Last Modified: March 11, 2012
Classification: Monoclonal Antibody
Rituximab is a synthetic (man made) antibody directed against a protein called CD20, found on the surface of normal and cancerous B-cells, which are part of the immune system. More than 95% of B-cell non-hodgkin's lymphomas (NHLs) express the CD20 target, making rituximab an affective therapy for these NHLs.
An antibody is a part of the immune system that "marks" things (such as germs, bacteria and, in this case, cancer cells) to be destroyed by the immune system. Once rituxan attaches itself to the B cells expressing CD20, it summons the body's immune system to attack and destroy those cells.
How to Take Rituximab
Rituximab is given by intravenous (into a vein) infusion. It may take several hours or longer to receive your first dose of rituximab. Depending on how you tolerate the medication, you may receive subsequent doses more quickly. The dosage and schedule is determined by the person's body size, type of cancer, and treatment regimen.
You should not receive rituxan if you have an active infection or receive a vaccine containing a live virus while on therapy (including oral polio, smallpox, MMR, nasal flu, and chickenpox vaccines).
Possible Side Effects of Rituximab
There are a number of things you can do to manage the side effects of Rituximab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Infusion and Allergic Reactions
Allergic or infusion reactions may occur during the treatment, typically within 30 minutes to 2 hours of beginning the first infusion. This is less common after the first treatment. You will be given diphenhydramine (Benadryl®) and acetaminophen (Tylenol®) before your treatment to reduce the chance of a reaction. During the infusion, if you experience difficulty breathing or swallowing, experience chest pain, cough or wheezing, swelling of lips or face, develop itching, rash or hives, lightheadedness, fever, chills, or shakes inform your nurse immediately. Additional medications may be given to alleviate your discomfort. Your infusion may be slowed or temporarily stopped.
Low White Blood Cell Count(Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
For more suggestions, read the Neutropenia Tip Sheet.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
You may experience flu-like symptoms, including muscle and body aches, headache, fever and chills. Acetaminophen may help relieve these symptoms. However, fever can be a sign of an infection and should be reported to your healthcare provider.
Other Side Effects
Rare, but serious side effects include:
- Progressive Multifocal Leukoencephalopathy (PML) is a rare, serious brain infection caused by a virus. Report any of the following to your healthcare provider right away: confusion, loss of balance, difficulty walking or talking, weakness on one side of your body or any vision changes.
- Abnormal heart rhythm. Report any feelings of irregular heartbeats, chest pain or palpitations.
- Severe skin and mouth reactions have been reported. Notify your healthcare provider if you develop painful sores or blisters, on your skin, lips or inside your mouth, rash or peeling skin.
- Bowel perforation has also been reported. Notify your healthcare provider if you experience new or worsening abdominal pain, fever, vomiting or constipation for 3 days or more.