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Rituximab (Rituxan)

 

Warning:  As with most powerful drugs, there are certain side effects of Rituximab that you should be familiar with.  This drug may cause severe breathing problems or heart problems, like low blood pressure, heart attack and irregular heartbeat.  These side effects are much more likely to occur if you have already have some sort of reaction to Rituximab. 

 

Some serious skin reaction have also been seen to occur in rare instances.  If you see that you are having an adverse reaction with your skin, you should seek medical attention immediately and report any rashes, sores, or blisters to your physician as soon as possible.

In very rare cases, Rituximab has been shown to cause a sometimes fatal, brain infection.  Signs of this include loss of balance, blurred vision and confusion.  If you experience any of these symptoms, you need to seek immediate medial attention.

 

Indications: Rituximab is a drug that is used either alone, or in combination with other drugs, to treat certain types of cancer.  This mechanism of this drug is that it attaches to a specific type of blood cell (B cells) and kills them.  This drug can also be used to treat some types of rheumatoid arthritis, if other drugs have not worked. 

Rituximab is mainly used in the treatment of the following conditions: 

  • rheumatoid arthritis  
  • follicular lymphoma stage III-IV that is resistant to chemotherapy or relapse after chemotherapy; 
  • follicular lymphoma Stage III-IV that had never been previously treated, in combination with CVP chemotherapy; 
  • Aggressive diffuse large b-cell CD20-positive Non Hodgkin's lymphoma (DLBCL), in combination with CHOP chemotherapy.  

Dosage: Rituximab is a drug that is administered via intravenous therapy, also known as IV therapy.  A doctor will be giving this medication to you slowly over several hours.  The dosage will be determined on the severity of your condition and the response that you have had to the treatment.  A typical treatment for cancer would be one dose every week until stopped by your physician.  Treatment for rheumatoid arthritis is 2 doses about 2 weeks apart.

Overdose: Rituximab is given in hospital by professionals; although it is not impossible, the risk of overdose is very difficult. An overdose of paclitaxel may cause a life threatening decrease in the number of blood cells in your bone marrow and cause severe health problems. Even in the absence of overdose, Rituximab can cause severe reactions in some patients. Contact your health care provider immediately if you experience: fainting; shortness of breath, blurred vision, pounding or irregular heartbeat, loss of consciousness, swelling of the lips, tongue, or throat. Difficulty breathing or swallowing should be reported immediately to your doctor. 

In the treatment of non-Hodgkin's lymphoma, Rituximab can lead to the development of tumor lysis syndrome (a serious metabolic disorder that is due to fast breakdown of cancer cells), which tend to lead to kidney failure and the need for dialysis treatment. Some patients die within 24 hours after receiving a dose of Rituximab. Before starting the treatment, it is extremely important to tell your doctor all details about your medical history. During and after the treatment, keep all appointments with your doctor.  

Missing dose: Rituximab is administered in hospital; it is basically difficult for you to miss any dose if you keep all appointments of your doctor. Therefore, be present at each appointment to take all doses of paclitaxel that your doctor has prescribed. If for some reasons you cannot go to the hospital for the treatment, contact your oncologist before the date scheduled for the injection.  

Contraindications:   The use of this drug can cause dizziness, so it is important that you do not drive, use heavy machinery, or participate in activities that require a high level of alertness.  The consumption of alcoholic beverages should also be avoided or kept to a minimum.  Before you have surgeries, make sure you inform your doctor about this and any other medications that you are on. 

In general, Rituximab is contraindicated or should be used with precaution in the following conditions: 

  • respiratory failure
  • filling of airspaces with fluid (pulmonary oedema)
  • antihypertensive therapy  
  • angina  
  • heart failure 
  • neutropenia 
  • thrombocytopenia 
  • women who are breast-feeding 
  • having a high number of circulating malignant cells  
  • allergy to Rituxan or one of its ingredients  
  • allergy to Chinese hamster ovary (CHO) cells
  • Pregnant women - if you are at childbearing age, talk to your doctor about contraception during treatment with Rituxan. 

Interactions:   As with all prescription drugs, it is important to know that the chemicals from other drugs can change the way the drug works.  Some of the drugs that may cause problems for people on Rituximab include drugs that treat high blood pressure, drugs that have effects on the immune system, and even some immunizations.  It is important to speak with your doctor and let him or her know about all of the drugs you are currently on before you start to take Rituximab.

 

This drug also attacks normal cells that multiply rapidly, causing adverse reaction in some patients. Common Rituximab side effects include:

  • hair loss
  • nausea and vomiting
  • loss of appetite
  • change in taste
  • runny nose
  • heartburn
  • weight gain
  • muscle or back pain
  • flushing
  • night sweats
  • joint pain
  • fatigue
  • sleep disorders
  • Mouth blistering 

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor if you experience any of these symptoms:

  • stomach pain 
  • unusual bruising or bleeding 
  • sore throat, fever, chills, ...
  • chest pain or tightness 
  • severe muscle or joint pain  
  • signs of infection such as sore throat, fever and chills 
  • joint pain or soreness
  • blood in urine or stools 
  • pain in lower back or the side 
  • Painful or difficulty urinating.