Obtain complete blood counts (CBC) including platelets prior to the first dose. 792FM.2 RITUXIMAB INTRAVENOUS INFUSION FOR RHEUMATOID ARTHRITIS (RA) AND VASCULITIS Target Audience: Health professionals in secondary care Rituximab is a genetically engineered chimeric mouse/human monoclonal antibody. The drug is infused in hospital over four to six hours on each visit. Chemocare.com uses generic names in all descriptions of drugs. Rituximab has been shown to be an effective alternative treatment and is . First infusion rate for low risk patients The recommended initial rate for infusion is 50 mg/hour; after the first 30 Oral can be given whilst Rituximab running or IV given when Rituximab has finished, due to incompatibility. Continue to monitor for cytopenias after final dose and . Female patients should be advised on and agree to use effective contraceptive Preparations & Storage: there is a significant NHS cost saving in terms of reduced NHS activity (50%) and reduced drug costs (40%) compared to the higher licensed . Repeat cyclophosphamide & Rituximab 2 weeks later. 2for NHL and 500mg/m for CLL) rituximab infusion at standard rate without a grade 2 or more infusion-related adverse reactions when rituximab is prescribed in the following settings: Infusion reactions may cause hives, itching, shortness of breath, chest pain or dizziness and are a very common side effect of treatment with . Rituximab is given by intravenous infusion, initially, two infusions are given two weeks apart. Rituximab: Administer as two 1000 mg IV infusions separated by 2 weeks. Rituximab suppresses the immune system. Rituxan is the trade name for rituximab. Rituximab is used to treat a range of inflammatory conditions, including cancers and leukaemia. rituximab administration guidelines 5. It is a 'biologic' medicine, that is, it is a manmade version of a naturally occurring antibody. Patient and carer advice For rituximab Alert card 4. Rituximab during pregnancy and breastfeeding. Hydrocortisone 100mg intravenous once only when required for the relief of rituximab infusion related reactions 6. It is licensed for use in RA with concomitant use of methotrexate following failure or intolerance to one or more Subsequently, you may be given six monthly or a variable dosing regime depending on B cell production. Rituximab. Hydrocortisone 100mg intravenous once only when required for the relief of rituximab infusion related reactions 6. Rituximab Infusion Rates: First cycle of rituximab should commence at 50mg/hour and increase in rate by 50mg/hour every 30 minutes (to a maximum of 400mg/hour) provided the patient does not develop any signs of infusion reaction. 3. RITUXIMAB PROTOCOL FOR GLOMERULONEPHRITIS (ADULT) 5 For infants exposed in utero to rituximab close to delivery, blood analysis to rule out hematological abnormalities is recommended as rituximab may affect fetal and neonatal B -cell development, potentially leading to increased susceptibility to infections. Rituximab 375mg/m2 intravenous infusionin 500ml sodium chloride 0.9% as per the rituximab administration guidelines 5. 12 It works by removing a particular type of white blood cell (B lymphocytes) by sticking to the proteins on the surface of the cell. Salbutamol 2.5mg nebule once only when required for the relief of rituximab related bronchospasm Take Home Medicines 7. During Rituxan therapy: Obtain CBC with differential and platelet counts at 2- to 4-month intervals during Rituxan therapy. Further doses of cyclophosphamide on its own may be given for a further . Biological medicines must be prescribed and dispensed by brand name, see Biological medicines and Biosimilar medicines, under Guidance on prescribing. 11. Therefore, serious fungal, bacterial and new or reactivated viral infections (for example, hepatitis B or C, shingles) can occur during or after treatment. This is known as an intravenous infusion. The cells that Rituximab affects help to fight infection. The 90-minute RITUXAN infusion rate for appropriate patients is 1: 20% of the total dose over the first 30 minutes (75 mg/m 2) 80% of the total dose over the following 60 minutes (300 mg/m 2) If the 90-minute infusion is tolerated in Cycle 2, the same rate can be used when administering the remainder of the treatment regimen (through Cycle 6 or 8) . A biosimilar is a biologic medical product that is almost an identical copy of an original medication that is manufactured by a different company. RA non-responders (especially when non-depleted) may respond to retreatment at 6 months. Rituximab is a biological medicine. 2.0 Infusion rates There are four different infusion rates that Rituximab can be given at:- 1. This is done by a doctor or nurse, so they can check if you have any side effects while you're taking rituximab. 10. Salbutamol 2.5mg nebule once only when required for the relief of rituximab related bronchospasm 2. Rituximab infusion reactions are caused primarily by cytokine release in the body. Generally, rituximab is avoided in the presence of active, significant infections. Prior to first infusion: Screen all patients for HBV infection by measuring HBsAg and anti-HBc before initiating treatment with Rituxan. The effects of rituximab usually last for between six and nine months. NB this guideline does not cover the use of sub-cutaneous rituximab. Patients receiving subsequent rituximab infusion who have received and tolerated first full dosethe (375mg/m. GPA and MPA - 375 mg/m2 body surface area, once weekly iv infusion for 4 weeks (four infusions in total - though some specialists use the RA protocol). Oral Mesna 7.5mg/kg (Max 500mg) oral or IV. is that both protocols appear equally effective. Rituximab. 12. Cytokines are immune system proteins in the body that help to fight infections but can cause an inflammatory response. In a retrospective review of 65 patients, the two regimens were compared and . CLL4 Trial Protocol (Chronic Lymphocytic Leukaemia Trial 4: A Randomised Comparison of Chlorambucil, Fludarabine and Fludarabine Plus Cyclophosphamide.). Rituximab in Neurological Disease Protocol (Use of) Date Ratified: March 2009 Date to be Reviewed: March 2011 Page 6 of 21 2. Rituximab Infusion Rates: First cycle of rituximab should commence at 50mg/hour and increase in rate by 50mg/hour every 30 minutes (to a maximum of 400mg/hour) provided the . Rituximab is known to interact poorly with the anti-psychotic drug 'clozapine'. In some cases, health care professionals may use the trade name rituxan when . infusion rate for rituximab. Rituxan solutions for infusion have been shown to be stable for an additional 24 hours at room temperature; however, since Rituxan solutions do not contain a preservative, diluted solutions should be refrigerated at 2C to 8C.13 1PROVIDE MEDICATION GUIDE TO PATIENT PRIOR TO RITUXAN INFUSION 2USE THE INFUSION FLOW SHEETTO RECORD ASSESSMENT Allopurinol 300mg once a day oral for 21 days (cycle 1 only) RA - 1g iv infusion followed by a second 1g iv infusion two weeks later. IV flush of Sodium Chloride 0.9% at rate of last infusion. Rituximab is given in hospital, through a drip into a vein. Usually, you'll start treatment with two infusions of rituximab, given two weeks apart. Depletion of B-cells has been reported in some infants born to mothers exposed to rituximab during pregnancy, and there is only limited data to support its use in pregnancy. Withhold antihypertensive medications on the morning of the infusion (as rituximab infusion may drop the blood pressure). Glucocorticoids administered as methylprednisolone 100 mg IV or its equivalent 30 minutes prior to each infusion are recommended to reduce the incidence and severity of infusion reactions.
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