Policies and procedures

Policy and Procedure System_PCPS160 Rituximab (Rituxan) Infusions

Key points: 

• Rituximab infusion reactions
  • Rituximab infusion can cause serious, including fatal infusion reactions including urticaria, hypotension, angioedema, hypoxia, bronchospasm and respiratory distress
  • Time of onset of symptoms ranges between 30 and 120 minutes.
  • These reactions are more common during the initial infusion. To minimize the risk of serious infusion reactions, the manufacturer’s administration directions for initial infusions should be followed.
• Prophylaxis prior to rituximab infusion
  • All patients should receive at least 650 mg of acetaminophen by mouth given 60 minutes prior to rituximab infusion.
  • It is strongly encouraged that all patients receive at least 25 mg of diphenhydramine either by oral or intravenous route, or a comparable agent, given 30 minutes prior to rituximab infusion.
  • All patients receiving rapid infusion must receive both 650 mg of acetaminophen by mouth given 60 minutes prior to rituximab infusion and 25 mg of intravenous diphenhydramine, or comparable agents, given 30 minutes prior to rituximab infusion

Policy & Procedure System_RX102 Monoclonal Antibody Dose Rounding

Key points:

• Pharmacists will evaluate orders for all monoclonal antibodies and may automatically round doses up or down to the nearest vial size “per policy,” if the rounded dose is within 10% of the original ordered dose
• If rounding occurs, “DOSE ROUNDED TO THE NEAREST VIAL SIZE PER POLICY” will be included on the medication label
• If chemotherapy, pharmacists will double check the order prior to and after any rounding

Procedure M-19.4 Intrathecal Infusions

Procedure M-19.3 Intraventricular Infusions

Consults, protocols, and therapeutic interchanges

System_RXCLIN 145 Pharmacy Consult for Rapid Rituximab Infusion

Key Points:

• This consult applies only to oncology or hematology indications. For other indications, discontinue consult and continue standard rituximab infusion.
• Pharmacists will review inclusion and exclusion criteria for rapid rituximab infusion. If the patient is eligible, the pharmacist will enter the new order for rapid rituximab “per policy”
• Pharmacists will document in Epic using i-Vents and consults notes

Additional information

Prior to beginning rituximab infusion, please check if a Hepatitis B and C serology has been performed within the past 6 months. 

• Micromedex
• UpToDate
• Lexicomp