What is this medication?
Antineoplastic Agent; Antirheumatic Agent; Immunosuppressant Agent; Monoclonal Antibody
Indicated for treatment of chronic lymphocyte leukemia, granulomatosis with polyangiitis, microscopic polyangiitis, non-Hodgkin lymphomas, pemphigus vulgaris, rheumatoid arthritis.
Note: Ruxience (rituximab-pvvr) and Truxima (rituximab-abbs) have been approved as biosimilars to Rituxan (rituximab).
“Alert: Black Box Warning
Rituximab administration can result in serious, including fatal, infusion-related reactions. Deaths within 24 hours of rituximab infusion have occurred. Approximately 80% of fatal infusion-related reactions occurred in association with the first infusion. Monitor patients closely. Discontinue rituximab infusion for severe reactions and provide medical treatment for grade 3 or 4 infusion-related reactions.
Severe, including fatal, mucocutaneous reactions can occur in patients receiving rituximab products.
Hepatitis B virus reactivation:
Hepatitis B virus (HBV) reactivation can occur in patients treated with rituximab products, in some cases resulting in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with rituximab. Discontinue rituximab and concomitant medications in the event of HBV reactivation.
Progressive multifocal leukoencephalopathy:
Progressive multifocal leukoencephalopathy (PML), including fatal PML, can occur in patients receiving rituximab products.”
How does this medication work?
Rituximab is a monoclonal antibody that kills CD20+ cells via multiple mechanisms. The direct effects of rituximab include complement-mediated cytotoxicity and antibody-dependent cell-mediated cytotoxicity, and the indirect effects include structural changes, apoptosis, and sensitization of cancer cells to chemotherapy.
How should I take this medication?
Intravenous: 375mg/m2 to 1000mg/m2 once weekly depending on indication.
How to Take: Must be administered in accordance with specific protocol rate guidelines by a trained medical professional. To be administered intravenously only. Do not administer IV push or bolus. Do not administer IV rituximab, Rituxan subcutaneously. If an infusion-related reaction occurs, slow or stop the infusion. If the reaction abates, restart infusion at 50% of the previous rate. Discontinue infusion in the event of serious or life-threatening cardiac arrhythmias.
What should I watch for while using this medication?
Before starting make sure your physician is aware of any allergies or medications you currently take, you may be at an increased risk to infections. There also have been reports of bowel obstruction/perforation, cytopenia, cardiovascular effects (i.e. shock, infarction, fibrillation, arrhythmias) and Hepatitis B reactivation in some patients.
What if I miss a dose?
Contact your physician immediately if you miss a dose. Rituximab is administered at a doctor's office or infusion facility, you cannot take any missed doses at home on your own.
How should I store this medication?
Diluted solutions for infusion may be stored refrigerated at 2°C to 8°C (36°F to 46°F) for 24 hours. Diluted solutions for infusion have been shown to be stable for an additional 24 hours at room temperature.
Do not use beyond expiration date stamped on carton. Keep the vial in the outer carton to protect it from light.
What are the possible side effects of using this medication?
Cardiovascular effects including flushing, hypertension and edema; dermatologic effects including night sweats, itchiness, skin rash; gastrointestinal symptoms such as pain, nausea and diarrhea; urinary tract infection; hematologic changes such as neutropenia, anemia, lymphocytopenia; hepatic disorders/impairments such as hepatobiliary disease and elevated liver enzymes; antibody development; infection; join and muscle pain; respiratory symptoms such as cough, rhinitis and nasopharyngitis.
Note this is not a complete list of side effects for Rituximab, Rituxan/Ruxience/Truxima only common ones.
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