Rituxan (Rituximab) Therapy for Steroid Resistant/Antibody Mediated Rejection
RATIONALE:
 Antibody Mediated Rejection (AMR) is caused by antibodies directed against the donor organ and in
heart transplantation can be both difficult to diagnose and treat. While graft dysfunction may be
present in some cases, in others there is only pathologic evidence, or sometimes no other notable
cause for graft dysfunction. Rituximab is a monoclonal antibody directed against CD20 and is
utilized to suppress or deplete the circulating mature B-cells.
PREMEDS:
 Acetaminophen 325 - 650mg po 30 minutes prior to Rituxan and every 6 hours as needed for fever
 Diphenhydramine 12.5 – 50mg IV 30 minutes prior to Rituxan
 ANA kit to infusion room/bedside
RITUXAN (Rituximab) ORDERS:
 Rituxan 375mg/m2 IV every week via high flow vein for a total of _____ weeks (usually for up to 4
weeks total)
 Dose must be double checked by pharmacist
INFUSION RATE:
First Infusion:
To be infused 50mg/hour x 30 minutes, then
100ml/hour x 30 minutes, then
NOTE:
Drug concentration
is 1mg/ 1mL
150ml/hour x 30 minutes, then
Continue in this fashion to a max of 400ml/hour
Second and Subsequent Infusions:
100ml/hour x 30 minutes, then
200ml/hour x 30 minutes, then
300ml/hour x 30 minutes, then
400ml/hour until infusion complete (as patient tolerates)
***400ml/hour = max rate of administration (as tolerated by the patient)***
MONITORING:
During Infusion: Check vital signs every 15 mins x 1 hour then every hour

If the patient experiences fever, chills, or rigors, the infusion must be slowed and restarted
after the adverse event resolves
After Infusion: The patient is free to go when the infusion is complete

Caution patients that infusion related reactions can be delayed, so if they experience back
pain, difficulty breathing, rash, chest pressure/pain, or in general don’t feel well, they
should go to the ER
REFERENCES:
1.) Rituxan [package insert]. San Francisco (CA): Genentech, Inc; 2007
2.) Singh N, Pirsch J, Samaniego M. Transplantation Reviews. 2009; 23: 34-46
3.) Becker YT, Becker BN, Pirsch JT, et al. American Journal of Transplantation 2004; 4: 996–1001
Revised November 2010