit.

Manage Hemophilia A with AmeriPharma® Specialty Pharmacy

Afstyla factor VIII therapy offers long-lasting therapeutic benefits for controlling and preventing frequent bleeding compared to other factor VIII medications. However, it is important to consult your doctor before using this medication.

If your doctor finds this medication suitable, you can count on AmeriPharma® Specialty Pharmacy for comprehensive support.

Our URAC-accredited specialty pharmacy offers home infusion therapies, hard-to-find medications, and expert guidance in over 40 U.S. states and territories.

If you or a loved one is navigating the complexities of hemophilia A, contact us for full-service coordination and 24/7/365 support. Get started today!