Generic Name: rituximab, Parenteral Solution

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SECTION 1 of 5

Highlights for rituximab

Parenteral Solution
1

Rituximab is an injected drug used to treat non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, and granulomatosis with polyangiitis and microscopic polyangiitis.

2

Rituximab is available as a solution that’s slowly injected (infused) into your vein. The medication is given to you by a doctor or nurse in their office or at a hospital.

3

Your dosing schedule depends on the condition that’s being treated. It’s important to go to all of your appointments to receive rituximab.

4

Common side effects include infusion reaction. This can cause symptoms such as hives, skin rash, shortness of breath, weakness, and dizziness.

5

This drug can decrease your body’s ability to fight off infections. You may have an increased risk of serious infections while you take this medication.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Infusion reactions. Serious reactions can happen during your infusion or within 24 hours after your infusion of rituximab. Your doctor should give you medicine before your infusion to reduce this risk. Tell your doctor or get medical help right away if you have any of these symptoms during or after an infusion:

  • fever
  • chills
  • hives (red itchy welts) or skin rash
  • itching
  • swelling of your lips, tongue, throat, or face
  • sudden cough
  • shortness of breath, difficulty breathing, or wheezing
  • weakness
  • dizziness or feeling faint
  • feeling like your heart is racing or fluttering (palpitations)
  • chest pain

Severe skin and mouth reactions. Tell your doctor or get medical help right away if you have any of these symptoms during your treatment with rituximab:

  • painful sores or ulcers on your skin, lips, or in your mouth
  • blisters
  • peeling skin
  • rash
  • blisters that contain pus (pustules)

Hepatitis B virus (HBV) infection reactivation. Your doctor will test you for HBV infection before starting treatment with this drug. If you’ve had the virus or are a carrier of the hepatitis B virus, rituximab could cause the virus to become active again.

Hepatitis B reactivation may cause serious liver problems, including liver failure. It may even be fatal. You shouldn’t receive rituximab if you have active HBV infection. Your doctor will monitor you for HBV infection during and for several months after you stop treatment with rituximab.

Progressive multifocal leukoencephalopathy (PML). Rituximab may raise your risk for PML. This is a rare, serious brain infection caused by a virus. It can lead to severe disability or even be fatal. People with weakened immune systems can get PML. There’s no known treatment for PML. Tell your doctor right away if you have any of these symptoms:

  • confusion or problems thinking
  • problems with balance
  • changes in the way you walk or talk
  • weakness or decreased strength on one side of your body
  • blurred vision or loss of vision

Risk of serious infections

Rituximab raises your risk for bacterial, fungal, and viral infections. This drug can also lower the ability of your immune system to fight infections. These infections can be serious and fatal. Call your doctor right away if you have any symptoms of infection, including:

  • fever
  • cold symptoms that don’t go away, such as runny nose or sore throat
  • flu symptoms, such as cough, tiredness, and body aches
  • earache or headache
  • pain when urinating
  • white patches in your mouth or throat
  • cuts, scrapes, or other injuries that are red, warm, swollen, or painful

Risk of heart problems

Rituximab may cause chest pain, irregular heart rate, and other heart conditions. If this happens, your doctor may stop your treatment with rituximab.

Risk of kidney problems

Rituximab may raise your risk for kidney disease. Your risk may be higher if you’re using the drug to treat non-Hodgkin lymphoma. Your doctor should do blood tests to check how well your kidneys are working.

Drug Features

Rituximab is a prescription drug. It’s available as an intravenous (IV) injection, which is only given by a healthcare provider.

This drug may be used as part of a combination therapy. That means you may need to take it with other drugs.

Why It's Used

Rituximab is used to treat:

  • non-Hodgkin lymphoma, alone or combined with chemotherapy
  • chronic lymphocytic leukemia when used with other drugs
  • rheumatoid arthritis inflammation and pain, used with methotrexate when other medications don’t work
  • granulomatosis with polyangiitis and microscopic polyangiitis, used with glucocorticoids

How It Works

Rituximab belongs to a class of drugs called monoclonal antibodies. It works by destroying certain immune cells that can develop cancer or attack your own body and joints, causing inflammation.

Rituximab targets a protein on B-cells. These are a type of white blood cell that helps your body fight infections. However, cancer can form on these cells. Or, your body can make abnormal B-cells that attack your own body. When rituximab binds to the protein on the B-cell, it destroys it. This stops the cancerous or abnormal B-cells from multiplying.

SECTION 2 of 5

rituximab Side Effects

Parenteral Solution

Most Common Side Effects

  • The most common side effect that occurs with rituximab when treating all conditions is infusion reactions. Symptoms may include:

    • hives (red itchy welts) or skin rash
    • itching
    • swelling of your lips, tongue, throat, or face
    • sudden cough
    • shortness of breath, difficulty breathing, or wheezing
    • weakness
    • dizziness or feeling faint
    • feeling like your heart is racing or fluttering (palpitations)
    • chest pain
  • Common side effects when treating non-Hodgkin lymphoma include:

    • fever
    • chills
    • infections
    • weakness or lack of energy
  • Common side effects when treating chronic lymphocytic leukemia include:

    • low white blood cell count
  • Common side effects that occur when treating rheumatoid arthritis include:

    • serious infections
    • upper respiratory tract infections, such as the common cold or bronchitis
    • urinary tract infections
    • high blood pressure
  • Common side effects that occur when treating granulomatosis with polyangiitis and microscopic polyangiitis include:

    • infections
    • nausea
    • diarrhea
    • headache
    • muscle spasms
    • low red blood cell count
    • swelling in your arms or legs (peripheral edema)

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  • serious infusion reactions. Symptoms may include:

    • hives (red itchy welts) or skin rash
    • swelling of your lips, tongue, throat, or face
    • sudden cough
    • shortness of breath, difficulty breathing, or wheezing
    • weakness
    • dizziness or feeling faint
    • feeling like your heart is racing or fluttering (palpitations)
    • chest pain
  • severe skin and mouth reactions. Symptoms may include:

    • painful sores or ulcers on your skin or lips or in your mouth
    • blisters
    • peeling skin
    • skin rash
    • blisters that contain pus (pustules)
  • hepatitis B virus infection. Symptoms may include:

    • loss of appetite
    • nausea
    • vomiting
    • fever
    • muscle pain
    • feeling tired easily
    • confusion
  • progressive multifocal leukoencephalopathy (PML). PML is a rare, serious brain infection caused by a virus. Symptoms may include:

    • confusion or problems thinking
    • problems with balance
    • changes in the way you walk or talk
    • weakness or decreased strength on one side of your body
    • blurred vision or loss of vision
  • tumor lysis syndrome (TLS): TLS is a serious illness that may lead to kidney failure and abnormal heart rhythm. Symptoms may include:

    • irregular heart rate
    • weakness or feeling tired
    • trouble breathing
    • anxiety
    • loss of appetite
    • nausea
    • vomiting
  • serious infections. Symptoms may include:

    • cold symptoms that don’t go away, such as runny nose or sore throat
    • flu symptoms, such as cough, tiredness, and body aches
    • earache or headache
    • pain when urinating
    • white patches in your mouth or throat
    • cuts, scrapes, or other injuries that are red, warm, swollen, or painful
  • heart problems. Symptoms may include:

    • chest pain
    • irregular heart rate
  • kidney problems

  • stomach and serious bowel problems. Rituximab can cause bowel problems, including blockage or tears. Symptoms may include:

    • stomach pain
    • feeling bloated
    • tender stomach
  • low blood cell counts

Pharmacist's Advice
Healthline Pharmacist Editorial Team

Rituximab can make you feel tired and dizzy after an infusion. The medicines that you take before your infusion to reduce side effects may also have this effect. It’s a good idea to have someone else drive you home after your treatments.

Infusion reactions are the most common side effect of rituximab. Serious reactions can happen during your infusion or within 24 hours after it. Your doctor should give you medicine before your infusion to reduce your risk. Tell your doctor or seek medical help right away if you have any of these symptoms during or after an infusion:

  • hives (red itchy welts) or skin rash
  • itching
  • swelling of your lips, tongue, throat, or face
  • sudden cough
  • shortness of breath, difficulty breathing, or wheezing
  • weakness
  • dizziness or feeling faint
  • feeling like your heart is racing or fluttering (palpitations)
  • chest pain

Mild side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

rituximab May Interact with Other Medications

Parenteral Solution

Rituximab can interact with other medications, herbs, or vitamins you might be taking. Your healthcare provider will look out for interactions with your current medications. Always be sure to tell your doctor about all medications, herbs or vitamins you’re taking.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with a history of reactions to rituximab

You shouldn’t take this drug if you’ve had a severe infusion reaction to rituximab in the past.

People with heart problems

If you have a history of heart problems, irregular heart rate, or chest pain, you may need treatment for your heart problem or your doctor may not prescribe this drug.

People with lung problems

Your doctor may watch you more closely for infusion reactions, which can make it harder to breathe.

People with kidney problems

Your doctor will do blood tests to check how well your kidneys are working.

People with an infection or weakened immune system

This drug can further weaken your immune system and raise your risk for serious infections. If you currently have an infection or develop one while being treated, you shouldn’t take this drug.

Pregnant women

Rituximab is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Rituximab should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women of childbearing age should use effective birth control while using rituximab and for 12 months after stopping treatment. Talk to your doctor about effective birth control.

Women who are nursing

It isn’t known if rituximab passes through breast milk. It isn’t known if this drug can cause side effects in a breastfeeding child.

You and your doctor may need to decide if you’ll take rituximab or breastfeed.

For Seniors

Seniors may be more likely than others to experience side effects from this drug. Some of these side effects could be dangerous.

For Children

The safety and effectiveness of rituximab haven’t been established in children under the age of 18 years. 

Allergies

Rituximab can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

SECTION 4 of 5

How to Take rituximab (Dosage)

Parenteral Solution

Your doctor will determine a dose that’s right for you based on your individual needs. Your general health may affect your dose. Tell your doctor about all health conditions you have before your doctor or nurse administers the drug to you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Rituximab comes with serious risks if you don't take it as prescribed.

If You Don’t Take It at All or Miss Doses

If you stop taking this medication, miss doses, or don’t receive it on schedule, your condition may get worse.

What to Do If You Miss a Dose

If you miss an appointment to receive rituximab, call your doctor right away to reschedule it.

How to Tell the Drug Is Working

For non-Hodgkin lymphoma and chronic lymphocytic leukemia, you may be able to tell the drug is working if your cancer goes into remission. Your doctor may do blood tests to check if this medication is working for you.

For rheumatoid arthritis, you may be able to tell if this drug is working if you have less pain, swelling, and stiffness in your joints. Your doctor may also do lab tests and X-rays to check your joints to see if the drug is working.

For granulomatosis with polyangiitis and microscopic polyangiitis, you may be able to tell it’s working if your blood vessels aren’t as inflamed. This will increase blood flow to your organs and decrease your symptoms.

Rituximab is a long-term drug treatment.

Your schedule will depend on your condition

Rituximab is given as an injection (infusion) into your vein at your doctor’s office or hospital. Your dosing schedule depends on the condition that’s being treated and how well you’re tolerating and responding to the drug. It’s important to keep all of your appointments to receive rituximab. If you miss an appointment, call your doctor right away to reschedule it.

How Long Does It Take?

The infusion can take several hours to complete.

The amount of time you’ll need to receive your rituximab infusion will depend on:

  • the condition being treated
  • the dose given. Your dose of rituximab will be calculated using your body surface area (BSA). The larger the dose, the longer the infusion will take.
  • first infusion or later infusion. The first infusion is given slowly so that your healthcare team can watch you closely for side effects. If you handle your first infusion well, your later infusions may not take as much time.

Can I Drive Home After?

It’s a good idea to have someone drive you home.

Rituximab can make you feel tired and dizzy after an infusion. The medicines that you take before your infusion to reduce side effects may also have this effect. 

Travel

Talk to your doctor before traveling.

Rituximab should only be given by a healthcare professional who’s familiar with your medical history. You should also only receive it at a medical facility that’s able to manage a severe infusion reaction.

Before you make travel plans, talk to your doctor to work out a schedule so that you don’t miss any appointments.

Clinical Monitoring

Your doctor will do tests to check your health and make sure that the drug is working. These tests include:

  • complete blood count and other tests to check your blood cell counts
  • ECG or electrocardiogram. This test checks that your heart is beating normally.
  • Serum creatinine and blood urea nitrogen (tests that check how well your kidneys are working)
  • tests to check your electrolytes
  • tests to check your uric acid
  • blood tests to see if you have hepatitis B or if you carry the virus. This test will be done before you start taking this drug.
  • monitoring for signs of infection
  • monitoring to detect stomach problems

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for rituximab.

SECTION 5 of 5

How Much Does rituximab Cost?

Parenteral Solution
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Lowest price for rituximab

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Kroger Pharmacy $14,697.90
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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on June 11, 2015

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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