Rituximab
Prior to administration:
- check baseline observations
- check for previous adverse events during previous infusions
- verify premedication has been taken. If not, administer 30 to 60 minutes prior to rituximab administration:
- paracetamol 1000 mg orally AND
- loratadine 10 mg orally (or similar antihistamine)
- a steroid may also be included as a premed according to local guidelines
Initial infusion:
- commence rituximab infusion at 50 mg/hr for 30 minutes
- repeat observations prior to each rate increase
- increase rate by 50 mg/hr every 30 minutes, up to a maximum of 400 mg/hr if observations are stable
- flush with ~ 100 mL of sodium chloride 0.9%
If an infusion reaction occurs, temporarily discontinue the infusion and notify medical officer
- when symptoms have completely resolved, recommence the infusion at half the rate prior to the reaction
- for severe reactions stop infusion and manage as per emergency
Transient hypotension may occur. Consider withholding antihypertensive medication for 12 hours before and during infusion.
Subsequent infusions:
If an adverse event was experienced with initial infusion recommence infusion at the same rate as initial infusion
- commence rituximab infusion at 100 mg/hr
- repeat observations prior to each rate increase
- increase rate by 100 mg/hr increments every 30 minutes to a maximum of 400 mg/hr if observations are stable
- flush with ~ 100 mL of sodium chloride 0.9%
If an infusion reaction occurs, temporarily discontinue the infusion and notify medical officer
- when symptoms have resolved, recommence the infusion at half the rate prior to the reaction
- for severe reactions stop infusion and manage as per emergency
Read more about rapid infusion rituximab
Read more about subcutaneous rituximab