What is the recommended administration protocol for rituximab (Rituxan) 1 gram?

Rituximab 1 Gram Administration Protocol

Rituximab 1 gram should be administered intravenously with appropriate premedication, starting at a slow infusion rate and gradually increasing as tolerated, with the first infusion typically taking 4-6 hours and subsequent infusions potentially shortened to 90 minutes if well-tolerated.

Premedication Requirements

Before administering rituximab 1 gram, the following premedications should be given 30 minutes prior to infusion:

• Acetaminophen (Tylenol) 1000 mg orally
• Antihistamine (such as diphenhydramine 50 mg) orally or IV
• Methylprednisolone 100 mg IV (for non-oncologic indications like rheumatoid arthritis, GPA/MPA, or pemphigus vulgaris) 1

First Infusion Protocol

For the first rituximab 1 gram infusion:

1. Dilute rituximab to a final concentration of 1-4 mg/mL in 0.9% Sodium Chloride or 5% Dextrose solution 1
2. Start infusion at a slow rate of 50 mg/hour
3. If no infusion reactions occur, gradually increase the rate in 50 mg/hour increments every 30 minutes
4. Maximum infusion rate should not exceed 400 mg/hour
5. Total infusion time for first dose: approximately 4-6 hours
6. Monitor patient closely during infusion for reactions (hypotension, bronchospasm, urticaria, angioedema)

Subsequent Infusions Protocol

For patients who tolerated the first infusion well (no grade 3-4 reactions):

1. Premedicate as with first infusion
2. Start at 100 mg/hour
3. Increase by 100 mg/hour increments every 30 minutes as tolerated
4. Maximum rate: 400 mg/hour
5. Total infusion time: approximately 3-4 hours

Rapid Infusion Protocol (90-minute option)

For patients who have previously tolerated a full rituximab infusion without serious adverse reactions:

1. Administer 20% of the dose (200 mg) over the first 30 minutes
2. Administer remaining 80% (800 mg) over the next 60 minutes
3. Total infusion time: 90 minutes 2, 3

This rapid infusion protocol has been shown to be safe and well-tolerated in patients who have previously received rituximab without significant reactions 4, 2.

Monitoring Requirements

• Vital signs should be monitored before infusion, every 15-30 minutes during infusion, and at the end of infusion
• Observe patient for at least 30 minutes after completion of infusion
• Have emergency medications readily available (epinephrine, antihistamines, corticosteroids, bronchodilators)
• For patients with pre-existing cardiac or pulmonary conditions, monitor more closely 1

Management of Infusion Reactions

If infusion-related reactions occur:

• Mild to moderate reactions: Temporarily stop infusion, treat symptoms, and resume at 50% reduced rate when symptoms resolve
• Severe reactions: Discontinue infusion immediately and provide appropriate medical intervention

Important Considerations

• Rituximab should be a clear, colorless solution; inspect visually for particulates before administration 1
• Do not mix rituximab with other medications
• Diluted solutions are stable for 24 hours refrigerated (2-8°C) and an additional 24 hours at room temperature 1
• For patients with high tumor burden or high circulating lymphocyte counts (>25,000/mm³), consider more cautious administration due to higher risk of cytokine release syndrome

By following this protocol, rituximab 1 gram can be administered safely while minimizing the risk of infusion-related reactions and optimizing patient comfort and clinic workflow.