RITUXIMAB-ABBS (TRUXIMA) 375 MG/M2 - NEUROLOGY/RHEUMATOLOGY		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	1 time a week	S	4 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	1 time a week	S	4 treatments	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	1 time a week	S	4 treatments	
		STAT, Normal, Clinic Collect		
	☐	CD19	1 time a week	S	4 treatments	
		STAT, Normal, Clinic Collect		
	☐	CD20 enumeration	1 time a week	S	4 treatments	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	1 time a week	S	4 treatments	
		Please verify Hepatitis Panel results within the last 6 months to Rituxan therapy.		
	☐	Insert Peripheral IV or Access Portacath	1 time a week	S	4 treatments	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	1 time a week	S	4 treatments	
		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	1 time a week	S	4 treatments	
		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	1 time a week	S	4 treatments	
		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	1 time a week	S	4 treatments	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	HEParin, porcine injection 500 Units	1 time a week	S	4 treatments	
		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	1 time a week	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	1 time a week	S	4 treatments	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	1 time a week	S	4 treatments	
		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) tablet 25 mg	1 time a week	S	4 treatments	
		25 mg, oral, 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) 375 mg/m2 in sodium chloride 0.9% IVPB	1 time a week	S	4 treatments	
		375 mg/m2, intravenous, once, Starting when released
	Initiate infusion at rate of 50 mg/hour. In the absence of infusion toxicity (SBP within 20 mmHG 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.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	1 time a week	S	4 treatments	
		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	1 time a week	S	4 treatments	
		25 mg, intravenous, once PRN, for mild to moderate infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	1 time a week	S	4 treatments	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	1 time a week	S	4 treatments	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	famotidine (PEPCID) injection 20 mg	1 time a week	S	4 treatments	
		20 mg, intravenous, once PRN, for mild to moderate infusion reactiona, Starting when released, Until Discontinued		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	1 time a week	S	4 treatments	
		40 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	ondansetron (ZOFRAN) IV 4 mg	1 time a week	S	4 treatments	
		4 mg, intravenous, once PRN, nausea, vomiting, Starting when released, Until Discontinued
	May cause QTc prolongation.		
	☐	promethazine (PHENERGAN) tablet 25 mg	1 time a week	S	4 treatments	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	1 time a week	S	4 treatments	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued