Rituxan

Adult Dosing .

Dosage forms:  INJ

Special Note

[uses, dosing may vary]

Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments

CD20-positive B-Cell non-Hodgkin lymphoma, relapsed or refractory

[monotherapy]

Dose: 375 mg/m^2/dose IV qwk x4wk or x8wk; Info: for pts w/ low-grade or follicular dz; may give additional 4wk tx in pts who progress after initial tx; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[ibritumomab tiuxetan combo tx]

Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for pts w/ low-grade or follicular dz; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

CD20-positive B-Cell non-Hodgkin lymphoma, previously untreated

[follicular type, chemo combo tx]

Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Info: give up to 8 cycles; if complete or partial response achieved, may give maint. monotherapy 375 mg/m^2/dose IV x1 on day 1 of 56-day cycle x12 cycles starting 56 days after completion of 1st-line combo chemo; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[follicular type, ibritumomab tiuxetan combo tx]

Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for pts w/ complete or partial response after completion of 1st-line combo chemo; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[diffuse large B-cell type, chemo combo tx]

Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Info: give up to 8 cycles; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

CD20-positive B-Cell non-Hodgkin lymphoma, non-progressing

[375 mg/m^2/dose IV x1 on days 1, 8, 15, 22 of 6-mo cycle]

Start: after completion of 1st-line combo chemo; Info: for pts w/ low-grade dz; give up to 16 doses (4 cycles); give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

CD20-positive CLL/SLL

[500 mg/m^2/dose IV x1 on day 1 of 28-day cycle, starting cycle 2]

Start: 375 mg/m^2/dose IV x1 on the day before cycle 1; Info: give x6 cycles; part of multi-drug chemo regimen; give HSV and PCP prophylaxis during tx and up to 12mo after D/C; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

rheumatoid arthritis, moderate-severe

[1000 mg IV q2wk x2 doses]

Info: for pts w/ inadequate response to TNF antagonist; may repeat course q16-24wk; use w/ methotrexate; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

granulomatosis w/ polyangiitis (GPA)

[induction tx]

Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

[subsequent tx]

Dose: 500 mg IV q2wk x2 doses, then 500 mg IV q6mo; Start: 16-24wk after last induction tx w/ rituximab, or w/in 4wk of dz control achieved w/ other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

microscopic polyangiitis (MPA)

[induction tx]

Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

[subsequent tx]

Dose: 500 mg IV q2wk x2 doses, then 500 mg IV q6mo; Start: 16-24wk after last induction tx w/ rituximab, or w/in 4wk of dz control achieved w/ other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

pemphigus vulgaris, moderate-severe

[500 mg IV q6mo]

Start: 1000 mg IV q2wk x2 doses, then starting at mo 12, give 500 mg IV q6mo; Info: use w/ glucocorticoids; may give additional 1000 mg IV x1 if relapse; maintenance and relapse doses should be dosed at least 16wk apart; consider PCP prophylaxis; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

myasthenia gravis (off-label)

[375 mg/m^2/dose IV qwk x4wk]

Alt: 1000 mg IV q2wk x2 doses; Info: may repeat course or give maintenance doses q1-6mo

renal dosing

[see below]

renal impairment: no adjustment

HD: no adjustment; no supplement; PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ

Special Note

[uses, dosing may vary]

Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments

CD20-positive B-Cell non-Hodgkin lymphoma

[previously untreated, 6 mo and older]

Dose: 375 mg/m^2/dose IV on days -2 and 1 during induction tx x2 cycles, then 375 mg/m^2/dose IV on day 1 during consolidation tx x2 cycles (total of 6 doses); Info: for pts w/ advanced stage, diffuse large B-cell lymphoma, Burkitt lymphoma, Burkitt-like lymphoma, or mature B-cell acute leukemia; part of multi-drug chemo regimen (Lymphome Malin B); give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[retreatment, 2 yo and older (off-label)]

Dose: 375 mg/m^2/dose IV qwk x4wk, may repeat q6mo x2y; Info: give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[relapsed or refractory, 2 yo and older (off-label)]

Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Start: 375 mg/m^2/dose IV x1, give 48h before cycle 1; Info: give x3 cycles (4 doses); part of multi-drug chemo regimen; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

[ibritumomab tiuxetan combo tx, 2 yo and older (off-label)]

Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for pts w/ relapsed or refractory low-grade, follicular or transformed dz; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive pts

B-cell precursor ALL, relapsed or refractory (off-label)

[2 yo and older]

Dose: 375 mg/m^2/dose IV on days 1 and 3 of cycles 1 and 2, and on day 3 only of cycle 3; Info: give up to 3 cycles; part of multi-drug chemo regimen

granulomatosis w/ polyangiitis (GPA)

[induction tx, 2 yo and older]

Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

[subsequent tx, 2 yo and older]

Dose: 250 mg IV q2wk x2 doses, then 250 mg IV q6mo; Start: 16-24wk after last induction tx w/ rituximab, or w/in 4wk of dz control achieved w/ other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

microscopic polyangiitis (MPA)

[induction tx, 2 yo and older]

Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

[subsequent tx, 2 yo and older]

Dose: 250 mg IV q2wk x2 doses, then 250 mg IV q6mo; Start: 16-24wk after last induction tx w/ rituximab, or w/in 4wk of dz control achieved w/ other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

pemphigus vulgaris, moderate-severe (off-label)

[9 yo and older]

Dose: 500 mg IV q2wk x2 doses; Alt: 375 mg/m^2/dose IV q2wk x2 doses; Info: consider PCP prophylaxis; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive pts

autoimmune hemolytic anemia, refractory (off-label)

[4 mo and older]

Dose: 375 mg/m^2/dose IV qwk x2-4wk

chronic ITP (off-label)

[3 mo and older]

Dose: 375 mg/m^2/dose IV qwk x4wk

post-transplant lymphoproliferative disorder (off-label)

[11 mo and older]

Dose: 375 mg/m^2/dose IV qwk x3-4wk

SLE, refractory (off-label)

[8 yo and older]

Dose: 375 mg/m^2/dose IV qwk x2-4wk; Alt: 750 mg/m^2/dose IV x1 on day 1 and 15 of regimen; Max: 1000 mg/dose

nephrotic syndrome, refractory (off-label)

[11 mo and older]

Dose: 375 mg/m^2/dose IV qwk x1-4wk; Max: 500 mg/dose

renal dosing

[not defined]

renal impairment: consider adult renal dosing for guidance

HD/PD: consider adult renal dosing for guidance

hepatic dosing

[not defined]