rituximab

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

Molecular weight :144 000

%Protein binding :No data

%Excreted unchanged in urine : No data

Volume of distribution (L/kg) :No data

half-life – normal/ESRD (hrs) :76.3 (after 1st infusion)/–205.8 (after 4th infusion)/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Use with caution

10 to 20 : Use with caution

<10 : Use with caution

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Use with caution

HD :Not dialysed. Use with caution

HDF/high flux :Unlikely to be dialysed. Use with caution

CAV/VVHD :Unknown dialysability. Use with caution

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

None known

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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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