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Rituximab

About Rituximab

Rituximab is a specialised prescription medication used to treat certain types of blood cancers, such as non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. It is also prescribed for specific autoimmune conditions, including severe rheumatoid arthritis and certain blood vessel disorders. By targeting and clearing out abnormal immune cells, this medicine helps control cellular overgrowth and reduces painful joint inflammation.

Because of how this medicine works, it is not a daily therapy but is instead given in structured treatment cycles spaced weeks or months apart. Since it is given directly into a vein as an infusion, you do not need to worry about taking it with or without food, though being well-hydrated before your appointment is highly recommended. Making healthy lifestyle choices, such as eating a balanced diet and avoiding contact with sick individuals, can help your body get the best results from your treatment.

While many people tolerate this medication well, it is common to experience temporary side effects during the infusion, such as mild fever, chills, or headache. However, you must contact your doctor immediately if you experience serious side effects, such as a severe skin rash, difficulty breathing, or signs of a new infection. Your healthcare team will monitor you closely during and after each session to manage these symptoms safely.

Before starting your first session, talk to your doctor if you have a history of heart disease, breathing disorders, or recurring viral infections like hepatitis B. Do not take this if you currently have a severe, active infection or a severely weakened immune system. Your medical team will perform specific blood tests beforehand to confirm that this treatment is safe for you.

This medicine can interact with other drugs that lower your body's immune response, which can significantly raise your risk of getting sick. It is also important to avoid smoking and limit alcohol consumption, as these habits can place extra strain on your organs and worsen treatment-related fatigue. If you are pregnant, breastfeeding, or are an older adult, consult your doctor to discuss how this therapy may affect you or your baby.

Uses of Rituximab

Rituximab is used in the treatment of Non-Hodgkin's disease, rheumatoid arthritis, chronic lymphocytic leukaemia, granulomatosis and pemphigus vulgaris. The detailed uses of Rituximab are as follows: • Non-Hodgkin’s Lymphoma (NHL): Rituximab is used to treat Non-Hodgkin’s Lymphoma alone or with chemotherapy. • Chronic Lymphocytic Leukemia (CLL): Rituximab is used in the treatment of Chronic Lymphocytic Leukemia (CLL) and B-cell Acute Lymphoblastic Leukemia (B-ALL. • Rheumatoid Arthritis (RA): Rituximab is used in the treatment of rheumatoid arthritis. • Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA): Rituximab helps to treat Granulomatosis with Polyangiitis and Microscopic Polyangiitis. • Pemphigus Vulgaris: Rituximab is used to treat pemphigus vulgaris for moderate to severe cases.

Medicinal Benefits

Using Rituximab as prescribed helps target the cells responsible for your condition while reducing disease activity. Here are the key benefits you can expect:

  • Provides targeted treatment: Specifically targets the cells causing the disease, helping to preserve healthy tissues while effectively managing the condition.
  • Supports long-lasting symptom relief: Helps reduce joint pain, swelling, and damage, improving mobility and making everyday activities easier. The benefits may last for several months after a treatment course.
  • Helps achieve disease remission: Can help bring certain blood cancers and autoimmune conditions into remission, reducing symptoms and supporting a better quality of life.

Directions for Use

  • Follow your doctor’s instructions on the dosage and timing of this medication to ensure safety.
  • Rituximab will be administered by the doctor or healthcare professional.
  • Do not self-administer.

Storage

Store in a cool and dry place away from sunlight

Side Effects of Rituximab

Common Side Effects (Usually mild):

  • Fever, chills, or shivering during or shortly after the infusion
  • Tiredness, weakness, or low energy
  • Mild headache or muscle aches
  • Nausea or mild stomach discomfort


Serious Side Effects (Consult your doctor right away):

  • Signs of an infusion reaction, such as chest tightness, wheezing, throat swelling, or severe dizziness
  • Signs of infection, including a high fever, persistent sore throat, severe cough, or burning when you urinate
  • Painful skin blistering, peeling, or a raw, spreading rash
  • Extreme fatigue, confusion, or changes in your vision, balance, or speech
  • Yellowing of your skin or eyes, dark-colored urine, or severe right-sided stomach pain, which may indicate liver damage

Drug Warnings

  • Speak up during your infusion: Tell your nurse immediately if you start to feel itchy, warm, dizzy, short of breath, or if you develop a sudden cough or throat tickle.
  • Avoid live vaccines: Do not receive any live vaccines (such as the nasal spray flu vaccine or MMR) while on this medication, as your immune system may not be strong enough to handle them.
  • Get screened for Hepatitis B: Ensure your doctor tests your blood for hepatitis B before starting treatment, as this medicine can cause an old, inactive infection to become active again.
  • Use effective birth control: Women of childbearing age must use highly effective birth control during treatment and continue using it for at least 12 months after the final infusion to prevent harm to an unborn baby.
  • Check your skin daily: Report any new sores, painful blisters, or peeling areas inside your mouth or on your skin to your doctor right away.

Drug Interactions

  • Immunosuppressants and Biologics: Combining Rituximab with other medicines that lower your immune system can significantly raise your risk of developing severe, life-threatening infections.
  • Blood Pressure Medications: Because Rituximab can cause a temporary drop in blood pressure during the infusion, your doctor may advise you to stop taking your daily blood pressure pills for a few hours before your session.

Drug-Drug Interactions Checker List:

  • CISPLATIN
  • TYPHOID VACCINE
  • CHOLERA VACCINE
  • Safety Advice

    • Safety Warning

      Alcohol

      consult your doctor

      It is not known if alcohol interacts with Rituximab. Please consult the doctor.

    • Safety Warning

      Pregnancy

      caution

      If you are pregnant or planning pregnancy, inform your doctor before receiving Rituximab. Your doctor may prescribe this medicine if the benefits outweigh the risks.

    • Safety Warning

      Breast Feeding

      caution

      If you are a nursing mother, inform your doctor before receiving Rituximab. Your doctor may prescribe this medicine if the benefits outweigh the risks.

    • Safety Warning

      Driving

      not applicable

      Rituximab will be administered in the hospital setting. Hence, avoid driving.

    • Safety Warning

      Liver

      caution

      If you have a pre-existing or a history of liver disease, inform your doctor before receiving Rituximab. A dose adjustment of this medicine or a suitable alternative may be advised based on your condition.

    • Safety Warning

      Kidney

      caution

      If you have a pre-existing or a history of kidney disease, inform your doctor before receiving Rituximab. A dose adjustment of this medicine or a suitable alternative may be advised based on your condition.

    • Safety Warning

      Children

      consult your doctor

      Rituximab will be given to the children only if needed. If administered, careful monitoring of the child is needed.

    Habit Forming

    No

    Diet & Lifestyle Advise

    • Prioritise Infection Prevention: Wash your hands frequently with warm water and soap, and avoid large crowds or close contact with anyone who is visibly sick or has a cold.
    • Practice Food Safety: Since your immune system will be temporarily lowered, eat only fully cooked meats, pasteurised dairy, and thoroughly washed produce to avoid foodborne illnesses.
    • Stay Well Hydrated: Drink plenty of water before and for several days after your infusion to support your kidneys as they process and clear the medication.
    • Incorporate Gentle Movement: If you are treating rheumatoid arthritis, engage in low-impact activities like swimming, walking, or gentle stretching to keep your joints flexible without overworking them.
    • Protect Your Skin: Use a broad-spectrum sunscreen and wear protective clothing when outdoors, as your skin may be more sensitive during treatment.

    Special Advise

    • A blood test should be performed such as liver function test, renal function test, and pulmonary function test, to check for liver/kidney function and pulmonary function.
    • Weekly blood tests should be done during the treatment to check for CBC (Complete blood count).

    Patients Concern

    Disease/Condition Glossary

    Non-Hodgkin’s Disease: Non-Hodgkin’s disease or Non-Hodgkin’s lymphoma is a blood cancer that affects your lymph system. It causes the uncontrollable growth of cancer cells in the lymph nodes. The lymph system is a part of the immune system which protects your body from disease and infections. Symptoms include lymph node swelling, abdominal pain, chest pain, cough, fever, and night sweats.

    Rheumatoid arthritis: It is an auto-immune disease (the body's immune system attacks its tissue) that causes joint pain and damage. It occurs when the immune system does not work properly. Symptoms of rheumatoid arthritis include pain, swelling, stiffness, deformities, and loss of joint function. Rituximab is used in combination with methotrexate for the treatment of rheumatoid arthritis.

    Chronic lymphocytic leukaemia: It is a type of cancer that occurs in the bone marrow and blood. It increases the number of lymphocytes (a type of white blood cell). The symptoms include fever, enlarged liver, bone or joint pain, shortness of breath, weakness, and bleeding from gums or bruises.

    Pemphigus Vulgaris: It is a condition that causes painful blisters on the skin and the lining of the mouth, nose, throat and genitals.

    FAQs

    Rituximab is used to treat Non-Hodgkin’s disease, rheumatoid arthritis, chronic lymphocytic leukaemia, granulomatosis and pemphigus vulgaris.

    Rituximab may cause bowel obstruction and perforation, reactivation of Hepatitis B infection, Cardiac arrhythmias, tumour lysis syndrome, and angina in some patients. Hence, inform your oncologist about your complete medical history, including current medication, to rule out any side effects/interactions.

    Rituximab contains the active substance rituximab, which is a monoclonal antibody. Rituximab works by binding to the CD20 protein found on certain B cells. This helps the body's immune system destroy these cells, making it effective in treating conditions such as certain blood cancers and autoimmune diseases.

    The common side effects of Rituximab are pale skin, painful urination, night sweats, flushing, back pain, nausea, vomiting, diarrhoea, stomach pain, mouth sores, peeling of skin, injection site reactions and pain at the site of injection. If any of these side effects persist or worsen, please consult your doctor.

    It is given as a slow liquid drip directly into a vein (intravenous infusion) by a trained healthcare professional in a clinic or hospital. Talk to your doctor to understand your specific treatment schedule.

    When used alone, Rituximab does not typically cause hair loss. However, if you are receiving it alongside chemotherapy drugs for cancer, hair thinning or loss may occur. Talk to your doctor about your specific combination of medicines.

    You can receive inactive (killed) vaccines like the standard flu shot, but they may not work as well since your immune cells are lowered. You must avoid live vaccines entirely. Talk to your doctor before scheduling any vaccination.

    You may feel tired or dizzy after your session, especially if you were given allergy medicines beforehand to prevent a reaction. It is highly recommended to have someone else drive you home after your first few appointments. Talk to your doctor for personalised advice.

    There is no direct drug interaction, but alcohol can worsen side effects like headaches, fatigue, and dehydration. It can also place extra strain on your liver, so it is best to limit or avoid alcohol. Talk to your doctor or pharmacist for guidance.

    This medicine is not recommended if you are pregnant or planning to become pregnant, as it can temporarily lower the immune system of the developing baby. You should use highly effective birth control during treatment and for 12 months after your last dose. Talk to your doctor to discuss family planning options.

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