Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

  1. Riabni
  2. Rituxan
  3. Ruxience
  4. Truxima

Descriptions


Rituximab injection is used alone or together with other medicines to treat a type of cancer called non-Hodgkin's lymphoma (NHL). It is also used in combination with other cancer medicines to treat mature B-cell non-Hodgkin's lymphoma (NHL) and mature B-cell acute leukemia (B-AL). It helps the immune system destroy cancer cells. Rituximab injection is a monoclonal antibody.

Rituximab injection is used together with other medicines (eg, fludarabine cyclophosphamide) to treat chronic lymphocytic leukemia (CLL).

Rituximab injection is used together with methotrexate to treat the symptoms of rheumatoid arthritis. It helps to keep joint damage from getting worse after other medicines (eg, adalimumab, etanercept, or infliximab) did not work well.

Rituximab injection is used together with steroids to treat granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). These are immune disorders that cause blood vessels to be inflamed.

Rituximab injection is also used to treat moderate to severe pemphigus vulgaris (PV), an immune disorder that causes painful blisters on the skin and mucous membranes.

This medicine is to be given only by or under the direct supervision of your doctor.

This product is available in the following dosage forms:

  • Solution

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of rituximab injection in children. However, use of rituximab injection is not indicated in children younger than 2 years of age with GPA or MPA, in children younger than 6 months of age with mature B-cell NHL and B-AL, or in children with other conditions.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of rituximab injection in the elderly. However, elderly patients are more likely to have infections and age-related heart and lung problems, which may require caution in patients receiving rituximab injection.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Rubella Virus Vaccine, Live
  • Varicella Virus Vaccine, Live
  • Zoster Vaccine, Live

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abatacept
  • Adenovirus Vaccine, Live
  • Anifrolumab-fnia
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Baricitinib
  • Belimumab
  • Cholera Vaccine, Live
  • Cisplatin
  • Dengue Tetravalent Vaccine, Live
  • Ebola Zaire Vaccine, Live
  • Infliximab
  • Influenza Virus Vaccine, Live
  • Poliovirus Vaccine, Live
  • SARS-COV-2 (COVID-19) Vaccine, Adenovirus 26 Vector (Janssen)
  • SARS-COV-2 (COVID-19) Vaccine, mRNA (Moderna)
  • SARS-COV-2 (COVID-19) Vaccine, mRNA (Pfizer)
  • Smallpox Monkeypox Vaccine, Live Non-Replicating
  • Smallpox Vaccine
  • Typhoid Vaccine, Live
  • Yellow Fever Vaccine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Influenza Virus Vaccine (Subvirion)
  • Pneumococcal Vaccine Polyvalent

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina (chest pain), history of or
  • Heart disease or
  • Heart rhythm problems (eg, arrhythmia), history of or
  • Hepatitis B, or history of or
  • Infection (eg, bacteria, fungus, or virus) or
  • Kidney disease or
  • Lung problems (eg, asthma, bronchitis), history of or
  • Stomach or bowel problems (eg, intestinal blockage, perforation, ulcers)—Use with caution. May make these conditions worse.
  • Hypogammaglobulinemia (immune system disorder), prolonged—Use with caution. May increase risk for infections.
  • Infection, severe and active—Should not be used in patients with this condition.

Proper Use

Before receiving this medicine, make sure you understand all the risks and benefits from receiving the medicine. It is important for you to work closely with your doctor during your treatment.

A nurse or other trained health professional will give you this medicine in a medical facility. It is given through a needle placed into one of your veins. The medicine must be given slowly, so the needle will have to remain in place for 90 minutes.

You may also receive other medicines (eg, fever medicine, allergy medicine, or steroid) at least 30 minutes to 60 minutes before starting treatment with this medicine to help prevent unwanted side effects.

This medicine should come with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have questions.

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. If you are a woman who can get pregnant, your doctor may do tests to make sure you are not pregnant before giving you this medicine. Use an effective form of birth control to keep from getting pregnant during treatment with this medicine and for at least 12 months after the last dose. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

This medicine may cause infusion-related reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you start to have a fever, chills or shaking, dizziness, trouble breathing, itching or rash, lightheadedness or fainting after receiving this medicine.

This medicine can cause a hepatitis B infection to come back. Check with your doctor right away if you have any symptoms of liver problems, including skin and eyes turning yellow, dark brown-colored urine, right-sided abdominal or stomach pain, fever, or severe tiredness.

Serious skin and mouth reactions (eg, paraneoplastic pemphigus, Stevens-Johnson syndrome, lichenoid dermatitis, vesiculobullous dermatitis, and toxic epidermal necrolysis) can occur during treatment with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness while you are receiving this medicine.

This medicine may cause a rare and serious brain infection called progressive multifocal leukoencephalopathy (PML). The risk for getting this infection is higher if you have rheumatoid arthritis. Talk to your doctor about the benefits of receiving this medicine and the risk for this infection. Check with your doctor right away if you have vision changes, loss of coordination, clumsiness, memory loss, difficulty speaking or understanding what others say, and weakness in the legs.

This medicine may cause a serious type of reaction called tumor lysis syndrome (TLS). Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

This medicine may increase your risk of developing infections (eg, viral, bacterial, or fungal) during or after treatment with this medicine. Avoid being near people who are sick or have infections while you are using this medicine. Wash your hands often. Tell your doctor if you have lupus or if you have any kind of infection before you start using this medicine. Also tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

Call your doctor right away if you start to have a cough that won't go away, weight loss, night sweats, fever, chills, flu-like symptoms (eg, runny or stuffy nose, headache, blurred vision, or feeling generally ill), painful or difficult urination, or sores, ulcers, or white spots in the mouth or on the lips. These may be signs that you have an infection.

While you are being treated with rituximab, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. You may receive non live vaccines at least 4 weeks before starting treatment with this medicine. Rituximab may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not get live vaccines (eg, nasal flu virus vaccine). Try to avoid persons who have taken live vaccines. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should wear a protective face mask that covers the nose and mouth.

This medicine may cause heart and heart rhythm problems (eg, heart attack, arrhythmia, cardiogenic shock). Check with your doctor if you have chest pain or discomfort, pain or discomfort in the arms, jaw, back, or neck, dizziness, fainting, fast, slow, or irregular heartbeat, cool, sweaty skin, or trouble breathing.

Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

This medicine may cause serious stomach and bowel problems, especially when used with other cancer medicines. Check with your doctor right away if you start having stomach pain while being treated with this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  1. Back pain
  2. black, tarry stools
  3. bleeding gums
  4. bloating or swelling of the face, arms, hands, lower legs, or feet
  5. blood in the urine or stools
  6. blurred vision
  7. body aches or pain
  8. burning or stinging of the skin
  9. chest pain or tightness
  10. chills
  11. confusion
  12. cough
  13. difficulty with breathing
  14. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  15. drowsiness
  16. dry mouth
  17. ear congestion
  18. fever
  19. flushed, dry skin
  20. fruit-like breath odor
  21. headache
  22. hives or welts, itching, rash
  23. increased hunger
  24. increased thirst
  25. increased urination
  26. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
  27. lower back or side pain
  28. nausea
  29. nervousness
  30. noisy breathing
  31. pain or tenderness around the eyes and cheekbones
  32. painful cold sores or blisters on the lips, nose, eyes, or genitals
  33. painful or difficult urination
  34. pale skin
  35. pinpoint red spots on the skin
  36. pounding in the ears
  37. seizures
  38. slow or fast heartbeat
  39. sneezing
  40. sore throat
  41. sores, ulcers, or white spots in the mouth or on the lips
  42. stomach pain
  43. stuffy or runny nose
  44. sweating
  45. swelling of the tongue or throat
  46. swollen glands
  47. tingling of the hands or feet
  48. trouble breathing
  49. unusual bleeding or bruising
  50. unusual tiredness or weakness
  51. unusual weight gain or loss
  52. vomiting

Less common

  1. Blistering, peeling, or loosening of the skin
  2. blisters on the trunk, scalp, or other areas
  3. burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feeling
  4. decreased frequency and amount of urine
  5. diarrhea
  6. difficulty with moving
  7. discouragement
  8. feeling sad or empty
  9. irregular heartbeat
  10. irritability
  11. joint or muscle pain
  12. loss of appetite
  13. loss of interest or pleasure
  14. lump or growth on the skin
  15. muscle cramp, pain, or stiffness
  16. numbness or tingling in the hands, feet, or lips
  17. painful blisters on the trunk of the body
  18. pain or redness at the injection site
  19. pain, swelling, or redness in the joints
  20. pounding or irregular heartbeat or pulse
  21. red skin lesions, often with a purple center
  22. red, itchy lining of the eye
  23. redness of the face, neck, arms, and occasionally, upper chest
  24. stabbing pain
  25. trouble concentrating
  26. trouble sleeping

Incidence not known

  1. Blue-yellow color blindness
  2. blurred vision or other change in vision
  3. burning or stinging of the skin
  4. decreased vision
  5. dilated neck veins
  6. dry cough
  7. extreme tiredness or weakness
  8. eye pain, tearing
  9. feeling of discomfort, illness, or weakness
  10. irregular breathing
  11. nosebleed
  12. painful cold sores or blisters on the lips, nose, eyes, or genitals
  13. sensitivity of the eye to light
  14. severe stomach pain
  15. severe vomiting, sometimes with blood
  16. sores, welts, or blisters
  17. stomach cramps
  18. swelling, stiffness, redness, or warmth around many joints
  19. swollen lymph glands
  20. vision loss

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Fear
  2. lack or loss of strength
  3. loss or thinning of the hair
  4. night sweats
  5. throat irritation

Less common

  1. Agitation or anxiety
  2. bone pain
  3. burning, dry, or itching eyes
  4. change in taste
  5. discharge, excessive tearing
  6. dry eyes
  7. excessive muscle tone
  8. feeling of constant movement of self or surroundings
  9. heartburn
  10. increase in body movements
  11. lightheadedness
  12. muscle tension
  13. redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
  14. sensation of spinning
  15. sleepiness
  16. swelling of the stomach

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/rituximab-intravenous-route/precautions/drg-20068057