Rituximab

Indications
 Intravenous
Non-Hodgkin's lymphoma
Adult: As a single agent, 375 mg/m2 BSA by IV infusion once wkly, for 4 doses at an initial rate of 50 mg/hr. May increase by 50 mg/hr every 30 min. If tolerated, subsequent infusions can be started at 100 mg/hr and increased by 100 mg/hr every 30 min. Max rate: 400 mg/hr. When used with CVP (cyclophosphamide, vincristine, and prednisolone) for follicular lymphoma or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen for diffuse large B-cell lymphoma, 375 mg/m2 BSA given on day 1 of each 21-day cycle, for 8 doses. For patients who were treated with 6-8 cycles of CVP chemotherapy and have not progressed, 375 mg/m2 BSA may be given once wkly for 4 doses, may repeat every 6 mth, for up to 16 doses. For maintenance treatment in those who have responded to induction chemotherapy, 375 mg/m2 BSA is given once every 3 mth until disease progression or a max period of 2 yr.
Intravenous
Refractory or relapsed follicular lymphoma
Adult: As a single agent, 375 mg/m2 BSA by IV infusion once wkly, for 4 doses at an initial rate of 50 mg/hr. May increase by 50 mg/hr every 30 min. If tolerated, subsequent infusions can be started at 100 mg/hr and increased by 100 mg/hr every 30 min. Max rate: 400 mg/hr. When used with CVP (cyclophosphamide, vincristine, and prednisolone) for follicular lymphoma or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen for diffuse large B-cell lymphoma, 375 mg/m2 BSA given on day 1 of each 21-day cycle, for 8 doses. For patients who were treated with 6-8 cycles of CVP chemotherapy and have not progressed, 375 mg/m2 BSA may be given once wkly for 4 doses, may repeat every 6 mth, for up to 16 doses. For maintenance treatment in those who have responded to induction chemotherapy, 375 mg/m2 BSA is given once every 3 mth until disease progression or a max period of 2 yr.
Intravenous
Rheumatoid arthritis
Adult: Given as two 1 g IV infusion doses, separated by 2 wk. Corticosteroids may be given before each infusion to minimise the risk and severity of infusion reactions.
Contraindications
 Lactation. Type I hypersensitivity or anaphylactic reactions to murine proteins or component of the formulation.
Warnings / Precautions
 Extensive tumor burden, pulmonary tumor infiltration or pulmonary insufficiency; history of cardiac disease; effective contraception during and up to 12 mth after treatment; pregnancy. Monitor CBC and platelet counts regularly. Premedication with analgesics, antihistamines and corticosteroids may be recommended. Monitor for signs of active infection or hepatitis in hepatitis B carriers. Discontinue treatment if viral hepatitis develops.
Adverse Reactions
 Fever and rigors. Pruritus, skin rashes, dyspnoea, bronchospasm, angioedema, transient hypotension, and flushing, tumor lysis syndrome, respiratory failure, thrombocytopenia, neutropenia, anaemia. Hypersensitivity reactions.
Potentially Fatal: Pulmonary or cardiac toxicity during infusion; severe mucocutaneous reactions; severe cytokine release syndrome associated with tumor lysis syndrome. Toxic epidermal necrolysis.
Drug Interactions
 Increased risk of renal toxicity when used with cisplatin. May decrease the efficacy of vaccines and increase the risk of infections in patients immunised with live vaccines. May lead to low WBC counts when used with clozapine.
See Below for More rituximab Drug Interactions
Mechanism of Actions
 Rituximab, a chimeric monoclonal antibody to CD20 antigen, binds to the antigen on the cell surface, activating complement-dependent cytotoxicity; and to human Fc receptors, mediating cell killing through an antibody-dependent cellular toxicity.
Duration: Detectable in serum 3-6 mth after completion of therapy; B-cell recovery 6-12 mth following completion of treatment.
Storage Conditions
 Intravenous: Store at 2-8°C.
ATC Classification
 L01XC02 - rituximab ; Belongs to the class of monoclonal antibodies antineoplastic agents. Used in the treatment of cancer.
Storage
 Intravenous: Store at 2-8°C.
Available As
  • Rituximab 100 mg
  • Rituximab 500 mg

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