DAY 1
PREMEDICATION WITH ACETAMINOPHEN 650 MG AND DIPHENHYDRAMINE 50 MG ORALLY MAY BE ADMINISTERED PRIOR TO RITIXUMAB INFUSION.
ADMINISTER RITUXIMAB 250 MG/MΒ² IV AT AN INITIAL RATE OF 50 MG/HR. IN THE ABSENCE OF INFUSION REACTIONS, ESCALATE THE INFUSION RATE IN 50 MG/HR INCREMENTS EVERY 30 MINUTES TO A MAXIMUM OF 400 MG/HR.
IMMEDIATELY STOP THE RITUXIMAB INFUSION FOR SERIOUS INFUSION REACTIONS AND DISCONTINUE IBRITUMOMAB THERAPEUTIC REGIMEN.
TEMPORARILY SLOW OR INTERRUPT THE RITUXIMAB INFUSION FOR LESS SEVERE INFUSION REACTIONS. IF SYMPTOMS IMPROVE, CONTINUE THE INFUSION AT ONE-HALF THE PREVIOUS RATE.
ADMINISTER 5 MCI IN-111 ZEVALIN (IBRITUMOMAB) OVER 10 MINUTES AS AN INTRAVENOUS INJECTION WITHIN 4 HOURS FOLLOWING COMPLETION OF THE RITUXIMAB INFUSION. USE A 0.22 MICRON LOW-PROTEIN-BINDING FILTER IN-LINE BETWEEN THE SYRINGE AND THE INFUSION PORT. AFTER INJECTION, FLUSH THE LINE WITH AT LEAST 10 ML OF NORMAL SALINE.
DAY 7, 8 OR 9
VERIFY THAT EXPECTED BIODISTRIBUTION IS PRESENT.
PREMEDICATION WITH ACETAMINOPHEN 650 MG & DIPHENHYDRAMINE 50 MG ORALLY PRIOR TO RITIXUMAB INFUSION
ADMINISTER RITUXIMAB 250 MG/MΒ² IV AT AN INITIAL RATE OF 100 MG/HR. INCREASE RATE BY 100 MG/HR INCREMENTS AT 30 MINUTE INTERVALS, TO A MAXIMUM OF 400 MG/HR, AS TOLERATED. IF INFUSION REACTIONS OCCURRED DURING RITUXIMAB INFUSION ON DAY 1 OF TREATMENT, ADMINISTER RITUXIMAB AT AN INITIAL RATE OF 50 MG/HR AND ESCALATE THE INFUSION RATE IN 50 MG/HR INCREMENTS EVERY 30 MINUTES TO A MAXIMUM OF 400 MG/HR.
ADMINISTER Y-90 ZEVALIN INJECTION THROUGH A FREE FLOWING INTRAVENOUS LINE WITHIN 4 HOURS FOLLOWING COMPLETION OF RITUXIMAB INFUSION.
IF PLATELET COUNT =150,000/MMΒ³, ADMINISTER Y-90 ZEVALIN OVER 10 MINUTES AS AN INTRAVENOUS INJECTION AT A DOSE OF 0.4 MCI PER KG (14.8 MBQ PER KG) ACTUAL BODY WEIGHT
IF PLATELET COUNT 100,000-149,000/MMΒ³ ADMINISTER Y-90 ZEVALIN 0.3 MCI PER KG (11.1 MBQ PER KG) ACTUAL BODY WEIGHT OVER 10 MINUTES AS AN IV INJECTION.
DO NOT ADMINISTER MORE THAN 32 MCI (1184 MBQ) Y-90 ZEVALIN DOSE REGARDLESS OF THE PATIENT'S BODY WEIGHT
MONITOR PATIENTS CLOSELY FOR EVIDENCE OF EXTRAVASATION DURING THE INJECTION OF Y-90 ZEVALIN. IMMEDIATELY STOP INFUSION AND RESTART IN ANOTHER LIMB IF ANY SIGNS OR SYMPTOMS OF EXTRAVASATION.
AFTER INJECTION, FLUSH THE LINE WITH AT LEAST 10 ML OF NORMAL SALINE.