Rituximab

What is Rituximab

Rituximab is a CD20-directed cytolytic antibody used to treat adults with non-Hodgkin lymphoma and chronic lymphocytic leukemia.

It is also indicated for the treatment of adults with rheumatoid arthritis and pemphigus vulgaris, and both pediatric and adult patients with granulomatosis with polyangiitis (Wegener’s granulomatosis) and microscopic polyangiitis.

Premedication is recommended before rituximab infusions due to the potential for infusion-related reactions.

Brand Names

• Rituxan
• RUXIENCE

Indications

1. acquired blood factor deficiency
2. acute lymphocytic leukemia (ALL)
3. Burkitt’s lymphoma
4. chronic lymphocytic leukemia (CLL)
5. graft-versus-host disease (GVHD)
6. hemolytic anemia
7. hemophilia A
8. human herpesvirus 8 (HHV-8) infection
9. immune thrombocytopenic purpura (ITP)
10. lupus nephritis
11. macroglobulinemia
12. mantle cell lymphoma (MCL)
13. microscopic polyangiitis
14. multicentric Castleman disease
15. multiple sclerosis
16. non-Hodgkin’s lymphoma (NHL)
17. pemphigus
18. rheumatoid arthritis
19. small lymphocytic lymphoma (SLL)
20. thrombotic thrombocytopenia purpura
21. Wegener’s granulomatosis

Side Effects

1. abdominal pain
2. acute respiratory distress syndrome (ARDS)
3. alopecia
4. anaphylactic shock
5. anaphylactoid reactions
6. anemia
7. anemia
8. angina
9. angioedema
10. antibody formation
11. anxiety
12. aplastic anemia
13. arthralgia
14. asthenia
15. bronchiolitis obliterans
16. bronchospasm
17. bullous rash
18. chills
19. colitis
20. conjunctivitis
21. cough
22. cytokine release syndrome
23. depression
24. diarrhea
25. dizziness
26. dyspepsia
27. dyspnea
28. elevated hepatic enzymes
29. encephalopathy
30. epistaxis
31. fatigue
32. fever
33. flushing
34. GI obstruction
35. GI perforation
36. headache
37. heart failure
38. hemolytic anemia
39. hepatic failure
40. hepatitis
41. hepatitis B exacerbation
42. hyperglycemia
43. hyperkalemia
44. hyperphosphatemia
45. hypertension
46. hyperuricemia
47. hypocalcemia
48. hypotension
49. hypoxia
50. infection
51. infusion-related reactions
52. insomnia
53. irritability
54. leukoencephalopathy
55. leukopenia
56. leukopenia
57. lichen planus-like eruption
58. lupus-like symptoms
59. lymphopenia
60. lymphopenia
61. migraine
62. musculoskeletal pain
63. myalgia
64. myocardial infarction
65. nausea
66. nephrotoxicity
67. neutropenia
68. neutropenia
69. night sweats
70. oliguria
71. optic neuritis
72. pancytopenia
73. paresthesias
74. pemphigus
75. peripheral edema
76. peripheral neuropathy
77. pneumonitis
78. progressive multifocal leukoencephalopathy
79. pruritus
80. rash
81. red cell aplasia
82. renal failure (unspecified)
83. rhinitis
84. serum sickness
85. sinusitis
86. sneezing
87. Stevens-Johnson syndrome
88. supraventricular tachycardia (SVT)
89. throat irritation
90. thrombocytopenia
91. thrombocytopenia
92. toxic epidermal necrolysis
93. tremor
94. tumor lysis syndrome (TLS)
95. urticaria
96. uveitis
97. vasculitis
98. ventricular fibrillation
99. ventricular tachycardia
100. vesicular rash
101. vomiting
102. weight gain

Monitoring Parameters

• CBC with differential
• hepatitis B serology
• serum creatinine/BUN
• serum electrolytes
• serum uric acid

Contraindications

• anemia
• angina
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• contraception requirements
• cytokine release syndrome
• geriatric
• GI obstruction
• GI perforation
• hepatitis
• hepatitis B exacerbation
• herpes infection
• hyperkalemia
• hyperphosphatemia
• hyperuricemia
• hypocalcemia
• hypogammaglobulinemia
• immunosuppression
• infants
• infection
• infusion-related reactions
• neonates
• nephrotoxicity
• neutropenia
• pregnancy
• progressive multifocal leukoencephalopathy
• pulmonary disease
• renal failure
• reproductive risk
• serious rash
• thrombocytopenia
• tumor lysis syndrome (TLS)
• vaccination
• viral infection

Interactions

• Abatacept
• Adalimumab
• Anakinra
• Antithymocyte Globulin
• Azathioprine
• Azelastine; Fluticasone
• Baricitinib
• Beclomethasone
• Belimumab
• Betamethasone
• Budesonide
• Budesonide; Formoterol
• Certolizumab pegol
• Ciclesonide
• Cisplatin
• Corticosteroids
• Corticotropin, ACTH
• Cortisone
• Cyclophosphamide
• Deflazacort
• Dexamethasone
• Echinacea
• Etanercept
• Fludrocortisone
• Flunisolide
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Formoterol; Mometasone
• Gold
• Golimumab
• Hydrocortisone
• Hydroxychloroquine
• Infliximab
• Leflunomide
• Live Vaccines
• Methotrexate
• Methylprednisolone
• Mometasone
• Natalizumab
• Ocrelizumab
• Palifermin
• Penicillamine
• Prednisolone
• Prednisone
• Sarilumab
• Sipuleucel-T
• Sulfasalazine
• Tocilizumab
• Tofacitinib
• Triamcinolone
• Tuberculin Purified Protein Derivative, PPD
• Upadacitinib