Rituximab: functions, dosage, side effects, how to use it

What drug is Rituximab?

What is rituximab for?

Rituximab is a drug that is used alone or with other drugs to treat certain types of cancer (eg non-Hodgkin's lymphoma, chronic lymphocytic leukemia). This is a type of medicine called a monoclonal antibody. It works by attaching to certain blood cells of your immune system (B cells) and killing them. This drug is also used with other monoclonal antibodies and radioactive drugs to treat certain cancers.

Rituximab is also used with methotrexate to treat moderate to severe forms of rheumatoid arthritis. It's usually used for rheumatoid only after other drugs haven't worked. This medication can reduce joint pain and swelling. It is also used to treat certain types of vascular disease (such as Wegener's granulomatosis, microscopic polyangiitis).

How is rituximab used?

Read the Medication Guide provided by your pharmacist before you start taking rituximab and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Your doctor should prescribe other drugs (such as acetaminophen, antihistamine, methylprednisolone) for you to take before each treatment to help reduce side effects, such as fever and chills. Be careful in following doctor's instructions.

This medication is given by slow injection into a vein by a healthcare professional as directed by your doctor. Your dosage and treatment schedule is based on your medical condition, other drugs you may be taking, and response to treatment.

Ask your doctor if you have to take regular medications (for example, medications for high blood pressure) before your treatment.

How is rituximab stored?

This medication is best stored at room temperature, away from direct light and damp places. Don't keep it in the bathroom. Don't freeze it. Other brands of this drug may have different storage rules. Observe the storage instructions on the product package or ask your pharmacist. Keep all medicines away from children and pets.

Do not flush medicines down the toilet or down the drain unless instructed to do so. Discard this product when it has expired or when it is no longer needed. Consult your pharmacist or local waste disposal company about how to safely dispose of your product.

Rituximab dosage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before starting treatment.

What is the dose of rituximab for adults?

Normal Dosage for Adults with Non-Hodgkin Lymphoma

Information about administering rituximab by a healthcare professional: Do not use as an intravenous boost or bolus. Used only as an intravenous (IV) infusion. Pre-medically before each infusion with acetaminophen and antihistamines. For RA patients, methylprednisolone 100 mg IV or equivalent is recommended 30 minutes before each infusion. Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

First infusion: Initiate infusion at a rate of 50 mg / hour. In the absence of infusion toxicity, increase the infusion rate to 50 mg / hour increments every 30 minutes, to a maximum of 400 mg / hour.

Subsequent infusion: Initiate infusion at a rate of 100 mg / hour. In the absence of infusion toxicity, increase the rate to 100 mg / hour incrementally at 30 minute intervals, to a maximum of 400 mg / hour.

For patients previously untreated Follicular Non-Hodgkins Lymphoma (NHL) and Large Diffuse B-Cell NHL (DLBCL): If the patient did not have a Grade 3 or 4 adverse event-related infusion during Cycle 1, 90 minutes of infusion may be given in cycle 2 with the content of the glucocorticoid chemotherapy regimen. Start the infusion at a rate of 20% of the total dose given in the first 30 minutes and use the remaining 80% of the total dose for the next 60 minutes. If a 90 minute infusion is tolerated in cycle 2, the same rate can be used for the next cycle. Patients who have clinically significant cardiovascular disease or who have circulating lymphocytes count greater than or equal to 5000 / mm3 before Cycle 2 should not be given the 90 minute infusion.

Inhibit infusion or slow down infusion rate for infusion reactions. Continue infusion at one-half the previous rate for improvement of symptoms.

Relapsed or heat-resistant, mild or follicular, CD20-positive, B-cell non-Hodgkin lymphoma (NHL): 375 mg / m2 IV once a week for 4 or 8 doses.

Interpretation for relapse or heat resistance, mild or follicular, NHL, CD20-positive B-cells: 375 mg / m2 IV once weekly for 4 doses.

Previously untreated: follicle B-cells CD20-positive NHL: 375 mg / m2 IV, given on Day 1 of each chemotherapy cycle, up to 8 doses. In patients with complete or partial response, start rituximab treatment 8 weeks after completion of rituximab in combination with chemotherapy. Administer rituximab as a single agent every 8 weeks for 12 doses.

No progress, Low-grade: B-cells CD20-positive NHL, after first-line CVP chemotherapy: After completion of 6 to 8 cycles of CVP chemotherapy, use 375 mg / m2 IV once a week for 4 doses at 6 month intervals for a maximum of 16 doses.

DLBCL: 375 mg / m2 IV given on day 1 of each chemotherapy cycle for up to 8 doses.

Chronic Lymphocytic Leukemia (CLL): 375 mg / m2 the day before starting FC chemotherapy, then 500 mg / m2 on day 1 of cycles 2 to 6 (every 28 days).

As a necessary component of the therapeutic regimen ibritumomab tiuxetan: rituximab 250 mg / m2 should be infused within 4 hours before administration of Indium-111- (In-111-) ibritumomab tiuxetan and within 4 hours before use of Yttrium-90 - (Y-90- ) tiuxetan ibritumomab. Use of rituximab and In-111-ibritumomab tiuxetan should precede rituximab and Y-90-ibritumomab tiuxetan by 7 to 9 days. (Note: ibritumomab tiuxetan therapeutic regimen is indicated for the treatment of patients with relapsed or refractory low grade or non-Hodgkin follicular B cell lymphoma, including patients with non-Hodgkin follicular refractory lymphoma rituximab.)

Normal Dosage for Adults with Rheumatoid Arthritis:

Information for all healthcare professionals regarding administering rituximab: Do not use as an intravenous boost or bolus. Use only as an intravenous (IV) infusion. Prior to any pre-medics infusion with acetaminophen and antihistamines. For RA patients, methylprednisolone 100 mg IV or equivalent is recommended 30 minutes before each infusion. Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

First infusion: Initiate infusion at a rate of 50 mg / hour. In the absence of infusion toxicity, increase the infusion rate to 50 mg / hour increments every 30 minutes, to a maximum of 400 mg / hour.

Subsequent infusion: Initiate infusion at a rate of 100 mg / hour. In the absence of infusion toxicity, increase the rate to 100 mg / hour incrementally at 30 minute intervals, up to a maximum of 400 mg / hour.

Inhibiting infusion or slowing the infusion rate for infusion reactions. Continue infusion at one-half the previous rate for improvement of symptoms.

Rheumatoid Arthritis: Rituximab is given in combination with methotrexate. Rituximab was given as two infusions of 1000 mg IV separated over 2 weeks. Glucocorticoids given as methylprednisolone 100 mg IV or the equivalent 30 minutes before each infusion are recommended to reduce the incidence and severity of infusion reactions. Further courses should be administered every 24 weeks or based on clinical evaluation, but not sooner than every 16 weeks.

Normal Dose for Adults with Lymphocytic Leukemia:

Information for all healthcare professionals about administering rituximab: Do not use this medication as an intravenous boost or bolus. Use only as an intravenous (IV) infusion. Pramedic before each infusion with acetaminophen and antihistamines. For RA patients, methylprednisolone 100 mg IV or equivalent is recommended 30 minutes before each infusion. Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

First infusion: Initiate infusion at a rate of 50 mg / hour. In the absence of infusion toxicity, increase the infusion rate to 50 mg / hour increments every 30 minutes, to a maximum of 400 mg / hour.

Subsequent infusion: Initiate infusion at a rate of 100 mg / hour. In the absence of infusion toxicity, increase the rate to 100 mg / hour incrementally at 30 minute intervals, up to a maximum of 400 mg / hour.

Blocking the infusion or slowing the infusion rate for an infusion reaction. Continue infusion at one-half the previous rate for improvement of symptoms.

Chronic Lymphocytic Leukemia (CLL): 375 mg / m2 IV days before initiation of fludarabine and cyclophosphamide (FC) chemotherapy, then 500 mg / m2 on day 1 of cycles 2 to 6 (every 28 days).

Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

Normal Dosage for Adults with Wegener Granulomatosus:

Information for all healthcare professionals regarding administering rituximab: Do not use as an intravenous boost or bolus. Use only as an intravenous (IV) infusion. Prior to any pre-medics infusion with acetaminophen and antihistamines. For RA patients, methylprednisolone 100 mg IV or equivalent is recommended 30 minutes before each infusion. Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

First infusion: Initiate infusion at a rate of 50 mg / hour. In the absence of infusion toxicity, increase the infusion rate to an increase of 50 mg / hour every 30 minutes, up to a maximum of 400 mg / hour.

Subsequent infusion: Initiate infusion at a rate of 100 mg / hour. In the absence of infusion toxicity, increase the rate to 100 mg / hour incrementally at 30 minute intervals, up to a maximum of 400 mg / hour.

Inhibiting infusion or slowing the infusion rate for infusion reactions. Continue infusion at one-half the previous rate for improvement of symptoms.

Wegener Granulomatosis (WG) and microscopic polyangiitis (MPA): 375 mg / m2 IV given once a week for 4 weeks.

Glucocorticoids given as methylprednisolone 1000 mg IV daily for 1 to 3 days followed by oral prednisone 1 mg / kg / day (no more than 80 mg / day and tapered per clinical need) are recommended for treating severe vasculitis symptoms. This regimen should be started within 14 days before or with initiation of rituximab and can be continued during and after the 4 week course of rituximab treatment.

The safety and efficacy of treatment with subsequent rituximab programs have not been established.

PCP prophylaxis is recommended for patients with WG and MPA during treatment and for at least 6 months after the last rituximab infusion.

Adult Dose for Microscopic Polyangiitis:

Information for all healthcare professionals regarding administering rituximab: Do not use as an intravenous boost or bolus. Use only as an intravenous (IV) infusion. Before premedic any infusion with acetaminophen and antihistamines. For RA patients, methylprednisolone 100 mg IV or equivalent is recommended 30 minutes before each infusion. Pneumocystis jiroveci pneumonia (PCP) and anti-herpes virus prophylaxis are recommended for patients with CLL during treatment and up to 12 months after appropriate treatment.

First infusion: Initiate infusion at a rate of 50 mg / hour. In the absence of infusion toxicity, increase the infusion rate to 50 mg / hour increments every 30 minutes, to a maximum of 400 mg / hour.

Subsequent infusion: Initiate infusion at a rate of 100 mg / hour. In the absence of infusion toxicity, increase the rate to 100 mg / hour incrementally at 30 minute intervals, up to a maximum of 400 mg / hour.

Inhibiting infusion or slowing the infusion rate for infusion reactions. Continue infusion at one-half the previous rate for improvement of symptoms.

Wegener Granulomatosis (WG) and microscopic polyangiitis (MPA): 375 mg / m2 IV given once a week for 4 weeks.

Glucocorticoids given as methylprednisolone 1000 mg IV daily for 1 to 3 days followed by oral prednisone 1 mg / kg / day (no more than 80 mg / day and tapered per clinical need) are recommended for treating severe vasculitis symptoms. This regimen should be started within 14 days before or with initiation of rituximab and can be continued during and after the 4 week course of rituximab treatment.

The safety and efficacy of treatment with subsequent rituximab courses have not been established.

PCP prophylaxis is recommended for patients with WG and MPA during treatment and for at least 6 months after the last rituximab infusion.

What is the dose of rituximab for children?

Safety and effectiveness in pediatric patients (less than 18 years) have not been established.

In what dosage is rituximab available?

Solution 100 mg / 10 ml 500 mg / 50 ml

Rituximab side effects

What side effects can be experienced due to rituximab?

Seek immediate medical help if you experience any of the following signs of an allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat.

Some people who receive rituximab injections have reactions to the infusion (within 24 hours after the drug is injected into a vein). Tell your nurse right away if you feel dizzy, weak, light-headed, short of breath, or if you have chest pain, wheezing, coughing up, or having a pounding heartbeat or a fluttering sensation in your chest.

Rituximab increases the risk of serious viral infection of the brain that can cause disability or death. Tell your doctor right away if you have symptoms such as confusion, trouble concentrating, problems with speaking or walking, vision problems, or weakness on one side of your body.

Call your doctor right away if you have any of the other serious side effects, even if they occur several months after you receive rituximab, or after your treatment ends:

• fever, chills, body aches, flu symptoms, feeling weak or tired
• persistent cold symptoms such as stuffy nose, sneezing, sore throat
• headache, earache, painful mouth ulcers, skin sores, warmth or swelling with reddish skin
• pain or burning when urinating, urinating less than usual
• severe skin rash with blistering, itching, peeling, or pus
• weak pulse, fainting, overactive reflex
• muscle weakness, tightness, or contractions
• lower back pain, blood in your urine, numbness or tingling feeling around your mouth

Other common side effects may include:

• mild stomach pain, nausea, or diarrhea
• muscle pain or joint pain
• back pain
• night sweats

Not everyone experiences this side effect. There may be some side effects not listed above. If you have any concerns about side effects, please consult a doctor or pharmacist.

Rituximab Drug Warnings and Cautions

What should be known before using rituximab?

In deciding to use a drug, the risks of taking the drug must be weighed against its benefits. This is a decision you and your doctor will make. For this drug, the following should be considered:

Allergy

Tell your doctor if you have ever had an unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read ingredients labels or packages carefully.

Children

There are no precise studies to determine the relationship of age to the effects of rituximab injection in the pediatric population. Safety and efficacy are yet to be determined.

Elderly

To date there have been no precise studies showing specific geriatric problems that will limit the usefulness of rituximab injection in the elderly. However, elderly patients are more likely to have age-related infections and heart and lung problems, which may require caution in patients receiving rituximab injection.

Is rituximab safe for pregnant and breastfeeding women?

There are no adequate studies regarding the risks of using this drug in pregnant or breastfeeding women. Always consult your doctor to weigh the potential benefits and risks before using this medication. This drug is included in the risk of pregnancy category C according to the US Food and Drug Administration (FDA).

The following references the pregnancy risk categories according to the FDA:

• A = No risk,
• B = not at risk in several studies,
• C = May be risky,
• D = There is positive evidence of risk,
• X = Contraindicated,
• N = Unknown

Rituximab Drug Interactions

What medicines may interact with rituximab?

Although certain drugs should not be used together at all, in other cases two different drugs can be used together even if interactions are possible. In this case, your doctor may want to change the dose, or other precautions may be needed. Tell your healthcare professional if you are taking any other prescription or non-prescription drugs (over-the-counter).

Using this medication with any of the following medicines is not recommended. Your doctor may decide not to treat you with this drug or change some of the other medicines you use: Rotavirus Vaccine, Live

Using this medication with any of the following medicines is not usually recommended, but may be necessary in some cases. If the two drugs are prescribed together, your doctor may change the dose or how often you use one or both drugs.

• adenovirus vaccine type 4, live
• adenovirus vaccine type 7, live
• bacillus of calmette and guerin vaccine, live
• cisplatin
• Influenza virus vaccine, live
• measles virus vaccine, live
• Mumps virus vaccine, live
• rubella virus vaccine, live
• smallpox vaccine
• typhoid vaccine
• varicella virus vaccine
• yellow fever vaccine

Using this medication with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If the two drugs are prescribed together, your doctor may change the dose or how often you use one or both drugs.

• Influenza virus vaccine (subvirion)
• neumococcal vaccine polyvalent

Can food or alcohol interact with rituximab?

Certain medications should not be used at or around the time of eating or consuming certain types of food because interactions can occur. Using alcohol or tobacco with certain drugs can also cause interactions to occur. Discuss with your healthcare professional the use of drugs with food, alcohol, or tobacco.

What health conditions can interact with rituximab?

The presence of other medical problems may affect the use of this drug. Make sure you tell your doctor if you have any other medical problems, especially:

• a history of angina (chest pain), or
• heart disease or
• a history of heart rhythm problems (for example, arrhythmias), or
• hepatitis B
• infection (for example, bacterial, fungal, or viral)
• Kidney illness
• a history of lung problems (eg, asthma, bronchitis)
• Stomach or intestinal problems (eg, intestinal obstruction, perforation, ulcers) - use with caution. It might make things worse.

Rituximab overdose

What should I do in an emergency or overdose?

In case of an emergency or overdose, contact the local emergency services provider (112) or immediately to the nearest hospital emergency department.

What should I do if I miss a dose?

If you forget a dose of this medicine, take it as soon as possible. However, when it is nearing the time of the next dose, skip the missed dose and return to the usual dosing schedule. Don't double the dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.