Description Of Product
Rituximab, Rituxan, [Ruxience, Truxima = Biosimilars]
Description: Antineoplastic Agent; Antirheumatic Agent; Immunosuppressant Agent; Monoclonal Antibody
“Alert: Black Box Warning
Rituximab administration can result in serious, including fatal, infusion-related reactions. Deaths within 24 hours of rituximab infusion have occurred. Approximately 80% of fatal infusion-related reactions occurred in association with the first infusion. Monitor patients closely. Discontinue rituximab infusion for severe reactions and provide medical treatment for grade 3 or 4 infusion-related reactions.
Severe, including fatal, mucocutaneous reactions can occur in patients receiving rituximab products.
Hepatitis B virus reactivation:
Hepatitis B virus (HBV) reactivation can occur in patients treated with rituximab products, in some cases resulting in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with rituximab. Discontinue rituximab and concomitant medications in the event of HBV reactivation.
Progressive multifocal leukoencephalopathy:
Progressive multifocal leukoencephalopathy (PML), including fatal PML, can occur in patients receiving rituximab products.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Rituximab is a monoclonal antibody that kills CD20+ cells via multiple mechanisms. The direct effects of rituximab include complement-mediated cytotoxicity and antibody-dependent cell-mediated cytotoxicity, and the indirect effects include structural changes, apoptosis, and sensitization of cancer cells to chemotherapy.
Indications For Use
Chronic lymphocyte leukemia, granulomatosis with polyangiitis, microscopic polyangiitis, non-Hodgkin lymphomas, pemphigus Vulgaris, rheumatoid arthritis.
Note: Ruxience (rituximab-over) and Truxima (rituximab-abbs) have been approved as biosimilars to Rituxan (rituximab).
Before starting make sure your physician is aware of any allergies or medications you currently take, you may be at an increased risk of infections. There also have been reports of bowel obstruction/perforation, cytopenia, cardiovascular effects (i.e. shock, infarction, fibrillation, arrhythmias) and Hepatitis B reactivation in some patients.
Intravenous: 375mg/m2 to 1000mg/m2 once weekly depending on indication.
Pharmacist Tips On Using
How to Take: Must be administered in accordance with specific protocol rate guidelines by a trained medical professional. To be administered intravenously only. Do not administer IV push or bolus. Do not administer IV rituximab, Rituxan subcutaneously. If an infusion-related reaction occurs, slow or stops the infusion. If the reaction abates, restart infusion at 50% of the previous rate. Discontinue infusion in the event of serious or life-threatening cardiac arrhythmias.
Cardiovascular effects including flushing, hypertension and edema; dermatologic effects including night sweats, itchiness, skin rash; gastrointestinal symptoms such as pain, nausea and diarrhea; urinary tract infection; hematologic changes such as neutropenia, anemia, lymphocytopenia; hepatic disorders/impairments such as hepatobiliary disease and elevated liver enzymes; antibody development; infection; joint and muscle pain; respiratory symptoms such as cough, rhinitis and nasopharyngitis.
Note this is not a complete list of side effects for Rituximab, Rituxan/Ruxience/Truxima only common ones.
Frequently Asked Questions
What do I do if side effects are intolerable?
If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.
Why would I be given a medication that increases my risk of infections?
This medication is used for autoimmune conditions which are essential when your immune system attacks your body inappropriately as if it were a foreign body like bacteria or viruses. In order to treat this, the immune function that is damaging your body must be subdued, however, this increases the risk of other infections occurring. While on immunosuppressant medications it is important to take all infections more seriously and get them checked out by your physician to ensure that your body is fighting them effectively.