Rituxan-Rituximab

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Description Your treatment is called rituximab (ri-TUK-see-mab) or Rituxan® (ri-TUK-san). It is commonly used to treat Non-Hodgkin’s Lymphoma and has also been used to treat other diseases. Rituximab is a new type of drug, called a monoclonal antibody, which targets cancer cells more precisely than chemotherapy drugs.

What Do I Need to Know Before Starting Treatment?

  • Be sure to tell your healthcare provider about any prescription or over-the-counter products you are taking, including dietary supplements, vitamins, herbal medicines and homeopathic remedies.
  • Use an effective birth control method while you are being treated. Chemotherapy drugs can cause harm to a fetus, so be sure to tell your healthcare provider right away if you or your partner become pregnant.
  • Avoid breastfeeding during treatment. It is not known if chemotherapy drugs pass into breast milk.
  • Some chemotherapy drugs can cause sterility. Talk with your healthcare provider about your options if you want to have children in the future.
  • Do not get any immunizations or vaccinations while you are being treated without the approval of your healthcare provider.
 

What Do I Need to Know Before Starting Rituximab?

  • Rituximab commonly causes a mild to moderate infusion reaction that causes fever and chills. In most cases, the reaction occurs 30 minutes to two hours after the infusion is started and ends before the treatment is finished. In rare cases, rituximab can cause a severe, life-threatening reaction. Symptoms include nausea, weakness, headache, skin rash, itching, swelling of the tongue or throat, wheezing, coughing, shortness of breath, lung congestion, irregular heart beat and low blood pressure. Tell your healthcare provider if you have any of these symptoms.
  • The chance of an infusion reaction is greatest during the first infusion and decreases with later infusions. To reduce your chance of having an infusion reaction, your healthcare provider may recommend you take acetaminophen (Tylenol®) and diphenhydramine (Benadryl®) before treatment.
  • If you are taking blood pressure medicine, you may be advised to stop taking your medicine for at least 12 hours before and during the rituximab infusion. Don’t stop taking your blood pressure medicine or change your dosage without first talking with your healthcare provider.
  • Rituximab can cause tumor lysis syndrome (TLS), which occurs when chemotherapy kills large numbers of cancer cells and causes abnormal changes in blood chemistry. In rare cases, TLS can cause kidney failure that requires dialysis. Your healthcare provider will check your blood for TLS.
  • Rituximab can cause the reactivation of several serious viral infections. Patients who carry the hepatitis B virus can suddenly develop severe hepatitis. Rituximab has also been linked to a very rare virus that causes a disease called progressive multifocal leukoencephalopathy (PML). Tell your healthcare provider if you have ever had hepatitis B or if you have any changes in vision or loss of speech.
  • Rituximab can cause irregular heart beat and chest pain. Those who have a history of heart disease have an increased risk of developing problems during treatment. Tell your healthcare provider if you have ever had a heart condition.
  • Rituximab can cause severe skin reactions, which in rare cases can be life threatening. Tell your healthcare provider right away if you develop painful sores, ulcers, blisters or peeling skin.
Your treatment can interact with other medicines, including:
  • Cisplatin
Contact you healthcare provider if you are taking any medications that can interact with your treatment.

Who Should Not Take This Treatment

You should not take this treatment if you are allergic to rituximab or any components of this drug.  

How Is the Treatment Given?

  • Your healthcare provider will give you your treatment by injection into a vein. The dose you receive will be based on your weight and height. Your healthcare provider will determine the number of treatments you receive.
  • You may be given medicines to help prevent and control nausea and vomiting before you receive your treatment. These medicines may be given either by mouth or by injection into a vein.
  • If you are given any medicine to take at home, do not share it with others. Sharing this medication with anyone else could be harmful.
 

When Should I Call My Healthcare Provider?

Call your healthcare provider right away if you have any of the following symptoms:
  • Shaking chills or fever of 100.5 degrees F or higher
  • Unusual bleeding, easy bruising or pinpoint red spots on your skin
  • Vomiting that is severe or lasts several hours
  • Painful or frequent urination or blood in your urine
  • Diarrhea that causes an additional four bowel movements a day, diarrhea that lasts more than one day, diarrhea at night or diarrhea with fever, cramps or bloody stools
  • Irregular or rapid heart beat, chest pain, chest tightness or shortness of breath
  • Dizziness or feeling lightheaded
  • In ability to eat or weight loss
 

What Are the Possible Side Effects?

All drugs can cause side effects, but every person reacts differently to each drug. The following chart lists the possible side effects that can occur with your treatment, how to recognize and minimize symptoms and possible treatments. The side effects are grouped by how often the side effect occurs: Common (occurs in more than 25 percent of patients), Less Common (occurs in 5 to 25 percent of patients) or Rare (occurs in less than 5 percent of patients).

Side Effect

How to Minimize Side Effect

Possible Treatments

Risk of Infection (Less Common)
  • Fever and chills
  • Painful urination
  • Sore throat and cough
  • Nasal congestion
  • Swelling or redness of the skin at the site of a wound
  • Wash your hands often.
  • Brush and floss your teeth daily.
  • Clean cuts right away with warm water, soap and antiseptic.
  • When your white blood cell count is low, stay away from crowds and people with colds or other illnesses.
  • You may be given medicine to increase your white blood cell count.
  • You may be given an antibiotic to treat or prevent infection.
  • Your healthcare provider may decrease your chemotherapy dose or delay further chemotherapy.
Anemia (Less Common)
  • Fatigue or weakness
  • Dizziness
  • Pale skin
  • Feeling out of breath
  • Feeling cold
  • Plan rest periods throughout the day.
  • Organize daily activities so that you conserve your energy.
  • Try to eat a well balanced diet and drink plenty of fluids.
  • Stand up slowly to avoid getting dizzy.
  • You may be given medicine to increase your red blood cell count.
  • Your healthcare provider may decrease your chemotherapy dose or delay further chemotherapy.
Nausea/Vomiting (Less Common)
  • Feeling queasy or sick to your stomach
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Eat food cold or at room temperature so the smell of food will not bother you.
  • Avoid fried, spicy or fatty foods.
  • Eat and drink slowly.
  • Drink plenty of liquids during the day, but to avoid bloating, drink small amounts of liquid during meals.
  • You will be given medicine to help reduce nausea and vomiting.
Diarrhea (Less Common)
  • Loose or watery stools several times a day
  • Abdominal cramping, gas and bloating
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Avoid caffeine; alcohol; raw fruits and vegetables; raw eggs; undercooked meats; spicy, fatty and greasy foods; milk and dairy products; foods that cause gas, such as beans and other legumes; high fiber and high-fat foods; foods left un- refrigerated for more than two hours (one hour for egg dishes and cream or mayonnaise-based foods); bulk laxatives; and stool softeners.
  • Drink eight to ten glasses of clear liquids every day.
  • Your healthcare provider may prescribe medicine to help treat diarrhea.
Rash (Less Common)
  • Usually mild and short-lived
  • Generally appears on the arms and trunk (occasionally on the face)
  • May be itchy
  • May appear as a flat, discolored area on the skin or as a small raised bump
  • Avoid prolonged exposure to heat.
  • Use creams or moisturizers regularly. Try wearing cotton gloves on your hands.
  • Avoid using perfume, cologne or aftershave since these products can be irritating to the skin.
  • Your healthcare provider may prescribe creams (mild steroids, antihistamines or antibiotics) to help treat the rash.
  • The rash may improve on its own without any treatment.
Fluid Retention (Less Common)
  • •Swelling around the eyes, lower legs, ankles, feet or abdominal area
  • •Rapid weight gain
  • Check your weight regularly.
  • Try to avoid eating salty foods, as this can cause fluid retention.
  • You may be given a diuretic (water pill) to reduce the amount of fluid in your body.
  • Your healthcare provider may decrease your chemotherapy dose or delay further chemotherapy.
Bleeding (Rare)
  • Unusual bleeding, easy bruising
  • Black or tar-like stools
  • Blood in your urine
  • Pinpoint red spots on your skin
  • Bleeding gums or nosebleeds
  • Avoid aspirin and aspirin-like drugs, such as ibuprofen.
  • Use caution with sharp objects, such as razors and nail cutters.
  • Avoid activities that can cause cuts, bumps and bruises.
  • You may be given medicine to increase your platelet count.
  • Your healthcare provider may decrease your chemotherapy dose or delay further chemotherapy
 

What Are The Other Possible Side Effects?

The following chart lists additional side effects found with this treatment. It does not list all possible side effects. For more information, talk with your healthcare provider.

Common Side Effects

  • Weakness
 

Less Common Side Effects

  • Headache
  • Throat irritation
  • Abdominal or back pain
  • Muscle and joint pain
  • Low or high blood pressure
  • Dizziness or lightheadedness
  • High blood sugar
 

Rare Side Effects

  • Flushing