Gilenya Protocol
Unlocking the Gilenya Protocol: A comprehensive guide to navigating the administration, precautions, and monitoring procedures associated with Gilenya, a leading treatment for multiple sclerosis.
2023-12-20 12:20:29 - Editor
Preliminary Labs:
- CBC, Varicella Zoster Antibodies
- (If not immune to Varicella, vaccination required and patient has to wait for one month before we consider Gilenya)
- EKG QTc >450 ms in males or >470 msec in females is abnormal
- Pregnancy test
- JCV
Precautions:
- No live vaccines while on Gilenya or for two months after terminating Gilenya
- Check for any medications that interfere with AV conduction. Check for heart failure.
- Inquire about any recent TIA / Stroke which increases risk of adverse effects.
- Avoid any meds that prolong QTc
Contradindications:
- Within the last 6 months: MI, unstable angina, stroke, TIA, decompensated Heart Failure
- Mobitz Type II second degree or third degree AV block
- Sick sinus Syndrome
- QTc >500 msec
- Cardiac arrhythmias that requred Class Ia or III antiarrhythmic
- Allergy to Gilenya
- Pregnancy
Admininstration protocol:
- Gilenya 0.5 mg one dose
- 6 hours of cardiac monitoring (specifically watch for third degree AV block and AV block with junctional escape)
- Hourly HR and BP for 6 hours
Cardiology consult and CONTINUE monitoring IF
- HR < 45
- Second degree AV block or higher
- Continue Monitoring longer IF
- If heart rate post dose at 6 hours is the lowest dose post dose
- Pharmacological treatment required for bradycardia
Outpatient dosing of Gilenya after first dose:
0.5 mg daily
Outpatient monitoring and adverse effects while on Gilenya:
- CBC (Lymphocyte count expected to reach 30% of baseline in 2 weeks)
- JCV titer: risk of PML
- Opthalmology followup for Macular edema
- Headache and altered mental status: consider PRES
- Increased BP
- Liver dysfunction
- Malignancies
- Shortness of breath