Precautions and Warnings With Rituximab

Rituximab may increase the risk of serious infections. If you currently have an infection or are prone to recurrent infections, your healthcare provider may advise against taking rituximab. Precautions and warnings also extend to people with an irregular heart rhythm, hepatitis B, or diabetes. Also, make sure your healthcare provider is aware of any other medications you are taking to avoid possible drug interactions.

What Should I Tell My Healthcare Provider?

Prior to receiving an infusion of rituximab (Rituxan®), tell your healthcare provider if you have:
  • A history of tuberculosis or hepatitis B
  • Any current infection
  • Infections that come and go (such as cold sores)
  • Any disease that affects the immune system, such as diabetes, cancer, HIV, or AIDS
  • Plans to receive vaccinations
  • An irregular heart rhythm (arrhythmia)
  • A certain type of chest pain known as angina
  • Any allergies, including to foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
Make sure to tell your healthcare provider about any other medicines you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.

Specific Rituximab Warnings and Precautions

Some warnings and precautions to be aware of prior to receiving rituximab include the following:
  • Infusion reactions are common with this medication. However, appropriate "premedication" can help limit the chance and severity of this. Premedication often includes acetaminophen (Tylenol®), an antihistamine, and a steroid. Infusion reactions can range from mild to fatal, and may include the following symptoms:
  • When rituximab is used to treat non-Hodgkin's lymphoma, it can sometimes cause tumor lysis syndrome, a group of serious symptoms that occurs when too many cancer cells die and are broken down at once. This most commonly occurs 12 to 24 hours after the first rituximab dosage. Your healthcare provider should monitor you carefully and aggressively treat this condition with medications, IV fluids, and possibly even dialysis if it occurs.
  • There have been reports of kidney failure in people who were given rituximab. This can occur either due to tumor lysis syndrome or possibly as the result of drug interactions with rituximab and cisplatin (a chemotherapy medication). Your healthcare provider may want to monitor your kidney function to check for this problem using simple blood tests.
  • This medicine can cause dangerous skin or mucous membrane reactions. These reactions can lead to significant tissue damage, disfigurement, and even death. Make sure to let your healthcare provider know right away if you develop any sort of rash or blistering anywhere on your body. These reactions have occurred anywhere from 1 to 13 weeks after a dose of rituximab.
  • In rare cases, people receiving rituximab have contracted JC virus infections that led to a serious condition known as progressive multifocal leukoencephalopathy (PML). Let your healthcare provider know if you develop any signs or symptoms of PML, such as:
    • Headaches
    • Coordination problems
    • Speech difficulties
    • Memory loss.
  • People who are carriers for hepatitis B may experience a reactivation of the virus while receiving rituximab. This can be quite serious -- potentially even fatal. If you have ever had hepatitis B, your healthcare provider will need to monitor you closely to make sure the virus is not becoming reactivated. Because people may not know if they've had a hepatitis B infection, everyone should be tested before starting this drug.
  • This drug may increase the risk of serious infections. Your healthcare provider may advise against using rituximab if you currently have an infection or are prone to recurrent infections, if you have a condition that increases your risk for infections, or if you have recently been exposed to a serious infection.
  • Rituximab can cause an irregular heart rhythm (arrhythmia). In some cases, these arrhythmias may be dangerous. If you develop an arrhythmia while receiving this drug, if you have had an arrhythmia in the past, or if you have a type of chest pain known as angina, your healthcare provider should monitor your heart rhythm while you are receiving an infusion and for a while afterwards.
  • There have been rare reports of intestinal blockage (obstruction) or perforation in people who were given rituximab in combination with chemotherapy. Make sure to let your healthcare provider know immediately if you develop signs or symptoms of such problems, such as:
    • A sudden change in bowel habits
    • Vomiting
    • Fever
    • Abdominal pain (stomach pain).
  • You should probably not receive live vaccines while taking rituximab. Talk to your healthcare provider before receiving any vaccines while on this medication.
  • Rituximab can potentially interact with a few other medications (see Drug Interactions With Rituximab).
  • Rituximab is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy, although the full risks are not currently known (see Rituxan and Pregnancy).
  • It is unknown if this medicine passes through breast milk in humans. Therefore, please check with your healthcare provider before receiving it while breastfeeding (see Rituxan and Breastfeeding).
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