All About Rituxan

What is Rituxan?

If you have certain cancers or other conditions that affect your immune system, your doctor may prescribe Rituxan for you.

It’s a prescription drug that’s used treat:

• rheumatoid arthritis (RA) in adults
• chronic lymphocytic leukemia (CLL) in adults
• granulomatosis with polyangiitis (GPA) in adults and some children
• microscopic polyangiitis (MPA) in adults and some children
• non-Hodgkin’s lymphoma (NHL) in adults
• pemphigus vulgaris in adults

To learn more about these conditions and how Rituxan is used to treat them, see the “Is Rituxan used for RA?” and “Is Rituxan used for other conditions?” sections below.

Rituxan basics

Rituxan is a type of immunotherapy. It contains the drug rituximab, which is a biologic medication. Biologics are made from parts of living organisms.

Rituxan is available in two biosimilar forms: rituximab-abbs (Truxima) and rituximab-pvvr (Ruxience). (Biosimilars are like generic drugs. But unlike generics, which are made for non-biologic drugs, biosimilars are made for biologic drugs.)

Rituxan comes as a solution that’s given as an intravenous (IV) infusion. (An IV infusion is an injection that’s given into your vein over a period of time). A healthcare professional will give Rituxan injections to you in a clinic, doctor’s office, or hospital.

Read on to learn about Rituxan’s uses, side effects, and more.

What are Rituxan’s side effects?

Like most drugs, Rituxan may cause mild or serious side effects. The lists below describe some of the more common side effects that Rituxan may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

• your age
• other health conditions you have
• other medications you may be taking

Your doctor or pharmacist can tell you more about the potential side effects of Rituxan. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Rituxan can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Rituxan’s medication guide.

Mild side effects of Rituxan that have been reported include:

• hair loss*
• diarrhea*
• cough
• feelings of mild depression
• headache
• nausea
• swelling of your hands or lower legs
• muscle spasms
• mild infections, such the common cold and urinary tract infection (UTI)
• rash or itching
• symptoms of infection, such as body aches, chills, fever, and fatigue (lack of energy)
• weakness
• weight gain

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* For more information on these side effects, see the “Side effect focus” section below.

Serious side effects

Serious side effects from Rituxan can occur, but they aren’t common. If you have serious side effects from Rituxan, call your doctor right away. However, if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Rituxan that have been reported include:

• tumor lysis syndrome (a condition that happens when tumor cells break down in your body and release their contents into your blood)
• serious infections, such as herpes and shingles
• heart problems, such as heart attack and ventricular fibrillation (a type of abnormal heart rhythm)
• kidney problems, such as kidney failure
• obstruction (blockage) or perforation (tearing) of your intestines
• low level of red blood cells
• low levels of certain white blood cells, such as lymphocytes and neutrophils
• boxed warnings:*
  • infusion reactions
  • severe skin and mouth reactions
  • progressive multifocal leukoencephalopathy (PML)
  • reactivation of hepatitis B virus (HBV)
• allergic reaction*

Note: Allergic reaction wasn’t reported in studies of Rituxan, but it may still happen.

* For more information on these side effects, see the “Side effect focus” section below.

Side effect focus

Learn more about some of the side effects Rituxan may cause.

Boxed warnings

Rituxan has boxed warnings. A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Infusion reactions. You may have infusion reactions during or after you receive does of Rituxan.

This side effect was common in studies of the drug, but it wasn’t serious for most people. Rarely, infusion reactions from Rituxan may lead to death.

Symptoms of infusion reactions can include:

• low blood pressure
• swelling of your lips and face
• trouble breathing

Severe skin and mouth reactions. You may have severe reactions on your skin or inside your mouth after receiving Rituxan. But, this is rare with Rituxan.

This side effect wasn’t reported in studies of the drug. But skin and mouth reactions can still happen. In rare cases, these reactions may be life threatening.

Symptoms of skin and mouth reactions include:

• skin peeling
• pustules (fluid-filled sacs on the skin)
• blisters
• other painful sores

Progressive multifocal leukoencephalopathy (PML). Using Rituxan may cause PML. PML is a rare but serious infection that affects the central nervous system and brain. In some cases, PML can be fatal.

Symptoms of PML include:

• changes in vision
• weakness
• trouble balancing
• problems using your arms or legs

Reactivation of hepatitis B virus (HBV). Rituxan may cause reactivation of hepatitis B virus in people who’ve had hepatitis B in the past.

Reactivation of HBV wasn’t reported in studies of the drug. But this can still happen when using Rituxan.

Hepatitis B can lead to serious liver problems, such as liver failure. Hepatitis B can also lead to death in rare cases.

Symptoms of hepatitis B include:

• tiredness
• jaundice (yellowing of the whites of your eyes or your skin).

What might help

If you have any symptoms of these boxed warning conditions, tell your doctor right away. They’ll likely recommend that you stop using Rituxan.

Before each Rituxan infusion, your doctor may give medications to you to help lessen your risk for an infusion reaction. (See the “How is Rituxan given?” section below for more information about this.)

Your doctor will also test you for hepatitis B virus before and during Rituxan treatment. If your test is positive for hepatitis B, your doctor may want to treat it before or while you take Rituxan. And they’ll closely monitor you for symptoms of HBV reactivation for up to 24 months after your last dose of Rituxan.

Hair loss

You may have hair loss while you’re using Rituxan.

In studies, hair loss only occurred in people using the drug for pemphigus vulgaris. Hair loss wasn’t reported in people using Rituxan for other conditions. (With pemphigus vulgaris, you have severe, painful blisters on your skin.)

So, you may be less likely to have hair loss from Rituxan if you’re using it to treat other conditions.

What might help

If you’re concerned about hair loss while you’re using Rituxan, talk with your doctor. They can discuss what you can expect with Rituxan treatment.

Diarrhea

You may have diarrhea after receiving Rituxan. This was a common side effect in studies of the drug.

Keep in mind that diarrhea can increase your risk for dehydration. With dehydration, your body loses large amounts of water and electrolytes.

What might help

Tell your doctor right away if you have diarrhea with Rituxan use.

Diarrhea from Rituxan is usually mild. But it may be a symptom of a rare, serious side effect, such as tumor lysis syndrome (TLS). (See the serious side effect list above for information about TLS.)

If your doctor determines that your diarrhea is mild or isn’t a symptom of a more serious side effect, they may suggest some ways to treat it.

Below are a few general recommendations your doctor may give for treating diarrhea.

• Hydration. If you have diarrhea, be sure to stay hydrated by drinking water or sports drinks, such as Gatorade.
• Diet choices. Certain foods can help relieve diarrhea. And, it’s best to eat bland foods that aren’t likely to upset your stomach. Examples of these foods include bananas, rice, apples, and toast. (This combination of foods is sometimes called the BRAT diet.)
• Medications. You may find over-the-counter (OTC) drugs to be helpful for diarrhea. These drugs include loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol). But before taking any drugs, be sure to talk with your doctor or pharmacist. They can make sure it’s safe for you to take these drugs while you’re using Rituxan.

Allergic reaction

Some people may have an allergic reaction to Rituxan. Although allergic reaction wasn’t reported in studies of Rituxan, it can still happen.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Rituxan. But if you think you’re having a medical emergency, call 911 or your local emergency number.

What are some frequently asked questions about Rituxan?

Find answers to some commonly asked questions about Rituxan.

Is Rituxan chemotherapy?

No, Rituxan isn’t a chemotherapy drug. Instead, Rituxan is a type of immunotherapy drug.

Chemotherapy works by killing cells that rapidly multiply (quickly make more cells). Cancer cells generally multiply faster than healthy cells do. But, chemotherapy also affects healthy cells that rapidly multiply. This leads to many of chemotherapy’s side effects.

Immunotherapy drugs work with your immune system. Rituxan affects a certain protein on cells in your immune system. This is how the drug helps your immune system fight off cancer cells.

For certain conditions, Rituxan may be used together with chemotherapy.

If you have questions about whether chemotherapy is right for you, talk with your doctor.

Does Rituxan treat MS or lupus?

Rituxan isn’t currently approved to treat multiple sclerosis (MS) or lupus. But, the drug may be used off-label for these purposes. (Off-label means using a drug for conditions other than those it’s approved to treat.)

MS and lupus are autoimmune diseases. These conditions cause your immune system to attack your own body.

With MS, your immune system breaks down the protective layer around your spinal cord and brain. This can lead to fatigue (lack of energy) and trouble walking, concentrating, or thinking.

Lupus can cause problems with almost every organ and tissue in your body, including your:

• brain
• heart
• kidneys
• lungs
• joints
• skin

Studies have shown Rituxan is an effective treatment for MS and lupus.

If you’d like to learn more about using Rituxan for MS or lupus, talk with your doctor.

What should I expect on the day after a Rituxan infusion?

Rituxan is given as an intravenous (IV) infusion (an injection into your vein that’s given over a period of time). After you receive a Rituxan infusion, your doctor will have you watch for certain side effects.

Side effects to watch for include:

• Tumor lysis syndrome (TLS). TLS occurs when cancer cells break down in your body and release their contents into your blood. This can cause symptoms, such as diarrhea, nausea, vomiting, muscle cramps, and joint pain. If untreated, TLS can lead to more serious conditions, including seizures and abnormal heart rhythm.
• Infusion reactions.* It’s possible to have an infusion reaction after receiving a dose of Rituxan. Symptoms of infusion reaction can include low blood pressure, swelling of your lips and face, and trouble breathing. Rarely, infusion reactions from Rituxan may lead to death. Before each Rituxan infusion, your doctor may give you medications to help lessen your risk for an infusion reaction.

In studies, TLS and infusion reactions happened up to 24 hours after a Rituxan dose was given.

Tell your doctor right away if you have any of the symptoms listed above after you’ve received a Rituxan infusion. But if your symptoms feel life threatening, call 911 or your local emergency number.

* Rituxan has a boxed warning about infusion reactions. A boxed warning is a serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

How long does Rituxan stay in your body?

Rituxan may stay in your body for several months after your last dose of the drug. But, the length of time that Rituxan stays in the body will be different for each person.

If you have questions about how long Rituxan might stay in your body, talk with your doctor or pharmacist.

Is Rituxan used for ITP or myasthenia gravis?

Rituxan isn’t currently approved to treat immune thrombocytopenia (ITP) or myasthenia gravis. But Rituxan may be used off-label to treat these conditions. (Off-label means using a drug for conditions other than those it’s approved to treat.)

With ITP, your immune system attacks your platelets. (Platelets are a type of red blood cell that help your blood to clot.) And this leads to a low level of platelets in your blood. Having a low platelet level can cause you to bruise or bleed more easily than usual.

Myasthenia gravis is a condition that prevents your nerve cells from clearly communicating with your muscles. This leads to muscle weakness and trouble with activities such as talking, swallowing, chewing, and walking.

Studies have shown that Rituxan is an effective treatment for ITP and myasthenia gravis.

To learn more about using Rituxan for these conditions, talk with your doctor.

How does Rituxan work? Does it suppress your immune system?

Rituxan is a form of immunotherapy. It works by attaching to proteins on immune cells and cancer cells. The exact way Rituxan works depends on the condition you’re using the drug to treat.

For instance:

• for rheumatoid arthritis (RA) and other conditions that affect your immune system, the drug works by attaching to a certain protein on overactive immune cells
• for cancers, the drug works by attaching to a certain protein on cancer cells

Rituxan can suppress (lessen the activity of) your immune system. And this can increase your risk for infections. Serious infections are a possible side effect of Rituxan. For more information about this, see the “What are Rituxan’s side effects?” section above.

Is Rituxan used for RA?

Rituxan is used to treat rheumatoid arthritis (RA), as well as other conditions. To learn about how it’s used for RA, read on. And to learn about the other conditions it’s used for, see the “Is Rituxan used for other conditions?” section just below.

RA is an autoimmune disease. With this condition, your immune system attacks your own body. Symptoms of RA can include joint swelling, stiffness, and pain.

Rituxan is used in adults with RA that’s moderate to severe and is currently causing symptoms (also called active RA). “Moderate to severe” means the RA has affected cartilage.

Rituxan is given for RA that’s been treated in the past with a drug called a tumor necrosis factor (TNF) inhibitor. And for RA, Rituxan is used together with methotrexate (Trexall).

Rituxan is a form of immunotherapy. It works by attaching to a protein on certain immune cells that are overactive in people with RA.

Is Rituxan used for other conditions?

In addition to treating rheumatoid arthritis (RA), which is described directly above, Rituxan is also used for other conditions.

Specifically, Rituxan is also used treat:

• Chronic lymphocytic leukemia (CLL). For this use, Rituxan can be prescribed for adults. CLL is a cancer that affects a type of white blood cell called lymphocytes. CLL starts in your bone marrow and then moves into your blood. (Bone marrow is the area in your bones where blood cells are made.) Rituxan can be used for CLL that has a protein called CD20 on its cells. And the CLL can either have been treated in the past or not have been have previously treated. For this purpose, Rituxan is used together with the cancer drugs fludarabine and cyclophosphamide (Cytotoxan).
• Granulomatosis with polyangiitis (GPA). For this use, Rituxan can be prescribed for adults and children ages 2 years and older. GPA is a type of ANCA-vasculitis. (ANCA is a protein in the blood that attacks the body’s blood vessels. And vasculitis refers to damaged and swollen blood vessels.) For this purpose, Rituxan is used together with corticosteroids, such as prednisone (Rayos).
• Microscopic polyangiitis (MPA). For this use, Rituxan can be prescribed for adults and children ages 2 years and older. MPA is also a type of ANCA-vasculitis. (See the section on GPA just above for details.) For this purpose, Rituxan is used together with corticosteroids, such as prednisone (Rayos).
• Non-Hodgkin’s lymphoma (NHL). For this use, Rituxan can be prescribed for adults. NHL is a cancer that affects white blood cells. Rituxan is used for NHL that’s relapsed (come back after being treated) or refractory (hasn’t improved with other treatments). Or, the drug can be used for NHL that’s low grade (slow to spread) or hasn’t worsened after other treatments. In some cases, Rituxan may also be used in NHL that hasn’t been treated before. Rituxan may also be used for a type of NHL called follicular lymphoma. For these purposes, Rituxan may be used by itself or in combination with prednisone (Rayos) and the following cancer drugs:
  • cyclophosphamide (Cytotoxan)
  • vincristine (Marqibo)
  • doxorubicin (Doxil)
  • other drugs called anthracycline drugs
• Pemphigus vulgaris. For this use, Rituxan can be prescribed for adults. Pemphigus vulgaris is a condition that causes pain blisters on your skin or in your mouth. Rituxan is used when this condition is moderate to severe.

Rituxan is a form of immunotherapy. When it’s used to treat:

• cancer, it attaches to certain proteins on cancer cells. Then, your immune system can fight off the cancer cells.
• other conditions that affect your immune system, it works by attaching to a protein on certain overactive immune cells.

How is Rituxan given?

Your doctor will explain how Rituxan will be given to you. They’ll also explain how much you’ll be given and how often. Be sure to follow your doctor’s instructions.

Below are commonly used dosages. But your doctor will prescribe the dosage that’s best for treating your condition.

Receiving Rituxan

Rituxan comes as a solution that’s given as an intravenous (IV) infusion. For an IV infusion, a healthcare professional will inject Rituxan into your vein over a period of time.

You’ll receive Rituxan infusions in a clinic, doctor’s office, or hospital.

Preparing for Rituxan infusions

For your first dose of Rituxan, you should plan to spend most of the day at the location where you’ll receive the dose. This is because your first dose of Rituxan will have an infusion time of 4 to 6 hours. Each dose after that will have an infusion time of 3 to 4 hours.

To help pass the time during your infusion, take a book, music, or other activity. Ask your doctor if you can bring a snack with you. You can also bring a sweater or jacket to help you stay comfortable in case the infusion room is cool.

Dosage

Your prescribed dosage of Rituxan depends on:

• the condition you’re using the drug to treat
• your height and weight
• any other medications you’re currently taking or have tried in the past

The usual dosages for each condition Rituxan is used to treat are as follows:

• For rheumatoid arthritis (RA), you’ll receive an infusion once every 2 weeks for the first two doses. After that, you’ll get one infusion every 24 weeks. If you’re still having RA symptoms, your doctor may lessen the amount of time between your infusions.
• For chronic lymphocytic leukemia (CLL), you’ll receive an infusion the day before you start your first cycle of chemotherapy. (See the “Receiving Rituxan with other drugs” section just below for more information.) Your next Rituxan infusion will be given on the first day of your second cycle of chemotherapy. You’ll keep receiving Rituxan infusions on the first day of chemotherapy cycles 3 through 6.
• For granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), you’ll receive four starter doses of Rituxan, with one infusion given weekly for 4 weeks. Then, 14 to 16 weeks later, you’ll get two follow-up doses. Each follow-up dose is given 2 weeks apart. After that, you’ll receive one Rituxan infusion every 6 months.
• For non-Hodgkin’s lymphoma (NHL), you may receive one infusion of Rituxan weekly or monthly. Or, you may be given Rituxan infusions on the first day of your chemotherapy cycle.
• For pemphigus vulgaris, you’ll receive one infusion every 2 weeks for the first two doses. After that, you’ll get one infusion 12 months later. Then, a fourth infusion will be given 6 months after that. You may receive more doses of Rituxan if your condition comes back between doses.

To learn more about these conditions and how Rituxan is used for them, see the “Is Rituxan used for RA?” and “Is Rituxan used for other conditions?” sections above.

Receiving Rituxan with other drugs

Before each Rituxan infusion, your doctor may give medications to you to help lessen your risk for an infusion reaction. (For information about infusion reactions, see the “What are Rituxan’s side effects?” section above.)

For this purpose, your doctor may prescribe antihistamines, such as:

• diphenhydramine (Benadryl)
• acetaminophen (Tylenol)

While you’re using Rituxan, your doctor may also prescribe drugs that help prevent certain infections. Examples of these infections include pneumonia and herpes.

Using other drugs with Rituxan will also depend on the condition you’re treating. For example:

• if you have RA, you’ll use Rituxan together with methotrexate (Trexall).
• If you have cancer, you might take Rituxan with corticosteroids or other cancer drugs. Examples of corticosteroids include prednisone (Rayos) and methylprednisolone (Medrol). Examples of other cancer drugs include:
  • cyclophosphamide (Cytotoxan)
  • doxorubicin (Doxil)
  • fludarabine
  • vincristine (Marqibo)

Questions about receiving Rituxan

Here are answers to some questions related to receiving Rituxan.

• What if I miss a dose of Rituxan? If you miss an appointment to get your Rituxan infusion, call your doctor’s office right away to reschedule. And check with your doctor about whether a missed dose will affect your usual dosing schedule.
• Will I need to use Rituxan long term? The length of time you’ll use Rituxan depends on the condition you’re using the drug to treat. In some cases, you may only receive up to 16 doses of the drug. Talk with your doctor about the length of time you should expect to use Rituxan.
• How long does Rituxan take to work? Rituxan begins working right away after your first dose is given. But, for conditions such as cancer, you may not notice the drug working in your body. Your doctor will monitor you periodically to make sure it’s working. Talk with your doctor about how they’ll monitor your condition during Rituxan treatment.

Questions for your doctor

You may have questions about Rituxan and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

• Before your appointment, write down questions like:
  • How will Rituxan affect my body, mood, or lifestyle?
• Bring someone with you to your appointment if doing so will help you feel more comfortable.
• If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

What does Rituxan cost?

Costs of prescription drugs can vary depending on many factors, such as what your insurance plan covers. The cost of Rituxan treatment also include fees to receive doses of the drug at a clinic, doctor’s office, or hospital.

To find current prices for Rituxan in your area, visit WellRx.com.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Rituxan manufacturer’s website to see if they have support options.

What should I know about Rituxan vs. Truxima?

Both Rituxan and Truxima contain the drug rituximab, which is a biologic medication. A biologic drug is made from parts of living organisms.

Truxima is a biosimilar form of Rituxan. Biosimilars are like generic drugs. But unlike generics, which are made for non-biologic drugs, biosimilars are made for biologic drugs.

Both Rituxan and Truxima are used to treat certain cancers and other conditions affecting the immune system. If you have these conditions, you may want to know more about how Rituxan and Truxima are alike and different.

To learn more about the differences and similarities of these two drugs, see this detailed breakdown. And be sure to talk with your doctor about which drug is right for your condition.

What should I know about Rituxan vs. Ocrevus?

Rituxan and Ocrevus are both used to treat certain conditions that affect your immune system.

Both medications are given by healthcare professionals as an intravenous (IV) infusion. (With an IV infusion, the drug is given as an injection into your vein over a period of time.)

Rituxan contains the active drug rituximab, but Ocrevus contains the active drug ocrelizumab.

If you’d like to know more about how Rituxan and Ocrevus compare with each other, check out this drug article. And talk with your doctor about which drug they recommend for you.

What should I know about Rituxan vs. bendamustine?

Rituxan and bendamustine are both used to treat certain cancers.

Rituxan contains the drug rituximab, while bendamustine is an active drug that comes as the brand-name medication Treanda.

Rituximab is a type of immunotherapy, while bendamustine is a chemotherapy drug. For more information about chemotherapy versus immunotherapy, see the “What are some frequently asked questions about Rituxan?” section above.)

Both Rituxan and Treanda are given by healthcare professionals as an intravenous (IV) infusion. (With an IV infusion, the drug is given as an injection into your vein over a period of time.)

For more information, take a look at this side-by-side comparison of Rituxan and Treanda. Also, let your doctor know if you have any questions about these two drugs.

What should I know about Rituxan vs. Rituxan Hycela?

Rituxan and Rituxan Hycela are each used to treat certain cancers.

Both medications are given as injections by a healthcare professional. Rituxan is given as an intravenous (IV) infusion (an injection that’s given into a vein over a period of time). Rituxan Hycela, on the other hand, is given as a subcutaneous injection (an injection that’s given under your skin).

Rituxan and Rituxan Hycela both contain the drug rituximab. But, Rituxan Hycela contains rituximab together with another drug called hyaluronidase. This additional drug allows rituximab to be given under your skin instead of into your vein.

To read more about these two drugs, check out this comparison. And ask your doctor which drug is best for you.

What should be considered before taking Rituxan?

Before taking Rituxan, talk with your doctor about your health history and other medical conditions you have. A few other important considerations are described below.

Interactions

Taking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.

Before taking Rituxan, be sure to tell your doctor about all medications you take (including prescription and over-the-counter types). Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Rituxan.

Interactions with drugs or supplements

The manufacturer of Rituxan didn’t look at drug interactions in studies of their medication. But, Rituxan is known to interact with the chemotherapy drug cisplatin.

It’s not known if other drugs interact with Rituxan.

Your doctor or pharmacist can tell you more about the interaction with cisplatin and any other possible interactions with Rituxan.

Other interactions

You should avoid getting any live vaccines while you’re using Rituxan.

Live vaccines contain a mild version of viruses or bacteria that cause the infections the vaccine protects you from. Live vaccines are different from inactivated vaccines, which contain an inactive (dead) form of bacteria or viruses.

Live vaccines generally don’t cause an infection in a person with a healthy immune system. But, Rituxan can weaken the ability of your immune system to fight off infections. As a result, you may have a higher risk for infection from a live vaccine while you’re using Rituxan.

Examples of live vaccines include:

• shingles
• chickenpox
• yellow fever
• measles, mumps, and rubella (MMR)

Talk with your doctor or pharmacist before you get any vaccines while you’re using Rituxan.

Boxed warnings

Rituxan has boxed warnings. These are serious warnings from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Rituxan’s boxed warnings include:

• Infusion reactions. You may have infusion reactions during or after you receive a dose of Rituxan. Rarely, infusion reactions from Rituxan may lead to death. Symptoms of infusion reactions can include low blood pressure, swelling of your lips and face, and trouble breathing.
• Severe skin and mouth reactions. Rarely, you may have severe reactions on your skin or in your mouth after using Rituxan. In some cases, these may be life threatening. Symptoms of skin and mouth reactions include skin peeling, pustules (fluid-filled sacs on the skin), blisters, and other painful sores.
• Progressive multifocal leukoencephalopathy (PML). Using Rituxan may cause PML. PML is a rare but serious infection that affects the central nervous system and brain. In some cases, PML can be fatal. Symptoms of PML include changes in vision, weakness, and trouble balancing or using your arms or legs.
• Reactivation of hepatitis B virus (HBV). Rituxan may cause reactivation of hepatitis B virus in people who’ve had hepatitis B in the past. Hepatitis B can lead to serious liver problems, such as liver failure. And in rare cases, it can also lead to death. Symptoms of hepatitis B include tiredness and jaundice (yellowing of the whites of your eyes or your skin).

For more information about these warnings, see the “What are Rituxan’s side effects?” section above.

Other warnings

Rituxan may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Rituxan. Factors to consider include those in the list below.

• Kidney problems. For some people who use Rituxan, the drug can cause kidney problems, such as kidney failure. If you have kidney problems before starting Rituxan, you may have a higher risk for this side effect. Talk with your doctor about any kidney problems you have before using this drug. They may recommend a treatment other than Rituxan for your condition.
• Lung problems. Since it was approved, Rituxan has very rarely been related to lung damage that may lead to death. Before taking Rituxan, be sure to tell your doctor if you have lung problems or lung disease or have had either of these in the past. Your doctor can recommend appropriate treatment options for your condition.
• Heart problems. Using Rituxan can lead to heart problems, such as heart attack and ventricular fibrillation (a type of abnormal heart rhythm). If you already have heart problems before taking Rituxan, you may have a higher risk for these side effects. Before starting Rituxan, tell your doctor about any heart problems you have. They’ll recommend if Rituxan is the right drug to treat your condition.
• Infections or a suppressed immune system. Make sure your doctor knows about any infections you have before you start using Rituxan. And make sure to tell your doctor if you have any conditions that suppress (lessen the activity of) your immune system. Rituxan can increase your risk for serious infections. Your risk for this side effect may be even higher if you already have either of these conditions.
• Allergic reaction. If you’ve had an allergic reaction to Rituxan or any of its ingredients, you shouldn’t take Rituxan. Ask your doctor what other medications are better options for you.

Use with alcohol

There aren’t any known interactions between Rituxan and alcohol.

If you drink alcohol, talk with your doctor about the amount that’s safe for you to drink while using Rituxan.

Pregnancy and breastfeeding

You shouldn’t use Rituxan during pregnancy or while breastfeeding.

Your doctor may recommend that you use birth control during treatment with this drug. And you shouldn’t breastfeed for at least 6 months after your last Rituxan dose.

To learn more about the effects of Rituxan when used while pregnant or breastfeeding, talk with your doctor.

What to ask your doctor

Talk with your doctor or pharmacist about using Rituxan. They can tell you more about this drug and other treatments that may be used for your condition.

Here’s a list of articles that may be helpful for learning about other treatment options:

• Current and Breakthrough Treatments for CLL
• Lymphoma Drugs
• Rheumatoid Arthritis Medication List

Some questions to ask your doctor about Rituxan include:

• Does Rituxan cause weight loss?
• What will my Rituxan treatment schedule be?
• How soon will Rituxan start working for me?
• What should I do if I have side effects from Rituxan?