What is the 90-minute rapid infusion protocol for rituximab (Rituxan) after the initial slow rate infusion?

Rituximab 90-Minute Rapid Infusion Protocol

The 90-minute rapid infusion protocol for rituximab can only be used for the second and subsequent infusions after the patient has tolerated the first standard infusion without significant reactions, and consists of administering 20% of the dose over the first 30 minutes followed by the remaining 80% over 60 minutes. 1, 2

Protocol Requirements and Patient Selection

• The 90-minute rapid infusion protocol can only be implemented after patients have received their first rituximab infusion at the standard slow rate (typically starting at 50 mg/hour with gradual escalation) without experiencing significant infusion-related reactions 1, 2
• Patients must have a circulating lymphocyte count less than or equal to 5,000/mm³ before receiving the rapid infusion protocol 3
• Patients with clinically significant cardiovascular disease should be excluded from rapid infusion protocols 3

Administration Procedure

• All patients should receive standard premedication before rituximab infusion, including acetaminophen, antihistamines, and the glucocorticoid component of their chemotherapy regimen 3
• The 90-minute infusion is administered as follows:
  • 20% of the total rituximab dose is given in the first 30 minutes 3, 1
  • The remaining 80% of the dose is administered over the next 60 minutes 3, 1
  • The total dose is typically delivered in 500 mL of sodium chloride 1, 2

Safety and Efficacy

• Multiple studies have demonstrated the safety of the 90-minute rapid infusion protocol with very low rates of infusion-related reactions 1, 2, 4
• In a prospective trial (NHL Study 10), the incidence of Grade 3-4 infusion-related reactions at Cycle 2 was only 1.1% among all patients receiving the 90-minute protocol 3
• Some centers have successfully implemented even shorter 60-minute infusion protocols for subsequent rituximab doses with good safety profiles 5, 6
• The rapid infusion protocol has been shown to be safe not only in oncology patients but also in patients with autoimmune rheumatic diseases 4

Monitoring Requirements

• All patients should be observed for infusion-related reactions during the rituximab infusion and for at least 30 minutes after completion 1
• Vital signs should be monitored regularly (e.g., every 15 minutes) during the infusion 2
• Patients should be advised to report any reactions occurring within 24 hours after rituximab infusion 1

Benefits of Rapid Infusion Protocol

• Substantial reduction in resource utilization and healthcare costs 1, 2
• Improved patient convenience and satisfaction 5
• Increased nursing satisfaction and improved workflow efficiency 5
• Allows for more infusions per chair per day in infusion centers 4

Management of Infusion Reactions

• If infusion reactions occur during the rapid infusion, the infusion should be interrupted immediately 7
• For moderate reactions, methylprednisolone 40 mg IV may be administered 7
• Monitor vital signs and symptoms until resolution 7
• The infusion may be resumed at 50% of the previous rate once symptoms resolve 7

Contraindications to Rapid Infusion

• History of grade 3-4 infusion-related reactions with prior rituximab administration 3
• Patients receiving their first-ever dose of rituximab 3, 1, 2
• High circulating lymphocyte count (>5,000/mm³) 3
• Significant cardiovascular disease 3

The 90-minute rapid infusion protocol has been widely adopted in clinical practice due to its demonstrated safety and efficiency, making it the standard approach for second and subsequent rituximab infusions in patients who have tolerated their first infusion without significant reactions.