Truxima (rituximab-abbs) is a prescription drug used to treat certain blood cancers, rheumatoid arthritis, and other conditions. Truxima can cause side effects that range from mild to serious. Examples include kidney problems and infections.

Truxima is used in adults to treat the following conditions in certain situations:

Truxima is a biologic drug. It’s a biosimilar version of Rituxan (rituximab).

The active ingredient in Truxima is rituximab-abbs*. (An active ingredient is what makes a drug work.) The drug is given as an intravenous infusion (an injection given over time into a vein).

Keep reading to learn about the common, mild, and serious side effects that Truxima can cause. For a general overview of the drug, including details about its uses, see this article.

* The reason “-abbs” appears at the end of the drug’s name is to show that the drug is distinct from similar medications that may be created in the future.

Some people may experience mild to serious side effects during Truxima treatment.

Below are just a few of the more common side effects reported by people who took Truxima in studies. These side effects can vary depending on what condition the drug is being used to treat.

Examples of the drug’s commonly reported side effects include:

  • mild to moderate infusion-related reactions*
  • mild or serious infection
  • flu-like symptoms, such as fever, chills, and body aches
  • nausea

* To learn more about this side effect, see the “Side effects explained” section below.

Mild side effects have been reported with Truxima. These include:

  • infection, such as the common cold
  • flu-like symptoms, such as fever, chills, and body aches
  • nausea
  • weakness
  • diarrhea
  • headache
  • muscle spasms
  • edema (fluid retention in your arms and lower legs)
  • mild to moderate infusion-related reactions*
  • mild allergic reaction*†

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bothersome, talk with your doctor or pharmacist. And do not stop using Truxima unless your doctor recommends it.

Truxima may cause mild side effects other than those listed above. See the drug’s prescribing information for details.

* To learn more about this side effect, see the “Side effects explained” section below.
† An allergic reaction is possible with Truxima use, but it’s not clear whether this side effect occurred in studies.

Serious side effects have been reported with Truxima. These include:

If you develop serious side effects while taking Truxima, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see the “Side effects explained” section below.
† An allergic reaction is possible with Truxima use, but it’s not clear whether this side effect occurred in studies.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Truxima, visit MedWatch.

Get answers to some frequently asked questions about Truxima’s side effects.

How long do side effects of Truxima usually last?

How long Truxima’s side effects last can vary depending on the specific side effect. Some side effects are usually temporary, such as diarrhea. Other side effects may come and go throughout your treatment with the drug, such as infections. And some side effects may affect you long term, such as heart problems.

Your doctor may prescribe medications to help prevent or manage the drug’s side effects. Talk with your doctor if you’re having ongoing side effects that bother you.

Can Truxima cause hair loss?

Hair loss isn’t a known side effect of Truxima. It wasn’t reported in studies of Truxima.

For some uses, Truxima is prescribed in combination with other medications. It’s possible that another medication could be contributing to hair loss.

If you’re experiencing unusual hair loss during Truxima treatment, talk with your doctor. They may be able to identify the cause and recommend ways to manage it.

Learn more about some of the side effects Truxima may cause.

Boxed warnings

Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). They alert doctors and patients about drug effects that may be dangerous.

Risk of serious mucous membrane and skin reactions

Truxima has a boxed warning for the risks of serious mucous membrane and skin reactions. Mucous membranes are the moist surfaces lining the inside of your mouth, your nose, and other areas.

Use of medications containing rituximab may cause serious reactions affecting your skin and mucous membranes. (Truxima is a biosimilar version of Rituxan [rituximab].) Reports of these reactions seem to be rare but can be life threatening.

Serious mucous membrane and skin reactions were not seen in studies of Truxima. But they’ve been reported since the drug was approved.

These reactions may cause symptoms such as:

  • pain, itching, or swelling
  • blisters
  • peeling
  • skin discoloration
  • bumps

What might help

If you have serious mucous membrane and skin reactions while using Truxima, talk with your doctor. They’ll likely recommend treatment in a hospital. They’ll also stop your Truxima treatment.

Risk of severe infusion-related reactions

Truxima has a boxed warning for the risk of severe infusion-related reactions. While mild to moderate infusion-related reactions were commonly seen in studies of Truxima, serious reactions were not common.

This side effect is more likely to occur during or after the first dose of Truxima. Symptoms may include:

  • fever and chills
  • nausea and vomiting
  • itching
  • dizziness
  • headache
  • trouble breathing
  • hives
  • low or high blood pressure
  • throat irritation

What might help

To help prevent or reduce the severity of infusion-related reactions, you’ll receive premedications before Truxima doses. These may include acetaminophen, an antihistamine such as diphenhydramine (Benadryl), and/or corticosteroids such as prednisone (Rayos).

If you have severe infusion-related reactions during Truxima treatment, your doctor may stop your treatment. Or they may slow the rate of your Truxima infusions. They may also prescribe medications to manage your symptoms.

Risk of HBV reactivation

Truxima has a boxed warning for the risk of HBV reactivation. Use of medications containing rituximab may cause HBV to reactivate if you’ve had hepatitis B in the past. (Truxima is a biosimilar version of Rituxan [rituximab].) Hepatitis B can lead to serious liver problems, such as liver failure. This side effect can be fatal in some cases.

Cases of HBV reactivation have been reported up to 2 years after treatment with rituximab ends. It isn’t clear whether this side effect occurred in studies of Truxima specifically.

Hepatitis B may cause symptoms such as:

  • jaundice (yellowish skin and eyes)
  • fatigue (low energy)
  • abdominal pain or swelling

What might help

To help prevent this side effect, your doctor will test you for HBV before prescribing Truxima. If they determine you have hepatitis B, they’ll recommend treating it. If they determine you had hepatitis B in the past, they’ll likely monitor you closely for signs of HBV reactivation during and after Truxima treatment.

If you develop symptoms of hepatitis B during or after Truxima treatment, talk with your doctor. They’ll likely recommend stopping Truxima and treating your hepatitis B.

Risk of PML

Truxima has a boxed warning for the risk of PML. PML is a rare but serious viral infection affecting the brain.

Use of medications containing rituximab may raise the risk of infection with JC virus, which may result in PML. (Truxima is a biosimilar version of Rituxan [rituximab].) This side effect can be fatal.

Cases of PML have been reported 12 months after treatment with rituximab ends. It isn’t clear whether this side effect occurred in studies of Truxima specifically.

PML may cause symptoms such as:

  • trouble with coordination or balance
  • weakness
  • vision changes

Factors that may increase the risk of PML when using Truxima include taking other medications in combination with Truxima, such as chemotherapy drugs or immunosuppressants.

What might help

If you think you have symptoms of PML during Truxima treatment, talk with your doctor. If they determine that you have PML, they’ll likely have you stop using Truxima.

Allergic reaction

Like most drugs, Truxima can cause an allergic reaction in some people. An allergic reaction is possible with Truxima use, but it’s not clear whether this side effect occurred in studies.

Symptoms can be mild to serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin (usually in your eyelids, lips, hands, or feet)
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

  • an antihistamine you swallow, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to Truxima, they’ll decide if you should continue receiving it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Truxima, they may have you switch to a different treatment.

Keeping track of side effects

During your Truxima treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking a new drug or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how your symptoms affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how Truxima affects you. They can then use this information to adjust your treatment plan if needed.

Below is important information you should consider before taking Truxima.

Boxed warnings

Truxima has boxed warnings about the risk of serious mucous membrane and skin reactions, severe infusion-related reactions, HBV reactivation, and PML. Boxed warnings are the most serious warnings from the FDA.

Risk of serious mucous membrane and skin reactions: Truxima may cause serious reactions affecting your skin and mucous membranes (the moist lining inside your mouth, your nose, and other areas). Reports of these reactions seem to be rare but can be life threatening.

Risk of severe infusion-related reactions: Severe infusion-related reactions may occur during an infusion of Truxima. In some cases, these reactions can be life threatening.

Risk of HBV reactivation: Truxima may cause HBV to reactivate if you’ve had hepatitis B in the past. Hepatitis B can lead to serious liver problems, such as liver failure. This side effect can be fatal in some cases.

Risk of PML: Truxima may rarely cause PML, a serious infection that affects the brain. PML can be fatal in some cases.

To learn more, see the “Side effects explained” section above.

Other warnings

Truxima can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Truxima is a good treatment option for you.

Talk with your doctor about your health history before you take Truxima. Be sure to tell them if any of the following factors apply to you:

Alcohol and Truxima

There are no known interactions between alcohol and Truxima.

If you have questions about consuming alcohol during Truxima treatment, talk with your doctor or pharmacist.

Pregnancy and breastfeeding with Truxima

Before starting Truxima treatment, it’s important to talk with your doctor if you’re pregnant, breastfeeding, or considering becoming pregnant or breastfeeding.

Pregnancy

Truxima is not safe to use during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor about your treatment options.

If you’re able to become pregnant, your doctor will likely recommend using a form of birth control during your Truxima treatment. They’ll also recommend that you use it for 12 months after your Truxima treatment ends.

Breastfeeding

Truxima is not safe to use while breastfeeding. Truxima’s manufacturer advises people not to breastfeed during treatment and for 6 months after treatment ends.

If you’re breastfeeding or planning to do so, talk with your doctor about your options.

Like most drugs, Truxima can cause a number of side effects that range from mild to serious. However, most are temporary and go away after a few days to weeks. If you have questions about side effects that Truxima can cause, talk with your doctor.

Examples of questions to help get you started include:

  • What can I do to prepare for my Truxima infusion that could reduce my risk of side effects?
  • Do my other health conditions put me at high risk for developing particular side effects with Truxima?
  • Do any of the other drugs or supplements I take increase my risk of side effects from Truxima?

To learn more about Truxima, see this article:

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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 another 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.