II. Indications
-
Leukemia and Lymphoma
- Non-Hodgkin's Lymphoma
- Large B cell Lymphoma
- Burkitt Lymphoma
- Chronic Lymphocytic Leukemia
- Acute Mature B Cell Leukemia
- Rheumatic Conditions
- Refractory Rheumatoid Arthritis
- ANCA Vasculitis
- Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis)
III. Contraindications
- Do not use with live virus Vaccines
- Update passive Vaccinations at least 4 weeks before starting Rituximab
- Hepatitis B Virus Infection
IV. Mechanism
- See Anti-CD20 Monoclonal Antibody
- Rituximab is a recombinant human Monoclonal Antibody directed against the CD20 Antigen
- Rituximab binds CD20 on the surface of B-Cells
- Triggers a cytotoxic immune response
- Depletes CD20 positive B Cells
V. Medications
- Rituximab (Rituxan)
- Rituximab Biosimilar agents
- Rituximab-Abbs (Truxima)
- Rituximab-Arrx (Riabni)
- Rituximab-Pvvr (Ruxience)
VI. Dosing
- See other references for disease specific dosing protocols
- Infuse at initial rate of 50 mg/h
- May be advanced as tolerated in 50 mg/h increments every 30 min
- Maximum infusion rate 400 mg/h
- Premedicate doses
- Acetaminophen
- Antihistamine
- Corticosteroid (e.g. Methylprednisolone 100 mg IV 30 minutes before dose)
-
Rheumatoid Arthritis
- Dose: 1 gram IV every 2 weeks for 2 doses
- Administered with Methylprednisolone 100 mg
-
Non-Hodgkin's Lymphoma or ANCA Vasculitis
- Dose: 375 mg/m2 IV weekly for 4 doses
VII. Adverse Effects
- Severe infusion reactions (black box warning)
- Typically follows first infusion within 30-120 minutes (up to 24 hours)
- Of associated fatalities, 80% occur with the first infusion
- Severe mucocutaneous syndrome (fatal events have occurred)
- Progressive Multifocal Leukoencephalopathy
- Tumor Lysis Syndrome
- Hepatitis B reactivation
- Acute Kidney Injury
- Cardiac Arrhythmia
- Severe cytopenia
- Bowel Obstruction and perforation
VIII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters, Pregnancy category X)
- Use reliable Contraception
- Before Initiating Rituximab
- Hepatitis B Virus Testing
- Quantitative serum Immunoglobulins
- Monitoring
- Complete Blood Count (baseline and periodically)
- Renal Function tests (periodically)
- Electrocardiogram (as needed)
IX. Resources
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI_NCI-GLOSS) | A drug used to treat certain types of B-cell non-Hodgkin lymphoma. It is also used with other drugs to treat chronic lymphocytic leukemia and rheumatoid arthritis. It is being studied in the treatment of other types of cancer and other conditions. Rituximab binds to a protein called CD20, which is found on B-cells, and may kill cancer cells. It is a type of monoclonal antibody. |
| Definition (NCI) | A recombinant chimeric murine/human antibody directed against the CD20 antigen, a hydrophobic transmembrane protein located on normal pre-B and mature B lymphocytes. Following binding, rituximab triggers a host cytotoxic immune response against CD20-positive cells. (NCI04) |
| Definition (PDQ) | A recombinant chimeric murine/human antibody directed against the CD20 antigen, a hydrophobic transmembrane protein located on normal pre-B and mature B lymphocytes. Following binding, rituximab triggers a host cytotoxic immune response against CD20-positive cells. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42613&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42613&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1702" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) |
| MSH | C092560 |
| SnomedCT | 108809004, 386919002 |
| English | Chimeric Anti-CD20 Antibody, C2B8 Monoclonal Antibody, monoclonal antibody anti-CD20, CD20 antibody, rituximab, rituximab, rituximab (medication), rituximab [Chemical/Ingredient], riTUXimab, Rituximab Biosimilar BI 695500, BI 695500, Rituximab, Rituximab (product), Rituximab (substance), anti-CD20 monoclonal antibody, RITUXIMAB |
| Spanish | rituximab (producto), rituximab (sustancia), rituximab |
