Standard induction dose: 200 mg by intravenous infusion over at least 1 hour at weeks 0, 4, and 8. After induction, maintenance is usually by subcutaneous injection at specified intervals, based on the patient's response and indication.
Patient Monitoring Requirements
Before infusion: Screen for active or latent infections, including TB and hepatitis; confirm vaccination status with avoidance of live vaccines.
During infusion: Monitor for infusion reactions (rash, itching, dyspnea, hypotension); closely observe for signs of hypersensitivity and infection.
Immediately after infusion: Continue to monitor for delayed hypersensitivity for at least 1 hour; assess vitals and watch for any emerging symptoms.
Periodic liver function tests (liver enzymes, bilirubin) are recommended for at least the first 16 weeks and then as clinically indicated, especially in those with underlying risk for hepatic injury.
Common and Serious Adverse Reactions
Common: Upper respiratory infections, headache, joint pain, diarrhea, injection site reactions, and mild skin or mucosal infections.
Serious: Severe allergic reactions (including anaphylaxis), serious infections (TB, hepatitis reactivation), and rarely hepatotoxicity.
Nurses must be alert for sudden onset of shortness of breath, swelling, severe rash, or hypotension—potential signs of life-threatening hypersensitivity.
Nursing Interventions and Emergency Protocols
For mild, non-life-threatening reactions (e.g., nausea, mild rash): Pause the infusion, assess severity, and provide symptomatic treatment as appropriate.
For severe reactions (anaphylaxis, severe dyspnea, hypotension, throat tightness): Immediately discontinue infusion, activate emergency response (call rapid response/code team), administer epinephrine and other emergency medications, maintain airway, and monitor vitals closely.
Document the reaction thoroughly, notify the prescriber, and ensure the patient receives appropriate follow-up care.
Extravasation Risk Classification and Management
Tremfya is classified as a non-vesicant and generally considered a non-irritant for infusion administration.
If extravasation occurs:
Stop the infusion immediately.
Elevate the affected limb.
Apply cold compress to the site.
Monitor for signs of tissue injury and report to medical staff; further intervention is typically supportive.
No specific antidote or aggressive management required, but documentation and patient reassurance are important.
References
U.S. Food & Drug Administration. Highlights of Prescribing Information: Tremfya (guselkumab). Accessed November 2025. https://accessdata.fda.gov
Tremfya HCP. Dosing in Moderately to Severely Active UC. Accessed November 2025. https://tremfya.com
Tremfya HCP. Moderately to Severely Active UC Dosing. Accessed December 2024. https://tremfyahcp.com
JNJ Medical Connect. Preparation and Administration of TREMFYA for Adult Patients. Published September 12, 2025. https://jnjmedicalconnect.com
IVX Health. Tremfya Infusion Center. Published April 7, 2025. https://ivxhealth.com
