What to Expect With Rituxan

How Rituxan is given

Rituxan® (rituximab) is given as an intravenous (IV) infusion once weekly for 4 weeks. An IV infusion is given to you through a needle that's placed in a vein. Here are some things you should know about IV infusions:

  • Infusions are used to treat a variety of conditions and are given by a trained professional in a doctor's office, an infusion center, or a hospital
  • If you have an infusion reaction, the infusion is slowed or stopped to help manage it
  • Rituxan infusions can result in some serious, sometimes life-threatening side effects
  • Infusion reactions with Rituxan may include fever, chills and shakes, itching, and coughing. If you experience any type of reaction, be sure to talk with your doctor
  • Before each infusion, be sure to review the Rituxan Medication Guide and discuss it with your doctor
  • Rituxan can lower certain blood cell counts. Your doctor may do blood tests during treatment with Rituxan to check your blood cell counts. Be sure to schedule any visits that require lab tests

Important Side Effect Information

It is important to learn all you can about Rituxan and the possible side effects that can occur when you receive Rituxan therapy. Be sure to ask your doctor or nurse about possible side effects of Rituxan.

This information does not take the place of talking to your doctor about your medical condition or your treatment. Talk with your doctor if you have any questions about your treatment with Rituxan. To learn more, please see the Medication Guide.

What is the most important information I should know about Rituxan?

Rituxan can cause serious side effects that can lead to death, including: 

  • Infusion Reactions: Infusion reactions are very common side effects of Rituxan treatment. Serious infusion reactions can happen during your infusion or within 24 hours after your infusion of Rituxan. Your healthcare provider should give you medicines before your infusion of Rituxan to decrease your chance of having a severe infusion reaction
  • Severe Skin and Mouth Reactions: Tell your healthcare provider or get medical help right away if you get any of these symptoms at any time during your treatment with Rituxan: painful sores or ulcers on your skin, lips, or in your mouth; blisters; peeling skin; rash; or pustules
  • Hepatitis B Virus (HBV) Reactivation: If you have had hepatitis B or are a carrier of hepatitis B virus, receiving Rituxan could cause the virus to become an active infection again. Hepatitis B reactivation may cause serious liver problems, including liver failure and death. You should not receive Rituxan if you have active hepatitis B liver disease. Your healthcare provider will monitor you for hepatitis B infection during and for several months after you stop receiving Rituxan
  • Progressive Multifocal Leukoencephalopathy (PML): PML is a rare, serious brain infection caused by a virus that can happen in people who receive Rituxan. People with weakened immune systems can get PML. PML can result in death or severe disability. There is no known treatment, prevention, or cure for PML

What should I tell my healthcare provider before receiving Rituxan?

Before receiving Rituxan, tell your healthcare provider if you:

  • Have had a severe infusion reaction to Rituxan in the past 
  • Have a history of other medical conditions including: 
    • Heart problems 
    • Irregular heartbeat 
    • Chest pain 
    • Lung or kidney problems 
  • Have had a severe infection, currently have an infection, or have a weakened immune system 
  • Have had a recent vaccination or are scheduled to receive vaccinations. You should not get certain vaccines before or during treatment with Rituxan 
  • Have taken Rituxan for GPA or MPA in the past 
  • Have any other medical conditions 
  • Are pregnant or planning to become pregnant. Talk to your healthcare provider about the risks to your unborn baby if you receive Rituxan during pregnancy. Females who are able to become pregnant should use effective birth control (contraception) during treatment with Rituxan and for 12 months after the last dose of Rituxan. Tell your healthcare provider right away if you become pregnant or think that you are pregnant during treatment with Rituxan 
  • Are breastfeeding or plan to breastfeed. It is not known if Rituxan passes into your breast milk. Do not breastfeed during treatment and for at least 6 months after your last dose of Rituxan 
  • Are taking any medications, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take or have taken: 
    • A tumor necrosis factor (TNF) inhibitor medicine 
    • A disease modifying anti-rheumatic drug (DMARD)

What are the possible side effects of Rituxan?

Rituxan can cause serious side effects, including:

  • Tumor Lysis Syndrome (TLS): TLS is caused by the fast breakdown of cancer cells. TLS can cause you to have kidney failure and the need for dialysis treatment or an abnormal heart rhythm. TLS can happen within 12-24 hours after an infusion of Rituxan. Tell your healthcare provider right away if you have any of the following signs or symptoms of TLS: nausea, vomiting, diarrhea, or lack of energy
  • Serious Infections: Serious infections can happen during and after treatment with Rituxan and can lead to death. Rituxan can increase your risk of getting infections and can lower the ability of your immune system to fight infections. People with serious infections should not receive Rituxan
  • Heart Problems: Rituxan may cause chest pain, irregular heartbeats, and heart attack. Your healthcare provider may monitor your heart during and after treatment with Rituxan if you have symptoms of heart problems or have a history of heart problems. Tell your healthcare provider right away if you have chest pain or irregular heartbeats during treatment with Rituxan
  • Kidney Problems: especially if you are receiving Rituxan for non–Hodgkin’s lymphoma (NHL). Rituxan can cause severe kidney problems that lead to death. Your healthcare provider should do blood tests to check how well your kidneys are working
  • Stomach and Serious Bowel Problems That Can Sometimes Lead to Death: Bowel problems, including blockage or tears in the bowel, can happen if you receive Rituxan with chemotherapy medicines. Tell your healthcare provider right away if you have any stomach-area pain during treatment with Rituxan

Your healthcare provider will stop treatment with Rituxan if you have severe, serious, or life-threatening side effects.

What are the most common side effects during treatment with Rituxan?

  • Infusion reactions
  • Infections (may include fever, chills)
  • Body aches
  • Tiredness
  • Nausea

In patients with GPA or MPA, the most common side effects of Rituxan also include:

  • Low white and red blood cells 
  • Swelling 
  • Diarrhea 
  • Muscle spasms

Other side effects include:

  • Aching joints during or within hours of receiving an infusion
  • More frequent upper respiratory tract infections

These are not all of the possible side effects with Rituxan.

Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at (800) FDA‐1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835‐2555.

Please see the Rituxan Prescribing Information and Medication Guide including Most Serious Side Effects for additional Important Side Effect Information.

The following information may help you prepare:

  • Your doctor may give you certain medicines before infusions to help reduce side effects. These may include acetaminophen (Tylenol®) and diphenhydramine HCI (Benadryl®)
  • Due to the possibility of infusion reactions the first infusion may take most of the day, but later infusions may take less time. Be sure to schedule enough time for the infusion, and take activities such as crossword puzzles or a book to help you pass the time
  • Take an extra sweater to help you stay warm in case the room is chilly

Some tips for your Rituxan infusions

Here are some helpful tips for your Rituxan infusion:

  • Remember to set aside enough time—your first infusion may take 3 to 5 hours. Following infusions may take slightly less time than your first. But they will still last several hours, so make sure you set aside enough time in your day
  • Be mindful of how you feel—even if you didn't experience side effects from previous infusions, you should still be mindful of how you feel. If you do experience any side effects, be sure to report them to your doctor right away
  • Take someone with you—you may find it nice to have this time to yourself and a loved one, so take someone along and pass the time catching up
  • Take activities—you may want to take activities such as crossword puzzles or a book to help you pass the time
  • Eating and drinking—there are no special rules about what you should eat or drink before an infusion. However, you may be at the infusion facility for the better part of the day. So consider taking some snacks or packing a meal
  • Additional medications—as always, remember to let your doctor or nurse know about any medications or supplements you're taking

Review the Medication Guide—before each infusion, remember to review the Medication Guide and ask your doctor any questions you may have.