Adult Dosing
Relapsed or refractory, low grade or follicular, CD20 positive, B-cell Non-Hodgkin's lymphoma
- 375 mg/m2 IV qwk x4-8 wks
Previously untreated follicular, CD20 positive, B-cell Non-Hodgkins lymphoma
- 375 mg/m2 IV given on Day 1 of each cycle of CVP chemotherapy, up to 8 doses
Non-progressing, low-grade, CD20 positive, B-cell Non-Hodgkins lymphoma
- For patients who have not progressed following 6-8 cycles of CVP chemotherapy, 375 mg/m2 IV qwk x4 wks q6 months, up to 16 doses
Diffuse large B cell NHL
- 375 mg/m2 IV on day 1 of each chemo cycle, up to 8 doses
Retreatment therapy for relapsed/refractory, low grade or follicular, CD20 postive, B-cell NHL
Chronic lymphocytic leukemia
- 375 mg/m2 IV on day prior to initiation of FC chemotherapy followed by 500 mg/m2 IV on Day 1 of cycles 2-6 (q4 wks)
Rheumatoid arthritis
- 1000 mg IV q2wks x2 doses
- Give in combination with methotrexate; premedicate with glucocorticoids 30 mins prior to infusion to decrease infusion reactions
Notes:
- Premedicate before each infusion with acetaminophen and an antihistamine. For RA patients, premedicate with methylprednisolone 100 mg IV 30 mins prior to infusion
- Do not administer as an IV bolus. For IV infusion only
- Withdraw the required amount from the vials and dilute to a final concentration of 1-4 mg/mL in an infusion bag containing 0.9% NaCl or 5% dextrose
Pediatric Dosing
- Safety and effectiveness in pediatric patients has not been established
[Outline]
- Fatal infusion reactions including hypoxia, pulmonary infiltrates, ARDS, MI, ventricular fibrillation or cardiogenic shock have occurred in patients receiving rituximab. Approximately 80% of fatal infusion reactions occur with 1st infusion. Monitor patients carefully. Discontinue therapy if severe infusion reactions and provide appropriate treatment [US Black Box Warnings]
- Acute renal failure requiring dialysis with some fatal outcome can occur in setting of tumor lysis syndrome after rituximab therapy [US Black Box Warnings]
- Severe mucocutaneous reactions, some fatal, have been reported with rituximab treatment [US Black Box Warnings]
- The onset of mucocutaneous reactions is variable with reports of occurrence on the first day of exposure to rituximab
- JC virus infection resulting in progressive multifocal leukoencephalopathy and death can occur in patients receiving rituximab [US Black Box Warnings]
- Hepatitis B virus (HBV) reactivation with fulminant hepatitis, hepatic failure, and death can occur in patients with hematologic malignancies treated with rituximab
- Rituximab is not recommended for treatment of patients with severe infections
- Suspend therapy if serious or life-threatening cardiac arrhythmias occur. Perform cardiac monitoring during and after all infusions for patients who develop clinically significant arrhythmia, or who have a history of arrhythmia or angina
- Severe, including fatal, renal toxicity can occur after rituximab administration in patients with NHL. Monitor closely for signs of renal failure and discontinue therapy in patients with a rising serum creatinine or oliguria
- Events of abdominal pain, bowel obstruction and perforation, in some cases leading to death have been reported with the therapy. Perform a thorough diagnostic evaluation and institute appropriate treatment for complaints of abdominal pain
- Safety of immunization with live viral vaccines following rituximab therapy has not been studied
- Monitor HBsAg at baseline if high HBV infection risk; CBC; Plt; ECG during infusion and following infusion if cardiac conditions including. arrhythmias and angina
- Monitor for signs/symptoms of active HBV infection or hepatitis during treatment and for several months after discontinuing if HBV carrier
Cautions: Use cautiously in
- Immunosuppressant use
- Hepatitis B carrier
- SLE
- Arrhythmias
- Angina
- Pulmonary disease
- High tumor burden
- Concomitant cispalstin
- Infection, latent or chronic
- Elderly patients
Pregnancy Category:C
Breastfeeding: Safety unknown. According to manufacturer data therapy should be weighed against the known benefits of breastfeeding.
Pricing data from www.DrugStore.com in U.S.A.
- Rituxan 10 MG/ML CONC [Vial] (GENENTECH)
10 ml = $704.97
30 ml = $1989.92
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
