Download Rituximab (Rituxan) Infusion Therapy

1.
ALLERGIES/REACTIONS:
2.
Height:
3.
INDICATION AND DOSE:
cm
Weight:
kg
 Relapse or refractory, low grade or follicular, CD20 positive, B-Cell NHL
RITUXIMAB (RITUXAN) 375 mg/m2 or (
mg/ m2) times
Frequency:
 Chronic Lymphocytic Leukemia
RITUXIMAB (RITUXAN) 375 mg/m2 times
THEN 500 mg/ m2 times
Frequency: Every 28 days
BSA =
BSA =
m2
BSA
BSA =
mg
mg for Cycle 1,
mg for Cycles 2-6
 Refractory immune (idiopathic) thrombocytopenia purpura
RITUXIMAB (RITUXAN) 375 mg/m2 or (
mg/ m2) times
Frequency:
BSA =
mg
 Wegener’s Granulomatosis
RITUXIMAB (RITUXAN) 375 mg/m2 or (
Frequency: Weekly times 4 doses
mg/ m2) times
BSA =
mg
 Microscopic Polyangiitis
RITUXIMAB (RITUXAN) 375 mg/m2 or (
Frequency: Weekly times 4 doses
mg/ m2) times
BSA =
mg
 Rheumatoid Arthritis
RITUXIMAB (RITUXAN) 1 g IV on days 1 and 15
4.
PRE INFUSION LABS:  CBC
 CMP
 LDH
 Uric Acid (URIC)  Phosphate (PHOS)
 Hepatitis Panel (acute and chronic)
5.
6.
12 HOURS PRE RITUXIMAB (RITUXAN):
 Start Allopurinol 300 mg PO daily – consider when treating malignancies
 Hold blood pressure medications 12 hours prior to Rituximab
Hydration IV:
30 MINUTES PRE RITUXIMAB (RITUXAN) GIVE:
 Acetaminophen (Tylenol) 650 mg PO. May repeat every 4 hours PRN chills or temperature greater
than 38 C.
 Diphenhydramine (Benadryl) 50 mg PO. May repeat every 4 hours PRN chills or temperature greater than
38 C.
 Methylprednisolone (Solu-Medrol) 100 mg IV prior to dose on Days 1 and 15 for Rheumatoid Arthritis only
 Methylprednisolone (Solu-Medrol) 40 mg IV times 1 dose for Chronic Lymphocytic Leukemia (CLL) and
lymphocytes greater than 25 K/mcL
 Methylprednisolone (Solu-Medrol) 40 mg IV times 1 dose
 Dexamethasone (Decadron) 10 mg IV times 1 dose.
LIMIT THE TOTAL DOSE OF ALL ACETAMINOPHEN CONTAINING PRODUCTS TO 3,000 MG PER DAY
Physician Initial:
PATIENT INFORMATION
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PHYSICIAN ORDERS
RITUXIMAB (RITUXAN) INFUSION
7.
RITUXIMAB (RITUXAN) ADMINISTRATION (CONCENTRATION = 1 MG/ML):
DO NOT ADMINISTER AS AN INTRAVENOUS PUSH OR BOLUS
 First Infusion:
(Required for initial dose OR patients with Chronic Lymphocytic Leukemia (CLL) and lymphocytes
greater than 25 K/mcL only)
 Mix 100 mg of total dose in 0.9% sodium chloride (Normal Saline) 100 ml and infuse at initial rate
 Initial rate = 50 mg/hour (50 ml/hour) times 30 minutes. Then increase rate 50 mg/hour
(50 ml/hour) every 30 minutes to a maximum of 400 mg/hour (400 ml/hour).
 If patient tolerates medication with no infusion reaction, call Pharmacy and request remainder of dose
 Subsequent Infusions:
 Initial rate = 100 mg/hour (100 ml/hour) times 30 minutes. Then may increase rate 100 mg/hour
(100 ml/hour) every 30 minutes to a maximum of 400 mg/hour (400 ml/hour).
DO NOT INFUSE OTHER MEDICATIONS INTO THE IV LINE WITH RITUXIMAB (RITUXAN)
8.
VITAL SIGNS:
 Check pre-infusion, every 30 minutes during, and 30 minutes post infusion
 Call physician if:
Systolic blood pressure less than
mmHg,
Pulse greater than
Temperature greater than
C
9.
 Nurse May Initiate CVAD Management Per Nursing Protocol #910.00
 Nurse May Utilize Local Anesthetic For CVAD Access Per Nursing Procedure #788
 Nurse May initiate IV Catheter Care, Outpatient Physician Order #858
 For Infusion Reactions Initiate Drug Related Hypersensitivity Physician Order #774
 If mild infusion reaction occurs the infusion may be resumed at one-half the previous rate upon
improvement of patient symptoms
10.
OUTPATIENTS:
 If stable 30 minutes post-infusion, discharge patient home on current reconciled home medications
NOTE: These orders should be reviewed by the attending physician, appropriately modified for the
individual patient, dated, timed and signed below.
DATE
TIME
PHYSICIAN’S SIGNATURE
Another brand of drug, identical in form and content, may be dispensed unless checked. 
PATIENT INFORMATION
Page 2 of 2
(05/09/12) 615
Revision I
PHYSICIAN ORDERS
RITUXIMAB (RITUXAN) INFUSION