Mabthera is rituximab, which we also know as Rituxin.
We always give the first total dose on two days. Day '0', we give a 100 mg test dose over 4 hours.
Second day, or Day '1', we give the remainder of the first dose, starting at 50mg/hour for the first hour, then increasing the rate by 50 mg/hour q 30 minutes until the infusion is complete.
We start subsequest doses at 100mg/hr for the first hour and increase by 50 mg/hour q 30 minutes for the remainder of the dose.
For all doses, we do vs checks q 15 min for the first hour, then q 30 minutes until the dose is done. Our premeds are acetaminophen 650 mg po and diphenhydramine 50 mg IV, given 30 minutes prior to starting the infusion.
We monitor the patient for decreased BP, for fever, chills, rigors.
For BPs < 90, we stop the infusion and hydrate with NS until the BP comes back up. For fever, chills, we give additional 50mg diphenhydramine IVP, hydrocortisone 100 mg IVP, and sometimes meperidine 25 mg IVP for rigors. Some of our patients have reported chills and fever hours after the infusion completed. For that, we recommend acetaminophen 650 mg po. Unless the patient is receiving chemo in addition to the rituximab, neutropenia is unlikely. But if the fever continues to escalate, we have them go to UCC or ER. (Usually, the fever will subside right away.)
We encourage fluids and do not restrict the diet (unless they are also on chemo). We recommend that they stop all vitamins/ supplements until the course of therapy is complete .
Hope this helps.