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Docetaxel-Pertuzumab-Trastuzumab Ver 1.3

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Chemotherapy Protocol BREAST CANCER DOCETAXEL-PERTUZUMAB-TRASTUZUMAB This protocol may require funding Regimen • Breast Cancer – Docetaxel-Pertuzumab-Trastuzumab Indication • Locally advanced or metastatic breast cancer that is HER2 or FISH positive provided; - prior adjuvant HER2 therapy has been completed more than 12 months before the diagnosis of metastatic disease - there has been no prior treatment with chemotherapy or HER2 therapy in the metastatic setting • WHO Performance status 0, 1 Toxicity Drug Docetaxel Pertuzumab Trastuzumab Adverse Effect Hypersensitivity, fluid retention, neuropathy, joint pains, nail changes, fatigue Diarrhoea, hypersensitivity reactions, headache, reduced appetite, dyspnoea, cough, vomiting, nausea, constipation, rash, pain, oedema, fatigue, asthenia, cardiotoxicity Cardio toxicity, acute respiratory distress syndrome, infusion related effects The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. The diarrhoea can be severe in patients treated with pertuzumab. It is important to ensure patients are given appropriate therapy for the treatment of diarrhoea. This is not included in the regimen on Aria and must be added from the support folder. Version 1.3 (July 2024) Page 1 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Monitoring Regimen • HER2 status before initiating therapy • Cardiac function must be assessed prior to starting treatment Thereafter, cardiac function should be assessed every 9 weeks and as clinically indicated. • Blood pressure on day 1 of each cycle • FBC, U&Es and LFTs prior to each cycle with docetaxel Dose Modifications Please discuss all dose reductions / delays with the relevant consultant before prescribing if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematology The following guidelines apply to docetaxel only. No dose modifications for haematological toxicity are necessary for pertuzumab or trastuzumab. If treatment with pertuzumab or trastuzumab is not tolerated it should be stopped. Prior to prescribing cycle one the following treatment criteria must be met; Criteria Neutrophil Platelets Eligible Level Greater than or equal to 1.5x109/L (unless due to bone marrow impairment) Greater than or equal to 100x109/L (unless due to bone marrow impairment Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL Version 1.3 (July 2024) Page 2 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Toxicity Neutropenia Grade (NCI-CTC) 1 2 3 4 75mg/m2 75mg/m2 Delay until grade 1 then 75mg/m2 Delay until grade 1 then 75mg/m2 Delay until grade 1 then 60mg/m2 60mg/m2 60mg/m2 Delay until grade 1 then 60mg/m2 Delay until grade 1 then 60mg/m2 Stop Febrile 3 Neutropenia 4 Delay until grade 1 then 60mg/m2 Delay until grade 1 then 60mg/m2 Stop Stop Platelets Greater than or equal to 100x109/L Less than 100x109/L 75mg/m2 Delay until greater than or equal to 100x109/L the 60mg/m2 60mg/m2 Stop Hepatic Impairment Drug Docetaxel Pertuzumab Trastuzumab Recommendation 1.5xULN 2.5xUL N/A or and N or Give 75% greater greater Greater than ULN and/ or 3.5xULN or greater and 6xULN or greater Not recommended The safety and efficacy of pertuzumab has not been established in hepatic impairment No dose adjustment necessary Renal Impairment Drug Docetaxel Pertuzumab Trastuzumab Dose (% of original dose) No dose adjustment necessary No dose adjustment necessary in mild to moderate renal impairment. No information in severe renal impairment – clinical decision No dose adjustment necessary Version 1.3 (July 2024) Page 3 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Other Docetaxel Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Peripheral neuropathy at NCI-CTC grade 3 should result in a dose reduction from 75mg/m2 to 60mg/m2 once the neuropathy has resolved to NCI-CTC grade 2 or below. If the NCI-CTC grade 3 neuropathy occurred at doses lower than 75mg/m2 or a NCI-CTC grade 4 toxicity develops consider stopping treatment. Excessive tearing / lacrimation are related to cumulative docetaxel doses and occur after a median of 400mg/m². Symptomatic treatment with hypromellose 0.3% eye drops four times a day may help. However, if the ocular irritation continues reduce the docetaxel dose to 80% of the original dose in the first instance. Delay the docetaxel where a NCI-CTC grade 3 cutaneous toxicity is present on day one of the cycle until it resolves to NCI-CTC grade 1 or below. The subsequent doses of docetaxel should be reduced from 75mg/m2 to 60mg/m2. If it occurs with a dose of 60mg/m2 or if there is no recovery after two weeks, docetaxel treatment should be stopped. Where a NCI-CTC grade 3 cutaneous toxicity occurs between cycles with recovery by day one then reduce the docetaxel dose as described. Docetaxel should be stopped in response to a NCI-CTC grade 4 cutaneous toxicity. Pertuzumab The diarrhoea can be severe in patients treated with pertuzumab. It is important to ensure patients are given appropriate therapy for the treatment of diarrhoea. This is not included in the regimen on Aria and must be added from the support folder. Pertuzumab and Trastuzumab Cardiac The LVEF should be fifty or above before starting cycle one of pertuzumab and trastuzumab. Subsequent Echocardiograms The flow chart below describes the process to be followed if there is an asymptomatic decline in LVEF during pertuzumab and trastuzumab treatment. This is taken from the study protocol as used in the reference section. Study treatment refers to pertuzumab and trastuzumab. Version 1.3 (July 2024) Page 4 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Version 1.3 (July 2024) Page 5 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab In general patients who develop symptomatic cardiac dysfunction should have pertuzumab and trastuzumab discontinued, be commenced on ACE inhibitor therapy and be referred to a cardiologist. Further treatment should be discussed with the relevant oncology consultant. Regimen 21 day cycle for 6 cycles of docetaxel, pertuzumab and trastuzumab. Pertuzumab and trastuzumab are then continued until disease progression or intolerance. This will be set up in Aria with six cycles. Cycle 1 Drug Docetaxel Pertuzumab Trastuzumab Dose 75mg/m2 840mg 8mg/kg Days 2 1 1 Administration Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 90 minutes Cycle 2, 3, 4, 5, 6 Drug Docetaxel Pertuzumab Trastuzumab Dose 75mg/m2 420mg 6mg/kg Days 1 1 1 Administration Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Cycle 7, 8, 9, 10, 11, 12 onwards Drug Pertuzumab Trastuzumab Dose 420mg 6mg/kg Days 1 1 Administration Intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Dose Information • The dose of docetaxel may be increased to 100mg/m2 from cycle two onwards if well tolerated. • Docetaxel induced fluid retention can lead to weight gain. This is not a reason to alter the doses • Docetaxel will be dose banded as per the CSCCN agreed bands Version 1.3 (July 2024) Page 6 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab • If the time between two sequential infusions of pertuzumab is less than six weeks, the 420mg dose should be administered as soon as possible without regard to the next planned dose. If the time between two sequential infusions is 6 weeks or more, the initial loading dose of 840mg should be readministered as a 60 minute intravenous infusion followed every 3 weeks thereafter by a maintenance dose of 420 mg administered over a period of 30 to 60 minutes. • Trastuzumab will be dose banded in accordance with national dose bands (21mg/ml) • If the patient misses a dose of trastuzumab by fourteen days or less, then the usual maintenance dose of 6mg/kg should be given as soon as possible. Do not wait until the next planned cycle. Subsequent maintenance doses should be given according to the previous schedule • If the patient misses a dose of trastuzumab by more than fourteen days, a reloading dose of 8mg/kg should be given over 90 minutes. Subsequent maintenance doses should then be given every 21 days from that point Administration Information Hypersensitivity reactions tend to occur with the first or second infusion of docetaxel. The docetaxel infusion should not be interrupted for minor symptoms such as flushing or localised rashes. Immediately discontinue the infusion for severe reactions which include profound hypotension, bronchospasm and generalised erythema. • Docetaxel doses of more than 200mg should be diluted in 500ml sodium chloride 0.9% (maximum concentration 0.74mg/ml) • Pertuzumab has been associated with hypersensitivity and infusion related reactions. Patients should be observed for 60 minutes after the first infusion and for 30 – 60 minutes after subsequent infusions. If patients have tolerated the first two infusions with no infusion related reactions consideration can be given to reducing this observation period. • Trastuzumab is associated with hypersensitivity reactions. Patients should be observed for six hours following the start of the first infusion of trastuzumab and for two hours following the start of subsequent infusions. If the patient has tolerated the first two infusions with no infusion related effects consideration can be given to reducing this observation period further Extravasation • Docetaxel – exfoliant • Pertuzumab - neutral • Trastuzumab - neutral Version 1.3 (July 2024) Page 7 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Additional Therapy • Antiemetics (docetaxel cycles only) 15-30 minutes before chemotherapy - metoclopramide 10mg oral or intravenous As take home medication - metoclopramide 10mg three times a day when required oral • To prevent fluid retention and hypersensitivity reactions prescribe dexamethasone 8mg twice a day orally for three days starting 24 hours before the docetaxel administration. On the occasions where individuals attend for treatment and have forgotten to take the dexamethasone premedication administer dexamethasone 20mg once only dose intravenous bolus. • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. • Diarrhoea is a common adverse effect, particularly on cycle one. Consider prescribing loperamide 4mg after the first loose motion then 2mg after each loose motion thereafter. This can be added from the support folder in Aria. • For treatment of pertuzumab or trastuzumab infusion reactions ‘once only when required’ doses of the following should be prescribed; - chlorphenamine 10mg intravenous - hydrocortisone 100mg intravenous - paracetamol 1000mg once oral Coding (OPCS 4.6) • Procurement – X70.8 (unspecified) • Delivery – X72.9 References 1. Baselga J, Cortes J, Sung-Bae K et al. Peruzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 2012; 366 (2): 109-119 Version 1.3 (July 2024) Page 8 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab REGIMEN SUMMARY Docetaxel-Pertuzumab-Trastuzumab Cycle 1 Day One 1. Pertuzumab 840mg intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes 2. Trastuzumab 8mg/kg intravenous infusion in 250ml sodium chloride 0.9% over 90 minutes 3. Chlorphenamine 10mg intravenous when required for infusion related reactions 4. Hydrocortisone 100mg intravenous when required for infusion related reactions 5. Paracetamol 1000mg oral when required for infusion related reactions Take Home Medicines 6. Dexamethasone 8mg twice a day oral for 3 days starting the day before the docetaxel infusion (day two of treatment) Administration Instructions Please supply sufficient for cycles one and two. 7. Metoclopramide 10mg three times a day when required oral Cycle 1 Day Two 8. Dexamethasone 8mg twice a day oral (from TTO) 9. Metoclopramide 10mg oral or intravenous 10. Docetaxel 75mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Cycle 2, 3, 4, 5 Day One 11. Dexamethasone 8mg twice a day oral (from TTO) 12.Pertuzumab 420mg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 13. Trastuzumab 6mg/kg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 14. Metoclopramide 10mg oral or intravenous 15. Docetaxel 75mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Version 1.3 (July 2024) Page 9 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab 16. Chlorphenamine 10mg intravenous when required for infusion related reactions 17. Hydrocortisone 100mg intravenous when required for infusion related reactions 18. Paracetamol 1000mg once only oral when required for infusion related reactions Take Home Medicines 19. Dexamethasone 8mg twice a day oral for 3 days starting the day before the docetaxel infusion 20. Metoclopramide 10mg three times a day when required oral Cycle Six Day 1 21. Dexamethasone 8mg twice a day oral (from TTO) 22.Pertuzumab 420mg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 23. Trastuzumab 6mg/kg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 24. Metoclopramide 10mg oral or intravenous 25. Docetaxel 75mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes 26. Chlorphenamine 10mg intravenous when required for infusion related reactions 27. Hydrocortisone 100mg intravenous when required for infusion related reactions 28. Paracetamol 1000mg once only oral when required for infusion related reactions Take Home Medicines 29. Metoclopramide 10mg three times a day when required oral Cycle 7, 8, 9, 10, 11 30.Pertuzumab 420mg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 31. Trastuzumab 6mg/kg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 32. Chlorphenamine 10mg intravenous when required for infusion related reactions 33. Hydrocortisone 100mg intravenous when required for infusion related reactions Version 1.3 (July 2024) Page 10 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab 34. Paracetamol 1000mg once only oral when required for infusion related reactions Cycle 12 35. Warning – Check further cycles required 36.Pertuzumab 420mg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 37. Trastuzumab 6mg/kg intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes 38. Chlorphenamine 10mg intravenous when required for infusion related reactions 39. Hydrocortisone 100mg intravenous when required for infusion related reactions 40. Paracetamol 1000mg once only oral when required for infusion related reactions Version 1.3 (July 2024) Page 11 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab DOCUMENT CONTROL Version Date Amendment Written By 1.3 July 2024 Trastuzumab updated with national dose banding Alexandra Pritchard Pharmacist Pertuzumab default 1.2 April 2015 administration rate for cycle 2 onwards changed to 30 minutes Rebecca Wills Pharmacist Bolus removed from intravenous Donna Kimber 1.1 Aug 2014 bolus throughout text Pharmacy Technician 1 Dec 2013 None Dr Deborah Wright Pharmacist Approved By Nanda Basker Pharmacist Dr Debbie Wright Pharmacist Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Caroline Archer Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.3 (July 2024) Page 12 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab Version 1.3 (July 2024) Page 13 of 13 Breast –Docetaxel-Pertuzumab-Trastuzumab
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/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Docetaxel-Pertuzumab-Trastuzumab.pdf

Carboplatin-Docetaxel-Pertuzumab-Trastuzumab_IV

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Chemotherapy Protocol BREAST CANCER CARBOPLATIN (AUC 6)-DOCETAXEL-PERTUZUMABTRASTUZUMAB (IV) Regimen • Breast Cancer – Carboplatin (AUC6)-Docetaxel-Per
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/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Carboplatin-Docetaxel-Pertuzumab-Trastuzumab-IV.pdf

Varicocele embolisation - patient information

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This factsheet explains what varicocele embolisation is, what the procedure involves and what the possible risks are.
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/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Varicocele-embolisation-3609-PIL.pdf

Duodenal atresia - patient information

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A scan has shown that your baby may have a condition called duodenal atresia.
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/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Duodenal-atresia-2828-PIL.pdf

Congenital diaphragmatic hernia (CDH) - patient information

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This factsheet has been designed to accompany the individualised discussions you will have about your care and the care of your
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/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Congenital-diaphragmatic-hernia-CDH-2825-PIL.pdf

Caesarean scar pregnancy (viable) - maternity information

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This factsheet explains what a caesarean scar pregnancy is, the risks associated with it and the options available to you.
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/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Caesarean-scar-pregnancy-viable-1663-PIL.pdf

Chimeric antigen receptor T-cell (CAR-T) therapy - patient information

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This factsheet explains what chimeric antigen receptor T-cell (CAR-T) therapy is and what it involves so you know what
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/Media/UHS-website-2019/Patientinformation/Cancercare/Chimeric-antigen-receptor-T-cell-CAR-T-therapy-3739-PIL.pdf

What to expect after a major trauma - patient information

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This factsheet contains important information about what to expect after a major trauma and who to contact if you need additional support.
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/Media/UHS-website-2019/Patientinformation/Major-Trauma-Centre/What-to-expect-after-a-major-trauma-3731-PIL.pdf

Hepatitis B in pregnancy - patient information

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Patient information factsheet Hepatitis B in pregnancy All pregnant women are offered a blood test for hepatitis B as part of their antenatal care. You have tested positive for hepatitis B and your baby will need to have an injection when they are born in order to prevent them from being infected with the virus. This factsheet explains more about this and the other injections your baby will need. We hope it helps to answer some of the questions that you may have. What is hepatitis B? Hepatitis B is a virus that affects the liver. It can cause damage to the liver if it’s not managed properly. How did I get it? It is often not possible to pinpoint exactly when someone caught hepatitis B. • It can be passed from mother to child during birth. • It can also be found in body fluids such as blood and semen and passed on through sexual contact, or from sharing injecting, tattooing or acupuncture needles. • It can also be passed on by sharing items such as toothbrushes, razors or nail clippers. It is not passed by sharing cups or plates. • Occasionally it can be passed by blood transfusions or medical treatment in countries where equipment or blood products may not be sterilised or screened properly. It’s estimated that a third of the world’s population has or has had hepatitis B at some point in their lives. Hepatitis B is more widespread in some areas, especially China, Africa and Eastern Europe. Most people who develop life-long (chronic) hepatitis B have caught it as a child, at a time when their immune system is not well developed. The most common causes of transmission in children are during childbirth or between children when they play. However, it’s also possible for people who have become infected in adulthood to develop chronic hepatitis B. Most adults who catch hepatitis B as an adult will get rid of it, as their immune system is stronger. When adults catch it, they become unwell and this is called ‘acute hepatitis B’. Is it possible to get rid of hepatitis B? Do I need treatment? It’s not usually possible to get rid of hepatitis B once you have been infected for more than six months. Not everyone with hepatitis B needs treatment though. Most people simply require monitoring (via blood tests). 1 www.uhs.nhs.uk Patient information factsheet We tend to give treatment to people if: • the virus is damaging the liver • you have a high level of the virus in your blood and become pregnant (see below) How can I make sure I don’t pass hepatitis B on to others? A vaccination is available which protects others from getting the virus. To stop the virus being transmitted, it’s essential that your sexual partner/s, children and people who live in the same house as you are tested to see whether they have hepatitis B already. If they are found not to have the virus (test negative), they will need to start a course of vaccinations performed by their GP. There are several different vaccination schedules used. It’s extremely important the person completes the course of vaccinations, otherwise they may not be fully protected. We also advise: • using condoms during sexual intercourse • not sharing toothbrushes, razors and nail clippers What are the chances of me passing hepatitis B on to my baby? Women with a low level of the virus in their blood have an approximately 10 to 20% chance of passing the virus on to their baby if no preventative measures are taken. In mothers with a high level of the virus in their blood, the risk is much higher; 70 to 90% of babies will catch hepatitis B from their mother in these cases. However, hepatitis B will not be passed on to 95% of babies born to mothers with the virus if the advice below is followed. What do I need to do to prevent passing hepatitis B on to my baby? There are three steps to preventing transmission to your baby: 1. Vaccination This is the most important step. Your baby will require four vaccinations within their first year of life. They will then need a ‘booster’ with their preschool vaccinations (at three-and-a-half years of age). The vaccinations are given at the following times (this is called the accelerated course): Vaccination 1: within 24 hours of birth – the doctor at the hospital will do this. Vaccination 2: at one month old – given by GP. Vaccination 3: at two months old – given by GP. Vaccination 4: at 12 months old – given by GP. Vaccination 5: with their other pre-school vaccinations (at three-and-a-half years old) – given by GP. It is extremely important to complete the course of vaccinations; otherwise your baby may not be protected. 2 www.uhs.nhs.uk Patient information factsheet 2. Immunoglobulin This is only necessary in rare cases. This is an injection given at the hospital if the baby is quite small or if you have a particularly high level of the virus in your blood. Immunoglobulin protects the baby from the hepatitis B virus in the first period after birth, when the vaccination alone may not be enough. 3. Medication In rare cases, some pregnant women with a high level of hepatitis B virus in their blood may be advised to start a course of treatment in the final trimester (the last three months) of pregnancy. The aim of the treatment is to reduce the amount of the virus in the blood. We know that by doing this we reduce the likelihood of passing the virus on to the baby. The medication you are most likely to be given is called Tenofovir. It is not known to be harmful to unborn babies or to cause birth defects and is recommended by the European Association of the Study of the Liver (EASL). It is really important you take the tablet every day and do not miss any doses. We advise mothers who are started on this treatment to take it for approximately four to 12 weeks after birth. We will advise you on exactly when to stop it and will then monitor your bloods closely. Occasionally, depending on your blood test results, we may advise you continue the medication long-term. Is it safe to breastfeed if I have hepatitis B/am taking Tenofovir? It is safe to breastfeed your baby provided they have received the first vaccination (and completes the course). It’s thought to be extremely unlikely that hepatitis B can be passed via breast milk, unless your nipples become cracked and start bleeding. If this happens we would advise you to stop breastfeeding temporarily. Tenofovir does pass into breast milk, meaning that the baby is exposed to small amounts of the drug. However, evidence to date does not suggest this will cause the baby harm. Tenofovir is therefore the drug recommended for women who have tested positive for hepatitis B and wish to breastfeed. Testing your baby for hepatitis B It is essential that your baby has a blood test when he or she is 12 months old to check the vaccinations have worked and that their blood shows no signs of the virus. The GP will arrange for you to bring your baby to the hospital to have the test. The test is important as although the vaccinations, immunoglobulin and medication work really well there is still a small risk. If your baby is found to have caught hepatitis B we can provide the most appropriate care. Please be aware that if all the advice has been followed this is very rare. Your postnatal hepatology appointment Although you may feel very well and not have any side effects from hepatitis B after your baby is born, you should remain under the care of the hepatology team (hepatology means liver disease). This is because your condition can change and we may need to start you on treatment. 3 www.uhs.nhs.uk Patient information factsheet Often people do not feel unwell when these changes occur but we can see them in your blood tests. This is most important in the two to three month period after your baby is born. During this time some mothers find that their hepatitis B gets worse although they feel fine (this is known as a ‘flare’). Attending your postnatal hepatology appointment is very important to protect your long-term health. Remember that the best way you can look after your baby is to look after yourself too. We are often happy to monitor your bloods remotely (in our virtual clinic) so you do not always have to come to the hospital. We will discuss this option with you. Practical tips We advise that you register your baby’s birth at the Registrar’s office as soon as possible, and then register the baby with your GP soon afterwards. (We recommend you register your baby to the same GP as you, making it easier for the GP to manage both your care and that of your baby). Once your baby is registered you can book the appointment for them to have their second vaccination. Keep a record of your baby’s vaccinations at home so you know exactly when they were done, when the next one is due and any results. Who to contact for help If your query relates to hepatitis B (this includes questions about your hepatitis B medication, follow-up care and any other concerns) contact the hepatology nurses on 023 8120 4617. If your query relates to booking a vaccination appointment, contact your GP. If your query relates to your pregnancy or the general wellbeing of your baby, contact your midwife or health visitors. Hepatology D Level West Wing Mailpoint 72 Southampton General Hospital Tremona Road Southampton SO16 6YD Main switchboard telephone: 023 8077 7222 Useful links www.nhs.uk/conditions/Hepatitis-B/Pages/Introduction.aspx www.hepb.org/pdf/pregnancy.pdf If you are a patient at one of our hospitals and need this document translated, or in another format such as easy read, large print, Braille or audio, please telephone 0800 484 0135 or email patientsupporthub@uhs.nhs.uk For help preparing for your visit, arranging an interpreter or accessing the hospital, please visit www.uhs.nhs.uk/additionalsupport 4 Version 2. Published May 2024. Due for review May 2027. 917 www.uhs.nhs.uk
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/Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Hepatology/Hepatitis-B-in-pregnancy-917-PIL.pdf

Anti-VEGF injection treatment - patient information

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You have been given this factsheet because your doctor has recommended anti-VEGF injection treatment for your eye condition.
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/Media/UHS-website-2019/Patientinformation/Eyes/Anti-VEGF-injection-treatment-1331-PIL.pdf
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