Quick Answer Overview
Looking for the exact dose of Truxima? For most patients it's an IV infusion of 375mg/m (used in many lymphomas and leukemia) or a flat 1000mg dose when treating rheumatoid arthritis. The drug comes in singledose vials of 100mg/10mL or 500mg/50mL, which are diluted and infused over 3090minutes depending on the schedule.
Why Dosage Matters
Getting the dose right isn't just a numbers game. The right amount gives you the best chance of disease control while keeping serious side effectslike infusion reactions, infections, or liver issuesat bay. Different conditions (NHL, CLL, rheumatoid arthritis, GPA/MPA) each have their own rhythm, so a onesizefitsall approach would leave you guessing, and guessing is never comfortable when your health is on the line.
Form & Strength
Truxima is supplied as a sterile solution ready for dilution. Knowing the vial strength helps your pharmacy team avoid waste and ensures you get the exact dose prescribed.
| Vial Strength | Amount per Vial | Typical Use |
|---|---|---|
| 100mg/10mL | 100mg | Rheumatoid arthritis, lowerdose regimens |
| 500mg/50mL | 500mg | Oncologic protocols, highdose infusions |
Both vials must be stored at 28C and used within 24hours after dilution. If a clinic needs a larger dose, they simply combine vialsalways under sterile conditions.
Standard Dosing Regimens
NonHodgkin's Lymphoma (NHL)
The classic oncology schedule calls for 375mg/m IV on Day1 of each chemotherapy cycle. Most patients receive up to eight infusions, followed by maintenance every eight weeks if they achieve a good response.
| Regimen | Cycle # | Dose (mg/m) | Frequency |
|---|---|---|---|
| RCHOP firstline | 18 | 375 | Day1 each 21day cycle |
| CVPR (postfirstline) | 14 | 375 | Weekly4, then every 6months (max16) |
| Relapsed/ refractory | 14/8 | 375 | Weekly4 or8, then every 8weeks |
Chronic Lymphocytic Leukemia (CLL)
When Truxima is paired with chemotherapy (often FC), the first dose is 375mg/m on the day before chemo, then 500mg/m on Day1 of cycles26.
Rheumatoid Arthritis (RA)
The rheumatoid arthritis protocol is a little differenttwo big infusions of 1000mg given two weeks apart. After the initial course, doctors usually repeat the treatment every 1624weeks based on disease activity.
GPA & MPA (Vasculitis)
Induction therapy mirrors the oncology schedule: 375mg/m weekly for four weeks together with highdose steroids. Maintenance may be 500mg IV every six months once the disease is under control.
Special Situations
Some centers have adopted a 90minute infusion protocol for selected patients. This is only allowed if the first infusion had no Grade3/4 reactions, the lymphocyte count is 5000cells/mm, and the patient has an ECOG performance status of 02. It can make the day feel a lot shorter, but safety always comes first.
How to Administer
Even though Truxima is a straightforward drug, the infusion steps are critical to keep reactions in check.
Preparing the Infusion
- Dilute the vial to a concentration of 14mg/mL using 0.9% sodium chloride or 5% dextrose.
- Never mix it with other IV medications in the same bag.
- Label the bag with dose, patient name, and "Truxima start infusion after premedication."
StepbyStep Infusion Rate
| Phase | First Infusion | Subsequent Infusions |
|---|---|---|
| Start rate | 50mg/hr | 100mg/hr |
| Increment | +50mg/hr every 30min | +100mg/hr every 30min |
| Maximum rate | 400mg/hr | 400mg/hr |
| 90min protocol* | 20% dose 30min, then 80% 60min | Same as above |
*Only for patients who tolerated the first infusion without serious reactions.
Premedication & Monitoring
Every infusion should be preceded by:
- Antihistamine (e.g., diphenhydramine 2550mg IV)
- Acetaminophen 6501000mg PO/IV
- Methylprednisolone 100mg IV for RA, GPA, or MPA
During the infusion, nurses watch for fever, chills, rash, or breathing difficulty. Blood workCBC, liver enzymes, and HBV screeningshould be checked before the first dose and periodically thereafter.
Managing Infusion Reactions
If you feel a flushing sensation, shortness of breath, or a sudden drop in blood pressure, the infusion is paused immediately. The team will administer additional steroids, antihistamines, or even epinephrine if needed. Once symptoms settle, the infusion can usually resume at a slower rate.
Safety & Contraindications
Truxima carries several boxed warnings that you should keep frontofmind.
Major Risks
- Fatal infusionrelated reactionsmost happen during the first infusion.
- Severe mucocutaneous reactions (e.g., StevensJohnson syndrome).
- HBV reactivationscreen everyone before starting therapy.
- Progressive multifocal leukoencephalopathy (PML), a rare brain infection.
When Not to Use
Active severe infections, uncontrolled hepatitis B, or pregnancy are clear contraindications. Women of childbearing potential must use reliable contraception for at least 12months after the last dose because Truxima can cross the placenta and affect fetal Bcell development.
Monitoring Recommendations
- HBV DNA PCR every 13months for patients with past exposure.
- Neurologic exam and MRI if new cognitive symptoms appear (watch for PML).
- Cardiac monitoring for patients with a history of arrhythmia, especially if highdose infusions are planned.
Real World Perspectives
Clinician Case Study
Dr. Patel, a hematologistoncologist, recently treated a 68yearold man with CLL and a history of chronic hepatitis B. After confirming negative HBV DNA and starting prophylactic entecavir, the patient received the standard 375mg/m induction dose followed by 500mg/m maintenance. He tolerated the infusions well, and his disease entered a partial remission after six cycles. Dr. Patel credits meticulous prescreening and patient education for the smooth course.
Patient Story
Maria, a 45yearold teacher living with rheumatoid arthritis, shares, "When my rheumatologist explained the twoinfusion schedule, I felt a wave of relief. Knowing exactly when I'd get the next dose helped me plan my school terms and family trips without constant anxiety." Her experience underscores how clear dosing information can improve quality of life.
Quick Reference Resources
- FDA Truxima prescribing information
- Drugs.com administration guide
- 2024 ACR rheumatoid arthritis recommendations
- Official Truxima HCP website (dose tables, safety updates)
Keep these links handyyou'll thank yourself when you need to doublecheck a number or a safety precaution.
Key Takeaways Summary
Understanding Truxima dosage is a balancing act. The drug comes in two vial strengths (100mg and 500mg) and is typically dosed at 375mg/m for cancer or a flat 1000mg for rheumatoid arthritis. Proper preparation, premedication, and vigilant monitoring keep infusion reactions and infection risks low. Use the tables above to match your condition with the right schedule, and always confirm the latest prescribing information before each infusion.
Ready to talk to your doctor or pharmacist? Bring this guide with you, ask about the specific regimen for your disease, and make sure you've been screened for hepatitis B. A clear plan means fewer surprises and more confidence in your treatment journey.
FAQs
What is the standard Truxima dose for non‑Hodgkin’s lymphoma?
The typical regimen is 375 mg/m² given by IV infusion on Day 1 of each chemotherapy cycle, usually every 21 days for up to eight cycles.
How is Truxima administered for rheumatoid arthritis?
Patients receive two 1000 mg IV infusions two weeks apart, followed by repeat dosing every 16‑24 weeks based on disease activity.
What pre‑medications are required before a Truxima infusion?
Standard pre‑medication includes an antihistamine (e.g., diphenhydramine 25‑50 mg IV), acetaminophen 650‑1000 mg PO/IV, and methylprednisolone 100 mg IV for RA, GPA, or MPA.
Can Truxima cause hepatitis B reactivation and how is it prevented?
Yes. All patients should be screened for HBV before starting therapy. Those with past exposure receive antiviral prophylaxis (e.g., entecavir) and regular HBV DNA monitoring.
What are the signs of an infusion‑related reaction to Truxima?
Typical signs include fever, chills, rash, flushing, shortness of breath, or a sudden drop in blood pressure. If any occur, the infusion is paused and appropriate medication (steroids, antihistamines, epinephrine) is administered.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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