Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Allergic reactions: In rare cases, some people may develop a serious allergic reaction to this medication. Signs of an allergic reaction include a severe rash, hives, swollen face or throat, or difficulty breathing. If these occur, get immediate medical attention.
Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily.
Tell your doctor about any signs that your blood is not clotting as quickly as usual. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.
Drowsiness and dizziness: Because this medication can cause drowsiness and dizziness, you should arrange to have someone drive you home after you receive this medication.
Heart problems: Serious and potentially life-threatening heart problems have occurred in people who were using rituximab. If you have a heart problem (e.g., arrhythmia, angina, heart failure), you will be monitored closely by your doctor during the infusion and immediately after the infusion is finished.
If you are taking medication for high blood pressure, you may need to temporarily stop the medication while receiving rituximab. Talk to your doctor for more information.
Hepatitis B infection: There have been rare reports of the recurrence of hepatitis B infection in people receiving rituximab (often in combination with chemotherapy) who had previously been infected with the virus.
If you are at risk of hepatitis B infection, you should have a blood test before starting therapy to check if you carry the virus. Talk to your doctor if you are unsure whether you are at risk.
If you are a carrier of hepatitis B virus, had a previous infection, or are at risk of infection, your doctor will monitor you closely during rituximab therapy and for up to one year after finishing it for signs and symptoms of hepatitis B infection. These include abdominal or joint pain, loss of appetite, feeling of sickness, and yellowing of the skin and eyes (jaundice). If you experience these symptoms, contact your doctor immediately.
Infection: This medication can reduce the number of cells that fight infection in the body (white blood cells), increasing the risk of developing an infection or reactivating an inactive infection (e.g., herpes, shingles). Avoid contact with people with contagious infections.
If you notice signs of an infection such as fever, chills, pain, redness and swelling, pus, cough, or difficult or painful urination, contact your doctor as soon as possible.
This medication should also not be started while you have an active infection or a weakened immune system. While you are taking rituximab, your doctor will monitor you for signs of infection.
Infusion-related reactions: There have been reports of severe infusion-related reactions, sometimes resulting in death, in people with who were given rituximab intravenously. Your health care provider will closely monitor you during and after the infusion. These reactions usually occur within 30 minutes to 2 hours of starting the infusion.
If you experience symptoms of an infusion reaction, such as fever, chills, difficulty breathing, tightness of chest or throat, stomach upset, and rash, tell your health care provider immediately.
It is important to take the medication(s) recommended by your doctor before your infusion of rituximab. If you experience a severe infusion reaction, your doctor will give you additional medications to treat the reaction. Ask your doctor for more information.
Progressive multifocal leukoencephalopathy (PML): There have been reports of PML after using rituximab. PML is a rare disorder that causes nerve damage in the brain. If you experience memory loss, vision loss, trouble thinking, or difficulty walking, contact your doctor immediately.
Tumour lysis syndrome (TLS): Rituximab may cause TLS, a potentially fatal condition that causes sudden kidney failure and abnormal heart rhythms. In the early stage of TLS, you may not have any symptoms, but your doctor will monitor for this condition with blood tests.
If you experience symptoms of TLS (e.g., a pounding, fast, or irregular heartbeat; vomiting; fatigue or weakness; difficulty concentrating; swelling, numbness or tingling in hands, face, or feet; back pain; muscle cramps; fainting; or trouble breathing), contact your doctor immediately.
Vaccines: Vaccines should not be given when you are receiving rituximab. Talk to your doctor if you need any vaccinations while taking this medication.
Pregnancy: This medication is not recommended for use during pregnancy. If you may become pregnant, use an effective method of birth control while you are using this medication, and for at least 12 months after the last treatment. Tell your doctor immediately if you become pregnant.
Breast-feeding: It is not known if rituximab passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.