CLINICAL USE
Monoclonal antibody: Lymphomas Diffuse large B-cell non-Hodgkin’s lymphoma in combination with other chemotherapy
Rheumatoid arthritis Lupus nephritis (unlicensed)
DOSE IN NORMAL RENAL FUNCTION
375 mg/m 2 weekly for 4 weeksFollicular lymphoma: 375 mg/m 2 once every 3 months for up to 2 years
Rheumatoid arthritis: two 1 g doses 2 weeks apartLupus nephritis: 375 mg/m 2 for 1–2 doses, two weeks apart
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
ADMINISTRATION
Reconstition
–
Route
IV infusion
Rate of Administration
1st dose: 50 mg/hour, then increase the rate every 30 minutes by 50 mg/hour to achieve a maximum rate of 400 mg/hourFurther doses: 100 mg/hour, increasing by 100 mg/hour every 30 minutes to achieve a maximum rate of 400 mg/hour
Comments
Add to sodium chloride 0.9% or glucose 5% to achieve a concentration of 1–4 mg/mL, and gently invert to prevent foamingUse immediately after dilution. Infusion solution is stable for 12 hours at room temperaturePrepared solution has 24 hrs chemical stability at 2–8°C
OTHER INFORMATION
Always give a premedication of paracetamol and an antihistamine before infusionMean serum half-life increases with dose and repeated dosing (76.3 hours after 1st infusion and 205.8 hours after 4th infusion). Detectable in body for 3–6 monthsAlternative regime for vasculitis (anecdotal): 1 g/m2 on days 1 and 14, repeated at relapse or after 6 monthsPatients with high tumour burden or malignant cells >50 000 mm3 may be at risk of severe cytokine release syndrome which may be associated with acute renal failure – treat with cautionRituximab has been used to reduce alloreactive antibodies pre-transplant, to treat focal segmental glomerulosclerosis, mixed essential cryoglobulinaemia, SLE, primary systemic vasculitis, PRCA, HUS, and PTLD.