Administration

• Rituximab is administered as an intravenous infusion, typically given over several hours.

• The first infusion should be started at a slow rate and gradually increased if tolerated. Subsequent infusions may be given at a faster rate if the initial infusion was well-tolerated.

• Premedication with acetaminophen and an antihistamine is recommended before each infusion to reduce the risk of infusion reactions.

Dosing

• For rheumatoid arthritis, the typical dose is two 1000 mg IV infusions separated by 2 weeks, repeated every 6 months or based on clinical evaluation.

• Dosing may vary for other indications. Always verify the appropriate dose for the specific condition being treated.

Monitoring

• Patients should be closely monitored during infusions, especially the first infusion, for signs of infusion reactions.

• Regular blood tests are recommended to monitor for side effects.

• Assess for signs of infection before and during treatment, as rituximab can increase infection risk.

Patient Education

• Inform patients about potential side effects, including infusion reactions, infections, and rare but serious adverse events like progressive multifocal leukoencephalopathy (PML).

• Advise patients to report any new or worsening symptoms promptly.

• Educate patients on the importance of regular follow-up and blood tests.

Precautions

• Screen for hepatitis B before initiating treatment, as rituximab can cause hepatitis B reactivation.

• Use caution in patients with a history of cardiovascular disease or pulmonary conditions.

• Rituximab should not be administered to patients with active infections.

Drug Interactions

• Avoid live vaccines during treatment and for several months after the last dose.

• Use caution when combining with other immunosuppressive medications.

Special Populations

• Rituximab can cross the placenta and affect B-cell levels in infants. Advise women of childbearing potential to use effective contraception during treatment and for 12 months after the last dose.