1st IV infusion rate: Initially 50 mg/hr; after the 1st 30 min, can be escalated in 50 mg/hr increments every 30 min. Max: 400 mg/hr. Subsequent IV infusion rate: Initially 100 mg/hr, & increased by 100 mg/hr increments every 30 min. Max: 400 mg/hr.
Premed & prophylactic medications Always give premed consisting of anti-pyretic (eg, paracetamol) & anti-histaminic drug (eg, diphenhydramine) before each infusion.
NHL & CLL Premed w/ glucocorticoids if not to be given in combination w/ glucocorticoid-containing chemotherapy.
CLL patient whose lymphocyte counts >25 x 109/L Administer prednisone/prednisolone 100 mg IV shortly before rituximab infusion.
Patient w/ GPA or MPA in disease remission or PV Premed w/ methylprednisolone 100 mg IV completed in 30 min prior to infusions.
Patient w/ GPA or MPA Methylprednisolone IV 1,000 mg daily for 1-3 days prior to 1st rituximab infusion. Last dose may be given on the same day as the 1st infusion. Followed by oral prednisone 1 mg/kg/day (not to exceed 80 mg/day, & tapered as rapidly as possible based on clinical need) during & after the 4-wk induction course of treatment.
Patient w/ GPA/MPA or PV Administer
Pneumocystis jirovecii pneumonia prophylaxis during & following treatment, as appropriate according to local clinical practice guidelines.
Follicular NHL: In combination w/ chemotherapy for induction treatment of previously untreated or relapsed/refractory patient w/ follicular NHL 375 mg/m
2/cycle for up to 8 cycles. Administer on day 1 of each chemotherapy cycle after IV administration of the glucocorticoid component of the chemotherapy if applicable.
Maintenance treatment for patient w/ previously untreated follicular lymphoma who has responded to induction treatment 375 mg/m
2 once every 2 mth (starting 2 mth after the last dose of induction therapy) until disease progression or max period of 2 yr.
Maintenance treatment for patient w/ relapsed/refractory follicular lymphoma who has responded to induction treatment 375 mg/m
2 once every 3 mth (starting 3 mth after the last dose of induction therapy) until disease progression or max period of 2 yr.
Monotherapy as induction treatment for patient w/ stage III-IV follicular lymphoma who are chemoresistant or are in 2nd or subsequent relapse after chemotherapy 375 mg/m
2 IV infusion once wkly for 4 wk.
Retreatment w/ monotherapy for patient who has responded to previous treatment w/ monotherapy for relapsed/refractory follicular lymphoma 375 mg/m
2 IV infusion once wkly for 4 wk.
In combination w/ CHOP chemotherapy for diffuse large B cell NHL 375 mg/m
2 on day 1 of each chemotherapy cycle for 8 cycles after IV infusion of the glucocorticoid component of CHOP.
CLL: In combination w/ chemotherapy for previously untreated & relapsed/refractory patient 375 mg/m
2 on day 0 of the 1st treatment cycle followed by 500 mg/m
2 administered on day 1 of each subsequent cycle for 6 cycles in total.
GPA & MPA: Induction of remission therapy 375 mg/m
2 IV infusion once wkly for 4 wk (4 infusions in total).
Maintenance treatment Initiate no sooner than 16 wk after the last rituximab infusion. Following induction of remission w/ other standard of care immunosuppressants, initiate during the 4-wk period that follows disease remission. Administer as two 500 mg IV infusions separated by 2 wk, followed by a 500 mg IV infusion every 6 mth thereafter.
PV: 1,000 mg IV infusion followed by a 2nd 1,000 mg IV infusion after 2 wk in combination w/ a tapering course of glucocorticoids.
Maintenance treatment 500 mg IV at mth 12 & 18, & then every 6 mth thereafter.
Relapse treatment 1,000 mg IV. Consider resuming or increasing the glucocorticoid dose based on clinical evaluation. Subsequent infusions may be administered no sooner than 16 wk following the previous infusion.
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