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RITUXIMAB (Rituxan) is a genetically engineered chimeric murine/human monoclonal IgG, kappa antibody directed against the CD20 antigen. CD20 is expressed on the majority of B-cells, but the antigen is not found on hematopoietic stem cells, pro-B-cells, normal plasma cells or other normal tissue. B cells are believed to play a role in the pathogenesis of RA and associated chronic synovitis. Administration of Rituxan results in a rapid and sustained depletion of circulating and tissue-based B cells. Rituxan is a sterile, clear, colorless, preservative-free liquid concentrate for intravenous administration. It is supplied at a concentration of 10 mg/ml in either 100 mg (10 ml) or 500 mg (50 ml) single-use vials.
Patient Medication Guide
Full Prescribing Information
Hypersensitivity to any component, murine proteins.
1. Tuberculosis screening
2. Hepatitis B screening
3. Ask patient if he/she:
If the answer is yes to any of these questions, review with ordering provider.
DO NOT ADMINISTER AS AN INTRAVENOUS PUSH OR BOLUS.
Recommended dose for RA is rituximab as two-1000mg separated by 2 weeks. Pre-medication should consist of glucocorticoids administered as methylprednisolone 100 mg IV or its equivalent 30 minutes prior to each infusion.
Recommended dose for GPA, Wegener’s granulomatosis, and MPA is rituximab as (375 mg/m2 IV infusion once weekly for 4 weeks. Glucocorticoids administered as methylprednisolone 1000 mg IV per day for 1 to 3 days followed by oral prednisone mg/Kg/day, NTE 80mg/day and taper as clinically needed) are recommended to treat severe vasculitis symptoms.
Obtain vital signs (patient temperature, blood pressure and pulse) upon arrival, after start of medication, every 15 minutes for the first hour of the infusion, every 30 minutes thereafter, upon discontinuing infusion and before the patient departs the facility. However, if prior history of an acute infusion reaction, monitor vitals every 10 minutes for 30 minutes then every 30 minutes and for 30 minutes after infusion.
Acute infusion reaction can occur during the administration of this agent. If patient reports mild to moderate reactions such as flushing, chills, and rigors, slow down the infusion rate and assess patient for symptom resolution. For more severe reactions such as hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, fever, chills or anaphylaxis, or where mild reactions persist, stop the infusion and treat the acute reaction (with diphehydramine, acetaminophen, IV normal saline, vasopressors). Then notify the supervising provider immediately to coordinate next plan of action.
Updated March 2018 - ARHP Practice Committee
The information contained in this biologic reference guide is offered solely for purposes of providing health care professionals with a quick and initial reference. Before prescribing or administering any drug contained in this biologic reference guide, health professionals should read the manufacturer’s complete prescribing information in order to be informed of the various clinical considerations to be taken into account. The American College of Rheumatology is providing this information as a benefit and service in furtherance of its educational mission. By providing this information, ACR is not endorsing or recommending any of the listed companies or any of their drugs or other products. The information contained in the biologic reference guides reflect the conclusions of the individual companies and not those of the ACR which specifically disclaims any responsibility or liability for the use of such information and/or for the performance of any of the drugs listed in this biologic reference guide.