The Ins and Outs of Starting Biologic Injections

Many Crohn’s disease and ulcerative colitis patients are prescribed a biologic treatment, where the method of delivery is via IV infusion or injection. Today, I want to focus on self-injections – from the experience of an IBD patient.

The initial prescription

If your doctor prescribes you a biologic injection, you will need to have some regular testing done before you are able to begin the new medication. This almost always includes TB, hepatitis B, a CBC, and possibly other lab work as well. Once the results come back and you’re approved to begin treatment, there are some variables that must be figured out.

First, where will you get your injection medication from? Will you pick it up from your regular pharmacy? Will you pick it up from a specialty pharmacy? Will your specialty pharmacy deliver it? Next, you’ll need to know how often you’re scheduled to inject the medication, and therefore how often you’ll need refills. Does the medication need to be stored in the fridge? These are important questions to ask your nurse or pharmacist.

The first dose

The first time you inject a biologic, often called a loading dose, the injection will likely be done by a nurse, either in your doctor's office or in your home. The nurse will train you on how to properly follow sterile procedures and inject the medication on your own. This is a great opportunity to ask any questions you may have about the medication, self-injections, etc.

Most medication companies offer injection training kits, welcome packages, nursing support, and a phone number or email address for any additional questions you may have. These are great resources and I highly recommend keeping them on hand.

Maintenance therapy

Once you finish your loading dose(s), you’ll begin maintenance therapy, which is your regular schedule of injections. Some medications require you to inject the medication weekly or bi-weekly, others are once a month or even just twice a year. If giving yourself injections feels challenging, difficult, scary, or emotional – please know you’re not alone.

This is a great opportunity to involve a friend or family member you trust in your IBD care. If someone else will be giving your injection regularly, I’d recommend they participate in the initial training the nurse offers, or that they utilize the medication's website for an injection tutorial.

Tips to prepare for biologic injections for Crohn's or colitis

First, for medication that is stored in the refrigerator, many patients find that taking it out of the fridge a few hours prior to injecting and allowing it to warm to room temperature makes for a more pleasant injection experience.

When you take out your medication, it’s important to check the quality control – ensure that there’s no unusual color or cloudiness in the medication, that the syringe or pen hasn’t been damaged, and that the medication itself is within the expiration date. If you find anything amiss here, it’s critical to call your pharmacy for advice, and to use a backup syringe or pen for your injection if available.

The injection itself is fairly quick, but it’s important to take caution in setting up to have a clean space and everything you need at a finger's reach. This would include alcohol swabs, gauze, bandaids, and your sharps container, as well as a clean dry flat surface (countertop, table, etc).

The big moment: administering your first self-injection

The actual injection takes just a few seconds. You’ll find the designated area on your body, clean it with an alcohol swab, pinch the skin on either side, and stick yourself with the syringe needle or auto-injectable pen tip. The prick of the needle on your skin will likely hurt for a second, but once the needle is in, I’ve found that the pain dissipates.

I’ve also found that patients have different preferences when it comes to injection speed. Some people like to push the medication quickly, remove the needle immediately, and be finished, even if it stings or burns. Others find that pushing or injecting the medication slowly is more comfortable. The decision is really up to you, and my guess is that it’ll come from trial and error.I will say that once you know what to expect, the whole process becomes much easier to tolerate.

Disposing of your needles is an important piece of the process, too. Your medication company will send you a sharps bin to dispose of your needles. When the bin is full, it should have instructions on how to seal it and mail it back for disposal.

Biologic injections for Crohn's or colitis

There you have it.

I know that needles can be intimidating, but you’ve got this. Hopefully what I shared above will help you feel confident and prepared to begin injecting a biologic medication. If you’ve been at this for a while and have other tips or tricks, please drop them below!