Rituximab side effects and Precautions

Rituximab Side Effects/Adverse Reactions:

General symptoms:

Rituximab side effects: Abdominal pain, back pain, chest pain, neck pain, discomfort, abdominal distension, pain at infusion site.

Cardiovascular system:

Rituximab side effects: Hypertension, bradycardia, tachycardia, orthostatic hypotension, arrhythmia. Digestive system: Diarrhea, indigestion, anorexia.

Hematologic and lymphatic systems:

Rituximab side effects: Lymphadenopathy.

Metabolic and nutritional diseases:

Rituximab side effects: Hyperglycemia, peripheral edema, increased LDH, hypocalcemia.

Musculoskeletal system:

Rituximab side effects: Arthralgia, myalgia, pain, increased muscle tone.

Nervous system:

Rituximab side effects: Dizziness, anxiety, abnormal sensations, hypersensitivity, irritability, insomnia, neuroticism.

Respiratory system:

Rituximab side effects: Increased cough, sinusitis, bronchitis, respiratory tract disease, obstructive bronchiolitis.

Skin and appendages:

Rituximab side effects: Night sweats, sweating, herpes simplex, herpes zoster.

Sensory organs:

Rituximab side effects: Tear secretion disorder, conjunctivitis, taste disturbance.

Hematologic and lymphatic systems:

Rituximab side effects: Coagulation disorder.

Skin and appendages:

There have been reports of severe bullous skin reactions in individual cases, including fatal toxic epidermal necrolysis (Lyell’s syndrome).

Common adverse reactions and management of rituximab:

  • 1.Skin reactions:
    • Manifestation: Rash, itching, urticaria.
      • a.Management: Mild symptoms may not require treatment. For severe symptoms, seek medical attention promptly and provide antiallergic or symptomatic treatment.
      • b.Note: Keep the skin clean and avoid scratching.
  • 2.Hematotoxicity:
    • Manifestation: Neutropenia, leukopenia, anemia, thrombocytopenia.
      • a.Management: Seek medical attention promptly for blood-boosting treatment.
      • b.Note: Regularly recheck complete blood counts.
  • 3.Infusion reactions:
    • Manifestation: Usually occur within 30 minutes to 2 hours of infusion, mild symptoms include fever, chills, rash, etc., severe symptoms may include pulmonary symptoms such as chest pain, cough, rhinitis, difficulty breathing, bronchospasm.
      • a.Management: For mild to moderate infusion-related reactions, it may be necessary to reduce the infusion rate; if there is difficulty breathing or severe hypotension, it may be necessary to stop the infusion; in case of severe and life-threatening infusion-related reactions, permanent discontinuation of the drug may be required.
      • b.Note: Immediately notify medical staff if you experience rash, chest tightness, difficulty breathing, or other discomfort during infusion.


  1. Before using rituximab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Contact your pharmacist for more details.
  2. Before using this medication, tell your doctor or pharmacist your medical history, especially of: lung diseases, heart problems (e.g., arrhythmias, previous heart attacks), bleeding/blood disorders, current/recent infections.
  3. This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Consult your doctor if you are using marijuana (cannabis).
  4. Before surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
  5. Rituximab may make you more susceptible to infections or may worsen current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.
  6. Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as the flu vaccine inhaled through the nose).
  7. To reduce the chance of cutting, bruising, or injury, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.
  8. Older adults may be at greater risk for heart problems (such as irregular heartbeat) or lung diseases when using this drug.
  9. During pregnancy, this drug should be used only when clearly needed. It may harm an unborn baby. Ask about reliable forms of birth control while using this drug and for 1 year after stopping treatment. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.
  10. It is not known if this drug passes into breast milk. Because of the potential risk to the infant, breastfeeding is not recommended while using this drug and for at least 6 months after the end of treatment. Consult your doctor before breastfeeding.

what to avoid after rituximab infusion?

1.Rituximab can cause premature birth and neonatal hematological abnormalities. Women of childbearing age should take effective contraceptive measures during treatment and for 12 months after discontinuation.

2.Your risk of infection may increase after medication. Wash your hands frequently and stay away from people with infections (such as colds) during treatment.
3.Low blood pressure may occur after medication. Antihypertensive drugs may need to be discontinued 12 hours before and during infusion. Blood pressure should be monitored during medication.

4.Regular monitoring of complete blood cell counts may be necessary during treatment. Patients with pulmonary insufficiency or tumor lung infiltration should undergo chest X-ray examinations during treatment. Patients who develop respiratory symptoms and hypotension after medication should be monitored for at least 24 hours.

5.Rituximab suppresses immune function, vaccination during treatment (e.g., attenuated hepatitis A vaccine, attenuated influenza vaccine) may reduce the efficacy of the vaccine and may increase the risk of infection caused by live vaccines. Vaccination with live vaccines should be postponed in patients who are on or have recently used rituximab.

Rituximab is a medication used to treat certain types of cancer, specifically some types of lymphoma and leukemia. Here are some of the specific types of cancer that rituximab can be used to treat:

  1. Non-Hodgkin lymphoma (NHL) – a type of cancer that starts in white blood cells called lymphocytes, which are part of the body’s immune system.
  2. Chronic lymphocytic leukemia (CLL) – a type of cancer that starts from cells that become certain white blood cells (called lymphocytes) in the bone marrow.
  3. Follicular lymphoma – a type of NHL that develops slowly and is often found in the lymph nodes, spleen, and bone marrow.
  4. Diffuse large B-cell lymphoma (DLBCL) – a type of NHL that grows quickly and is often found in the lymph nodes, but can also affect other parts of the body.
  5. Mantle cell lymphoma – a rare and aggressive type of NHL that can affect the lymph nodes, spleen, and bone marrow.

It’s important to note that rituximab is not used to treat all types of cancer, and its use will depend on the specific type of cancer and the individual patient’s condition. Always consult with a healthcare professional for appropriate treatment options.

Rituximab is manufactured by several companies in the United States, including Genentech and Biogen. The price of rituximab can vary depending on factors such as dosage, treatment regimen, and whether it’s branded or generic. As of my last update, the average wholesale price for a single 100 mg vial of rituximab is around 1,400-1,600 in the United States. However, actual costs can differ based on negotiated discounts, insurance coverage, and other variables. It’s important to consult with a healthcare provider or pharmacist for the most accurate and up-to-date pricing information.

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