rituximab

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

Tell your doctor if you have ever had hepatitis B. Rituximab can cause this condition to come back or get worse.

What is rituximab?

Rituximab is used alone or in combination with other medicines to treat the following conditions in adults:

• non-Hodgkin's lymphoma or chronic lymphocytic leukemia;
• rheumatoid arthritis; or
• pemphigus vulgaris--a severe autoimmune reaction that causes blisters and breakdown of the skin and mucous membranes.

Rituximab is also used in adults and children at least 2 years old with certain disorders that cause inflammation of blood vessels and other tissues in the body.

Rituximab may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before receiving rituximab?

Tell your doctor if you have ever had:

• liver disease or hepatitis (or if you are a carrier of hepatitis B);
• an infection, including herpes, shingles, cytomegalovirus, chickenpox, parvovirus, West Nile virus, or hepatitis B or C;
• kidney disease;
• lung disease or a breathing disorder;
• a weak immune system (caused by disease or by using certain medicines);
• heart disease, angina (chest pain), or heart rhythm disorder; or
• if you have used rituximab in the past, or you have had a severe allergic reaction to rituximab.

You should be up-to-date on any needed immunizations before starting treatment with rituximab. Tell your doctor if you (or a child receiving rituximab) have received any vaccines within the past 4 weeks.

How is rituximab given?

Your doctor will perform blood tests to make sure you do not have conditions that would prevent you from safely using rituximab.

Rituximab is given as an infusion into a vein. A healthcare provider will give you this injection.

Rituximab is not given daily. Your schedule will depend on the condition being treated. Follow your doctor's dosing instructions very carefully.

Before each injection, you may be given other medications to prevent certain side effects of rituximab.

You will need frequent medical tests.

If you've ever had hepatitis B, using rituximab can cause this virus to become active or get worse. You may need frequent liver function tests while using this medicine and for several months after you stop.

If you need surgery, tell the surgeon ahead of time that you are using rituximab.

What happens if I miss a dose?

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while receiving rituximab?

Do not receive a "live" vaccine while using rituximab. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

What are the possible side effects of rituximab?

Some side effects may occur during the injection (or within 24 hours afterward). Tell your caregiver right away if you feel itchy, dizzy, weak, light-headed, short of breath, or if you have chest pain, wheezing, sudden cough, or pounding heartbeats or fluttering in your chest.

• confusion, memory problems, or other changes in your mental state;
• weakness on one side of your body;
• vision changes; or
• problems with speech or walking.

• painful skin or mouth sores, or a severe skin rash with blistering, peeling, or pus;
• redness, warmth, or swelling of the skin;
• severe stomach pain, vomiting, constipation, bloody or tarry stools;
• irregular heartbeats, chest pain or pressure, pain spreading to your jaw or shoulder;
• tiredness or jaundice (yellowing of the skin or eyes);
• signs of infection --fever, chills, cold or flu symptoms, cough, sore throat, mouth sores, headache, earache, pain or burning when you urinate; or
• signs of tumor cell breakdown --confusion, weakness, muscle cramps, nausea, vomiting, fast or slow heart rate, decreased urination, tingling in your hands and feet or around your mouth.

Common side effects may include:

• low white and red blood cells (fever, chills, body aches, pale skin, unusual tiredness, infections);
• nausea, diarrhea;
• swelling in your hands or feet;
• headache, weakness;
• painful urination;
• muscle spasms;
• depressed mood; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect rituximab?

Tell your doctor about all your other medicines, especially:

• medicines to treat conditions such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, or psoriasis --adalimumab, certolizumab, etanercept, golimumab, infliximab, leflunomide, methotrexate, sulfasalazine, tocilizumab, tofacitinib, and others.

This list is not complete. Other drugs may affect rituximab, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your doctor or pharmacist can provide more information about rituximab.