Rituximab

Other Name: Rituxan ®

About This Drug

Rituximab is a monoclonal antibody used to treat cancer. This drug is given in the vein (IV).

Possible Side Effects (More Common)

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Rash-skin irritation, redness or itching (dermatitis)
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Infusion-related reactions
  • Hepatitis B – if you have ever had hepatitis B, the virus may come back during treatment with this drug. Your doctor will test to see if you have ever had hepatitis B prior to your treatment.
  • Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel: extreme tiredness, agitation, confusion, or have: hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, seizures or coma. If you start to have any of these symptoms let your doctor know right away.
  • Tumor lysis: This drug may act on the cancer cells very quickly. This may affect how your kidneys work. Your doctor will monitor your kidney function.
  • Changes in your liver function. Your doctor will check your liver function as needed.
  • Nausea and throwing up (vomiting): these symptoms may happen within a few hours after your treatment and may last up to 24 hours. Medicines are available to stop or lessen these side effects.
  • Loose bowel movements (diarrhea) that may last for a few days
  • Abdominal pain
  • Infections
  • Cough, runny nose
  • Swelling of your legs, ankles and/or feet or hands
  • High blood pressure Your doctor will check your blood pressure as needed.
  • Abnormal heart beat

Possible Side Effects (Less Common)

  • Shortness of breath
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.

Infusion Reactions

Infusion Reactions are the most common side effect linked to use of this drug and can be quite severe. Medicines will be given before you get the drug to lower the severity of this side effect. The infusion reactions are worse with the first dose of the drug and become less severe with more doses of the drug.

While you are getting this drug in your vein (IV), you may have a reaction to the drug. Your nurse will check you closely for these signs:

  • Trouble catching your breath
  • Feeling like your tongue or throat is swelling
  • Feeling your heart beat quickly or in a not normal way (palpitations)
  • Feeling dizzy or lightheaded
  • Flushing, itching, rash, and/or hives

Treating Side Effects

  • Ask your doctor or nurse about medicine to stop or lessen headache, loose bowel movements (diarrhea), constipation, nausea, throwing up (vomiting), or pain.
  • If you get a rash do not put anything it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if the rash bothers you.
  • Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack of water in the body from losing too much fluid).
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • If you have a nose bleed, sit with your head tipped slightly forward. Apply pressure by lightly pinching the bridge of your nose between your thumb and forefinger. Call your doctor if you feel dizzy or faint or if the bleeding doesn’t stop after 10 to 15 minutes.

Important Information

  • After treatment with this drug, vaccination with live viruses should be delayed until the immune system recovers.
  • Symptoms of abnormal bleeding may be: coughing up blood, throwing up blood (may look like coffee grounds), red or black, tarry bowel movements, blood in urine, abnormally heavy menstrual flow, nosebleeds, or any unusual bleeding.
  • Symptoms of high blood pressure may be: headache, blurred vision, confusion, chest pain, or a feeling that your heart is beat differently.
  • Urinary tract infection. Symptoms may include:
    • Pain or burning when you pass urine
    • Feeling like you have to pass urine often, but not much comes out when you do
    • Tender or heavy feeling in your lower abdomen
    • Cloudy urine and/or urine that smells bad
    • Pain on one side of your back under your ribs. This is where your kidneys are.
    • Fever, chills, nausea and/or throwing up

    Food and Drug Interactions

    There are no known interactions of rituximab and any food. This drug may interact with other medicines.

    Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

    When to Call the Doctor

    Call your doctor or nurse right away if you have any of these symptoms:

    • Fever of 100.5 F (38 C) higher
    • Chills
    • Trouble breathing
    • Rash with or without itching
    • Blistering or peeling of skin
    • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
    • Easy bleeding or bruising
    • Blood in urine or bowel movements
    • Feeling that your heart is beating in a fast or not normal way (palpitations)
    • Nausea that stops you from eating or drinking
    • Throwing up (vomiting) more than 3 times in one day
    • Abdominal pain
    • Loose bowel movements (diarrhea) 4 times in one day or diarrhea with weakness or lightheadedness
    • No bowel movement in 3 days or if you feel uncomfortable
    • Feeling dizzy or lightheaded
    • Changes in your speech or vision
    • Feeling confused
    • Weakness of your arms and legs or poor coordination (feeling clumsy)
    • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of skin or eyes
    • Symptoms of a urinary tract infection (see important information)

    Call your doctor or nurse as soon as possible if you have any of these symptoms:

    • Swelling of your legs, ankles and/or feet
    • Fatigue and /or weakness that interferes with your daily activities
    • Joint and muscle pain or muscle spasms that are not relieved by prescribed medicines
    • Cough that lasts longer than normal

    Reproduction Concerns

    • Pregnancy warning: This drug is known to cross the placenta. This drug may have harmful effects on an unborn baby. Effective methods of birth control should be used during treatment with this drug and for 12 months after the last treatment. If exposure occurs to an unborn baby, the baby’s immune system may be affected, which could last for months after birth. Until the immune system recovers, live vaccines should not be administered to the baby. Be sure to talk with your doctor if you are pregnant or planning to become pregnant while getting this drug.
    • Breast feeding warning: It is not known if rituximab is passed into human breast milk. In animal studies, this drug was detected in in breast milk. For this reason, women should talk to their doctor about the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and badly harm a breast feeding baby.

    Revised December 2016