The TEPEZZA Infusion Process Explained Step by Step

Starting TEPEZZA treatment (TEPEZZA®/teprotumumab-trbw) can certainly feel like a big leap, especially if one has never received an infusion medication before (1). The good news is that the process is usually predictable and well-structured: most patients who are prescribed Tepezza receive 8 IV infusions, spaced every 3 weeks, over about 5 months. Given below is a clear, step-wise, patient-friendly walkthrough of what happens before, during, and after each infusion, so one can prepare themselves on what to expect and how to stay on track.

Step 1: Confirming if you are a candidate and building a care team

Before the first infusion is scheduled, your thyroid eye disease (TED) specialist will confirm whether TEPEZZA is appropriate for your diagnosis and medical history (2). TEPEZZA is given for the treatment of TED. At this stage, your clinic will typically coordinate with the infusion center (where you will receive the medication), insurance and specialty pharmacy channels (if needed for prior authorization) and your broader care team (endocrinology/primary care) when relevant. Many practices also establish a baseline symptom and eye exam profile (vision, alignment, proptosis measurements) to track progress over time.

Step 2: Understand the dosing schedule (what “8 infusions” really means)

A full course of TEPEZZA treatment typically consists of 8 infusions in total, given once every 3 weeks. The FDA-approved dosing schedule is:

• 1st infusion: 10 mg/kg
• Infusions 2–8: 20 mg/kg every 3 weeks

Step 3: Scheduling and planning the first infusion

Your infusion appointments are usually set well in advance so you can keep consistent timing. A typical schedule would be:

• Infusions 1 and 2: typically take around 90 minutes in the infusion chair
• Infusions 3–8: may be reduced to about 60 minutes if prior infusions were well tolerated

This does not include time needed for check-in, vitals measurement, IV placement, and post-infusion observation.

Step 4: Preparing for your first infusion visit

Infusion centers are typically calm, clinic-like environments with recliners and nursing staff who specialize in IV medications. One can expect to go through:

• Check-in and paperwork (especially for the first visit)
• Vitals (blood pressure, pulse and temperature)
• Symptom review (how you felt after the last infusion, any new issues or discomfort following the prior infusion)
• IV placement in your arm (peripheral IV is common)

Once the IV is placed, you will be seated in an infusion chair (which is usually a recliner) while the medication is administered.

Step 5: The infusion itself (what “getting TEPEZZA” feels like)

TEPEZZA is administered by IV infusion, not by IV push or bolus. IV infusions involve administration of the medication via an IV tubing, one end of which is attached to an IV bag or bottle containing the medication and the other end of which goes into the arm through an IV cannula. The infusion enters the bloodstream by gravitational flow without any positive pressure. During the infusion, one can read, listen to music, work on a laptop, or rest. Some centers allow minimal eating like a light snack, and you can also use the restroom if required (nurses can either pause the infusion or in some centers, the IV setup is usually hung on a mobile carrier). So, the nurses are always monitoring you as per your personal protocol for infusion reactions and overall tolerance (explained next).

Step 6: Monitoring during treatment (why consistency matters)

An important disclaimer contained within TEPEZZA’s patient materials is the importance of completing the full course of all 8 infusions unless your medical team advises otherwise (3). To ensure proper monitoring, clinics often track eye symptom changes such as pressure, pain, redness, excessive tearing, and swelling, vision and double vision changes and other known side effects (e.g., muscle cramps, hearing symptoms, blood sugar changes in some patients). Also, it is increasingly common for clinics to perform audiology monitoring (4). It may be scheduled at baseline and periodically during and after therapy, depending on clinic protocol.

Step 7: Post-infusion monitoring and discharge

Once the infusion is complete, your nurse will remove your IV and recheck your vitals if needed. The staff will walk you through the precautions to be taken and what to watch for at home. They will also have you schedule your next infusion for 3 weeks later. It is important to adhere to the follow-up appointment schedule for the infusions as spacing between treatments is part of the planned treatment regimen.

Step 8: What to expect between infusions

The waiting period between infusions almost always raises two common questions:

1. When will results become noticeable?
2. What are the symptoms to watch out for?

The response time for results varies from patient to patient (5). Some people notice changes early, while others see gradual improvement over the course of the program. Your doctor/specialist will help interpret changes in proptosis/bulging, soft tissue inflammation, diplopia, function and quality of life. Thus, it is always important to follow your prescriber’s guidance. But in general, it is safe to call your care team if you notice sudden vision changes, significant worsening in eye pain, new or rapidly worsening hearing symptoms and severe or concerning systemic symptoms after an infusion. As mentioned above, upon discharge, your infusion center and prescribing team should give you a clear “when to call” list.

Step 9: What to expect after the course of infusions is completed

After the final infusion, you will be asked to schedule follow-ups to document treatment response, monitor for delayed side effects, and decide whether any additional TED management is needed (e.g., supportive care, prism correction, surgical planning, etc.). Proper adherence to continued follow-up visits is the most important and commonly emphasized parameter for all patients receiving TEPEZZA treatment.

To ensure that each TEPEZZA infusion visit goes smoothly, consider bringing your photo ID and insurance card, a snack and water (if allowed), a sweater or blanket (infusion centers can run cool), headphones, a book, or a laptop charger. It is important to either memorize or have a short list of symptoms since your last infusion to make the care team aware of them.

Get Started with TEPEZZA Treatment Today

The TEPEZZA infusion process is designed to be consistent and manageable: 8 infusions, every 3 weeks, with longer early sessions that may be shortened if well tolerated. With good planning and regular follow-up, most patients find the routine becomes familiar after the first visit or two.

If you are interested in learning more about TEPEZZA for thyroid eye disease or considering starting treatment, schedule an appointment with Dr. Raymond Douglas without delay.

References

1. Couch, S. M. Teprotumumab (Tepezza) for Thyroid Eye Disease. Mo Med 119, 36-41 (2022). 
2. Douglas, R. S.et al. Teprotumumab Efficacy, Safety, and Durability in Longer-Duration Thyroid Eye Disease and Re-treatment: OPTIC-X Study. Ophthalmology 129, 438-449 (2022). https://doi.org/10.1016/j.ophtha.2021.10.017
3. <Tepezza FDA label.pdf>.   
4. Hori, K., Wenger, T., Davuluru, S., Zhang-Nunes, S. & Choi, J. S. Otologic Symptoms in Patients Treated With Teprotumumab: A Multi-Institutional National Cohort Study. Laryngoscope 136, 395-402 (2026). https://doi.org/10.1002/lary.700455 Mukit, F. A.et al. Side Effects and Adverse Events After Treatment With Teprotumumab for Thyroid Eye Disease: A Retrospective Observational Case Series. Cureus16, e58585 (2024). https://doi.org/10.7759/cureus.58585