Rituximab
Cytostatic · Monoclonal antibody
Indications
Relapsed or chemoresistant stage III-IV follicular lymphoma. In combination with CVP chemotherapy for untreated stage III-IV follicular lymphoma. In combination with CHOP chemotherapy for CD20 positive diffused large B cell non-Hodgkin's lymphoma.
Dosage
Adults: Follicular lymphoma as single agent: 375 mg/m² by IV infusion once weekly for 4 wk. Follicular lymphoma with CVP: 375 mg/m² by IV infusion for 8 cycles on Day 1 of each chemotherapy cycle after corticosteroid component of CVP. Large B-cell lymphoma: 375 mg/m² by IV infusion on Day 1 of each chemotherapy cycle for 8 cycles after corticosteroid component of CHOP. See literature. Children: Not recommended.
Administration
Do not administer as an IV push or bolus. Interrupt rituximab infusion for severe reactions and resume at a 50% reduction in rate (e.g. from 100 to 50 mg/hours) when symptom have completely resolved. In most cases, patients who have experienced nonlife-threatening reactions have been able to complete the full course of therapy. Reconstitution: Withdraw necessary amount of rituximab and dilute to final conc. of 1-4 mg /mL into an infusion bag containing either NS or D5W. Stability: Store under refrigeration. Protect vials from direct sunlight. Solution for infusion is stable at 2°C-8°C for 24 hours and at room temperature for an additional 12 hours.
Adverse Effects
Headache, fever, chills, nausea, leucopenia, pruritus, rash, neutropenia, thrombocytopenia, anaemia, rhinitis, diarrhoea, dyspepsia, agitation, insomnia, nervousness, bronchitis, severe vision loss, hearing loss, loss of other senses, HTN, Hypercholesterolaemia, migraine, UTI, inf-related reactions, angioedema, infections, blood dyscrasias, GI upset, anorexia, skin reactions, alopecia, asthenia, decreased IgG levels, hyperglycaemia, wt loss, oedema, increased LDH, hypocalcaemia, paraesthesia, hypoaesthesia, vasodilatation, dizziness, anxiety, conjunctivitis, lacrimation disorder, tinnitus, ear pain, cardiovascular events, cardiac disorders, hypertension, bronchospasm, respiratory disease, chest pain, dyspnoea, increased cough, dysphagia, stomatitis, throat irritation, sweating, hypertonia, myalgia, arthralgia, pain, flushing, malaise, cold syndrome, fatigue, shivering, multi-organ…
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Active hepatitis B infection. Severely immunocompromised state. Hypersensitivity to murine proteins. Acute, severe infection. Precautions: Patients with a high number (>25000 mm³) of circulating malignant cells or high tumour burden e.g. CLL and Mantle cell lymphoma; history of pulmonary insufficiency, pulmonary tumour infiltration. Withhold antihypertensive medications 12 hrs prior to and throughout infusion. History of cardiac disease. Neutrophil count <1.5x/10^9L and/or platelet count <75x10^9/L. Infusion reaction, infection. Immunization. Progressive multifocal leukoencephalopathy. Use effective contraception method during and for 12 mth after treatment. High tumour burden. Monitor FBC. History of recurrent or chronic infection or conditions predisposing to infection. Screen…
Interactions
Vaccines.
Advice to Patient
This medication is administered by infusion. Contact prescriber if there is fever, chills, fatigue, wheezing, shortness of breath, unrelieved GI disturbances, persistent dizziness, swelling of extremities, chest pain, chest tightness, skin rash, skin redness, sore throat, irritated throat, unhealed sores, unusual weight gain, difficulty in breathing, unusual bruising or bleeding, white plaques in mouth or genital area. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Avoid highly crowded places to prevent infection. People around you should wear mask and gloves. Do not get vaccinated without consulting prescriber. Close monitoring is done and relief is provided as during infusion of this medication you may suffer from congestion, difficulty in breathing, high fever or chills.
Pharmacokinetics
Onset: Immune thrombocytopenia: Initial response: 7 to 56 days; Peak response: 14 to 180 days. NHL: B-cell depletion: Within 3 weeks. Rheumatoid arthritis (RA): B-cell depletion: Within 2 weeks. Duration: NHL: Detectable in serum 3 to 6 months after completion of treatment; B-cell depletion is sustained for up to 6 to 9 months and B-cell recovery begins approx. 6 months following completion of treatment; median B-cell levels return to normal by 12 months following completion of treatment. RA: B-cell depletion persists for at least 6 months. Half-life elimination: CCL: Median terminal half-life: 32 days (range: 14 to 62 days). NHL: Median terminal half-life: 22 days (range: 6 to 52 days). RA: Mean terminal half-life: 18 days (range: 5 to 78 days). GPA/MPA: 23 days (range: 9 to 49 days).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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