Page 66 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Protocol for Administration of Rituximab (Rituxan®)

Rituximab is chimeric murine/human monoclonal antibody directed against the CD20 antigen found on
the surface of most B cells. Rituximab is used for the treatment of post-transplant lymphoproliferative
disorders (PTLD), antibody mediated rejection, and refractory immune-mediated thrombocytopenia.
Rituximab is usually given weekly x 4 doses, but may also be given as a single dose.

Premedication: 1 hr prior to infusion
 Acetaminophen: 10 – 15 mg/kg PO/NG (maximum: 650mg) X 1; then every 6 hours as needed
for pain/fever
 Benadryl: 1mg/kg IV or PO X 1; then every 6 hours as needed for itching (maximum 50mg)

Dose:
Rituximab dose should be based on body surface area (BSA)
2
Rituximab Dose: 375 mg/m IV
2
To calculate BSA (m ): √ (ht [cm] x wt [kg])/ 3600)

Infusion:
DO NOT ADMINISTER AS AN INTRAVENOUS PUSH OR BOLUS
 First Infusion:
Initial rate:
0.5 mg/kg/hr (max rate: 50 mg/hr) x 1 hour
If hypersensitivity or infusion-related reactions do not occur, may increase by rate by 0.5
mg/kg/hr (max 50 mg/hr increase) every 30 minutes, to maximum rate of 400 mg/hr
 Subsequent Infusions:
If patient tolerated first infusion well, infuse at the following rate:
Initial rate:
1 mg/kg/hr (max rate 100 mg/hr)
May increase rate by 1 mg/kg/hr at 30 minute intervals up to a maximum rate of 400
mg/hr as tolerated.
***If hypersensitivity or infusion related reactions develops***
The infusion should be temporarily interrupted. The infusion can continue at a 50% reduction in rate
once the patient’s symptoms have resolved

Anaphylaxis:
 Discontinue Rituximab immediately
 Initiate epinephrine, steroids, and other necessary resuscitative measures
 Do not re-challenge patient with Rituximab

Drug Interactions:
Antihypertensive medications: May exacerbate hypotension; consider withholding antihypertensive
medications for 12 hours prior to rituximab administration.

Monoclonal antibodies: Allergic reactions may be increased in patients who have received
diagnostic or therapeutic monoclonal antibodies due to the presence of human anti-chimeric
antibody (HACA).

Updated November 9, 2017 66