BMA Concise Guide to Medicine & Drugs

Rituximab

Brand name MabThera

Used in the following combined preparations None

QUICK REFERENCE

Drug group Anticancer drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Rituximab is a monoclonal antibody that suppresses the immune system and reduces inflammation. It works by reducing the number of B- lymphocytes (a type of white blood cell involved in the production of antibodies by the immune system). It is used with chemotherapy to treat some types of lymphoid cancers, especially B-cell lymphomas and chronic lymphocytic leukaemia, and in combination with methotrexate to treat severe rheumatoid arthritis. It may also be used to treat systemic lupus erythematosus, autoimmune anaemias and platelet disorders, vasculitis, and some skin conditions, such as pemphigus. It is also used to treat acute graft rejection in transplant patients.

Because rituximab suppresses the immune system, serious infections can occur or reactivate with its use. It is important that you tell your doctor if you have previously had hepatitis B or tuberculosis as they may reactivate with rituximab treatment.

INFORMATION FOR USERS

This drug is given only under medical supervision and is not for self-administration.

How taken/used Intravenous infusion.

Frequency and timing of doses Usually 4–8 courses of treatment over a period of up to 2 years, but the precise dosing schedule depends on the condition being treated.

Adult dosage range Each dose: 375–500mg/m2 of body surface area, depending on condition being treated.

Onset of effect Response to rituximab is often evident only about 6 weeks after the start of treatment.

Duration of action 6–9 months.

Diet advice None.

Storage Not applicable. The drug is not normally kept at home.

Missed dose The drug is administered in hospital under close medical supervision. If you miss your dose, contact your doctor as soon as possible.

Stopping the drug Discuss with your doctor. Stopping the drug prematurely may lead to worsening of the underlying condition.

Exceeding the dose Overdosage is unlikely since treatment is carefully monitored and supervised.

POSSIBLE ADVERSE EFFECTS

Fever, chills, shivering, nausea or vomiting, and flushing may occur during the first infusion. Less commonly, allergic reactions (e.g. wheezing, swelling of the tongue, itchiness, or a rash) or abdominal pain may also occur. People with angina may have a worsening of their symptoms. Rarely, forgetfulness, confusion, or paralysis may occur. Rituximab suppresses the immune system and therefore susceptibility to infection is increased. The drug is given under medical supervision and side effects are monitored. Nevertheless, you should also inform your doctor if you develop an infection or any other adverse effects.

INTERACTIONS

Vaccines Rituximab suppresses the immune system, so live vaccines should not be used while undergoing rituximab treatment. The drug may also make attenuated vaccines less effective. Discuss with your doctor.

Antihypertensive drugs The blood-pressure-lowering effect of these drugs may be enhanced when taken together with rituximab.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have an infection, wound, dental problem, or have had recent surgery.

· You have previously had tuberculosis or hepatitis B.

· You have angina or other heart problems.

· You are pregnant, think you may be pregnant, or intend to become pregnant.

· You have recently been vaccinated or are due to be vaccinated.

· You are taking any other medications, especially for high blood pressure.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended

Over 60 No special problems.

Driving and hazardous work Avoid such activities until you know how rituximab affects you because it can cause dizziness and fatigue.

Alcohol No special problems.

PROLONGED USE

Rituximab increases susceptibility to infection, and any infection that develops should be treated promptly. Very rarely, a serious brain infection may develop; you should tell your doctor immediately if you develop memory problems, confusion, difficulty walking, or vision problems.

Monitoring Periodic blood tests may be carried out. Body temperature, blood pressure, and heart rate may be monitored when you receive rituximab infusions.