Obinutuzumab 1000 mg Maintenance Infusion Every 6 Months		version 12/18/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☐	Referral to IV Infusion Room	Every 180 days	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	 treatments	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every visit	S	 treatments	
		STAT, Normal, Clinic Collect		
	☐	Magnesium level	Every visit	S	 treatments	
		STAT, Normal, Clinic Collect		
	☐	Hepatitis B surface antigen	Once	S	1 treatment	
		Routine, Status: Future, Expected: S, Expires: S+365, Lab Collect		
	☐	Hepatitis B core antibody total	Once	S	1 treatment	
		Routine, Status: Future, Expected: S, Expires: S+365, Lab Collect		
	☐	QuantiFERON-TB Gold Plus, 4 tube	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Lab Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	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	
		No details available for preview		
	☐	Nursing communication	Every visit	S	 treatments	
		Withhold antihypertensive therapies for 12 hours prior to, during, and for 1 hour after obinutuzumab administration.		
	☐	Nursing communication	Every visit	S	 treatments	
		Beginning with treatment dose 6, IV glucocorticoids should only be administered in patients who have experienced an infusion reaction with prior infusions.		
	☐	Nursing communication	Every visit	S	 treatments	
		Consider a 90-minute infusion rate for patients with lupus nephritis who do not experience a >= Grade 3 infusion reaction with the previous infusion, starting with treatment dose 2.
	
	o All subsequent infusions (beginning with treatment dose 2 [Week 2]):
	If no >= Grade 3 infusion reaction occurred during treatment dose 1, infuse at 100 mg/hour for 30 minutes, then 900 mg/hour over approximately 60 minutes.
	If a Grade 1 or 2 infusion reaction with ongoing symptoms occurs, or if a >= Grade 3 infusion reaction occurred during the prior ~90-minute infusion, administer all subsequent infusions at the standard infusion rate.		
	☐	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		
	☐	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		
	☐	HEParin, porcine injection 500 Units	Every visit	S	Until discont'd	
		500 Units, intra-catheter, once PRN, line care, Starting when released, Until Discontinued
	Heparin flush for Implanted Vascular Access Device Maintenance.		
	☐	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	 treatments	
		650 mg, oral, once, Starting when released
	Give 30 minutes prior to Obinutuzumab.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	Every visit	S	 treatments	
		50 mg, intravenous, once, Starting when released
	Give 30 minutes prior to Obinutuzumab		
	☐	dexAMETHasone (DECADRON) IV 20 mg	Every visit	S	 treatments	
		20 mg, intravenous, once, Starting when released
	Give 30 minutes prior to Obinutuzumab.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	obinutuzumab (GAZYVA) 1,000 mg in sodium chloride 0.9% 250 mL (4 mg/mL) IVPB	Every 180 days	S	 treatments	
		100 mg/hr, intravenous, once, Starting when released
	Gently invert to mix; do not shake; Do not administer IV push or as a bolus. Administer through a dedicated IV line; do not mix with or infuse with other medications.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), 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) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor 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		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	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