RITUXIMAB 1000 MG FOR RHEUMATOLOGY		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room Appointment request for initial dose.	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for initial dose.		
	☑	Referral to IV Infusion Room Appointment request for subsequent dose.	Once	S+14	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine
	Appointment request for subsequent dose.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Sedimentation rate	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	C-reactive protein	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Every visit	S	Until discont'd	
		Please verify Hepatitis Panel results within the last 6 months to Rituxan therapy.		
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		At start of infusion: obtain vital signs every 15 minutes x 4, then every 30 minutes.		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for any signs of infusion reaction. For minor infusion reaction (fever, chills, pruritis, uticaria, chest pain, mild hypotension, hypertension, or mild dyspnea) stop or slow infusion rate by 50%. If symptoms do not resolve within 5-10 minutes give Benadryl as ordered. Notify MD if symptoms do not resolve within 5-10 minutes. With MD approval, give Solu-medrol as ordered. When symptoms resolve, restart medication at 25% of the original rate. After 15-30 minutes gently increase rate and monitor patient closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of Severe Infusion Reaction: severe dyspnea, wheezing, stridor, angioedema, or marked hypotension. For severe infusion reaction take the following steps; STOP Infusion and start Normal Saline solution, Notify physician and administer Benadryl as ordered, Monitor vital signs, Administer  Epinephrine as ordered. Consult MD for further orders.		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Flush portacath before removing needle from portacath.		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Give 30 minutes prior to start of infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	Every visit	S	Until discont'd	
		25 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 100 mg	Every visit	S	Until discont'd	
		100 mg, intravenous, once, Starting when released
	Give 30 minutes prior to start of infusion.		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	Until discont'd	
		Contact a pharmacist if an ALTERNATE rituximab product or biosimilar is required to be added to this therapy plan.		

Pharmacy Consult 	

	
	Interval	Defer Until	Duration	
	☐	Pharmacy consult to screen for rituximab administration method	Every visit	S	 treatments	
		Hospital Performed, Normal		

Medications 	

	
	Interval	Defer Until	Duration	
	☑	riTUXimab-abbs (TRUXIMA) 1,000 mg in sodium chloride 0.9% 250 mL (4 mg/mL) IVPB	Once	S	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 1: Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mm HG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.		
	☑	riTUXimab-abbs (TRUXIMA) 1,000 mg in sodium chloride 0.9% 250 mL (4 mg/mL) IVPB	Once	S+14	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 15: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	riTUXimab-abbs (TRUXIMA) 1,000 mg in sodium chloride 0.9% 1,000 mL IVPB	Once	S	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 1: Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mm HG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	riTUXimab-abbs (TRUXIMA) 1,000 mg in sodium chloride 0.9% 1,000 mL IVPB	Once	S+14	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 15: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	RiTUXimab (PF) (RITUXAN) 1,000 mg in sodium chloride 0.9% 250 mL IVPB	Once	S	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 1: Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mm HG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	RiTUXimab (PF) (RITUXAN) 1,000 mg in sodium chloride 0.9% 250 mL IVPB	Once	S+14	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 15: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	RiTUXimab (PF) (RITUXAN) 1,000 mg in sodium chloride 0.9% 1,000 mL INITIAL INFUSION RATE IVPB	Once	S	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 1: Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mm HG of baseline, PULSE between 60 and 120 and TEMP less than 38 degrees C, and no symptoms), then increase infusion rate by 50 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.		
	☐	RiTUXimab (PF) (RITUXAN) 1,000 mg in sodium chloride 0.9% 1,000 mL NON-INITIAL INFUSION IVPB	Once	S+14	1 treatment	
		1,000 mg, intravenous, once, Starting when released
	DAY 15: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 6 hours PRN, headaches, fever, Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for mild to moderate infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	PRN	S	Until discont'd	
		40 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	ondansetron (ZOFRAN) IV 4 mg	PRN	S	Until discont'd	
		4 mg, intravenous, once PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued