Patient Instructions (Immunosuppression Safety & Monitoring)

Patient Name: [Patient name]

Date of Birth: [Date of birth]

Date: [Encounter date]

Clinician/Service: [Ordering clinician or service]

Clinic Phone: [Clinic phone number]

After-Hours/Urgent Line: [After-hours or on-call number]

Key Takeaways

• Know your medicines: You are on immunosuppressive therapy: [Medication name(s) with brand in parentheses if applicable] (Include all immunosuppressive medicines, including steroids if applicable.)
• Reduce infection risk: These medicines weaken your immune system and can make infections more serious or harder to fight.
• Act if you get a fever: Fever is ≥100.4°F (38°C). Call the clinic the same day if you have fever or feel significantly ill. (If medication-specific hold rules are documented, include here. Otherwise state: "Do not stop or hold your medicine unless the clinic tells you to.")
• Follow the vaccine rule: Non-live vaccines are generally safe; live vaccines need clinician approval. Ask before any live vaccine.
• Keep labs on time: [Labs needed and frequency if documented]. Next labs due: [Next due date or "Please call the clinic to confirm"].
• Watch for red flags: Go to ER now for trouble breathing, chest pain, confusion/fainting, severe allergic reaction, or blue lips. Call the clinic urgently for fever/chills, new blistering rash, severe sore throat with fever, persistent vomiting, unusual bruising/bleeding, or yellow skin/eyes.
• (Include only if patient is on chronic steroids) Do not stop steroids suddenly—call us first.

Your Medication(s)

• [Generic name] ([Brand name]) — [oral / subcutaneous / intravenous / other], [frequency] (Include start date if starting today or recently.)
• (Repeat for each additional immunosuppressive medicine.)

(Include only for methotrexate) Methotrexate safety: This is taken once weekly, NOT daily.

(If no specific medicines are documented) These instructions apply generally to immunosuppressive therapy. Please confirm your exact medication list and schedule with the clinic.

If You Get Sick

Everyday prevention

• Wash hands often and avoid close contact with people who are visibly ill.
• Notify the clinic before travel or if you will be in high-risk settings.

Mild symptoms (no fever, improving)

• Continue your medicine unless told otherwise.
• Monitor symptoms and contact the clinic if worsening.

Fever or suspected infection

• Fever is temperature ≥100.4°F (38°C).
• Call the clinic the same day for fever, new infection symptoms, or if you are prescribed antibiotics.
• (If medication-specific hold guidance is documented, include it; e.g., "For biologics or methotrexate: Hold the next dose until you speak with the clinic.")
• (If no medication-specific guidance is documented) Do not stop or hold your medicine unless the clinic tells you to—call us the same day.

Call 911 or go to the ER now

• Trouble breathing or severe shortness of breath
• Chest pain
• Confusion, fainting, or you cannot stay awake
• Severe allergic reaction (swelling of face/tongue, difficulty breathing)
• Blue or gray lips or skin

Call the clinic urgently (same day)

• Fever or shaking chills
• New painful rash with blisters
• Severe sore throat with fever
• Persistent vomiting or inability to keep fluids down
• Unusual bruising or bleeding
• Yellowing of skin or eyes

Vaccines

• Generally safe (non-live): Flu shot (injection), pneumonia vaccines, shingles vaccine (Shingrix), COVID-19 vaccines, hepatitis B. These may be less effective while on immunosuppressive therapy.
• Avoid unless approved by your doctor (live): Nasal spray flu vaccine, MMR, chickenpox (varicella), yellow fever, oral typhoid.

Household members should stay up to date on vaccines. Bring vaccine records to your next visit or upload them to the patient portal.

Labs & Follow-Up

(List required monitoring using patient-friendly names. Include frequency and next due date if documented.)

• [Test name, e.g., Blood counts]: [Frequency]; Next due: [Date or "Please call to confirm"]
• (Repeat for each required test.)

We will contact you if results are urgent or abnormal. You can view results in the patient portal. Do not change your dose based on labs unless instructed.

(Include only if a procedure is upcoming and documented) If you have an upcoming surgery, dental work, or procedure, notify the surgeon/dentist and our clinic ahead of time so we can provide a safe medication hold plan.

Next appointment: [Date and time if scheduled, otherwise "To be scheduled—contact the clinic"]

Contact Us

• Routine questions: [Patient portal or clinic phone]
• Urgent same-day: [Nurse line or urgent number]
• After-hours: [On-call instructions or after-hours number]
• Emergencies: Call 911