Systemic Anti-Cancer Therapy Regimen Library
LEU HCL - RITUximab
Treatment Overview
This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.
Cycle 1 - 42 days
RITUximab, first dose: Consider withholding routine anti-hypertensives for 12 hours prior to first RITUximab dose.
RITUximab, subsequent doses: Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice.
Cycle details
Cycle 1 - 42 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration | 1, 8, 15, 22, 29, 36 |
|
| loratadine * | 10 mg | oral administration | 1, 8, 15, 22, 29, 36 |
|
| dexamethasone * | 12 mg flat dosing | intravenous | 1 | 15 minutes |
| RITUximab * | 375 mg/m² | intravenous | 1, 8, 15, 22, 29, 36 |
6 hours |
RITUximab, first dose: Consider withholding routine anti-hypertensives for 12 hours prior to first RITUximab dose.
RITUximab, subsequent doses: Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice.
Full details
Cycle 1 - 42 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| dexamethasone * | 12 mg flat dosing | intravenous | 15 minutes |
Instructions:
30 to 60 minutes prior to RITUximab, or as per institutional practice. |
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider withholding routine anti-hypertensives for 12 hours prior to RITUximab. Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour. |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice. Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice. |
Day: 15
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice. Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice. |
Day: 22
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice. Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice. |
Day: 29
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice. Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice. |
Day: 36
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| paracetamol | 1000 mg flat dosing | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 to 60 minutes prior to RITUximab. |
|
| RITUximab * | 375 mg/m² | intravenous | 6 hours |
Instructions:
Consider administering corticosteroid premedication before RITUximab if previous doses not well tolerated or if clinically indicated as per institutional practice. Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Antiviral prophylaxis for hepatitis B virus: | Required for anti–HBc positive patients at risk of reactivation |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis may be considered |
| Emetogenicity: | Minimal |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis may be considered |
References
Medicines and Hepatitis B Reactivation Prescriber Update 38(1): 2-3 March 2017. https://medsafe.govt.nz/profs/PUArticles/March2017/MedicinesAndHepatitisB.htm
Rituximab and Hepatitis B Reactivation Prescriber Update 34(3):27 September 2013. https://www.medsafe.govt.nz/profs/PUArticles/Sept2013RituximabHepB.htm
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.