Pharmacy - Rituximab

Why have I been prescribed rituximab?

Rituximab is a medication that can be used to manage auto immune conditions. It is used in several specialities including renal, dermatology, rheumatology and neurology.

The clinical team that prescribes this medicine for you will tell you about your condition and why rituximab is being prescribed.

How does it work?

Rituximab belongs to a group of medicines known as immunosuppressants. It helps to reduce or suppress your body’s own immune system. Your immune system works to protect you against infections, however, sometimes it can overreact or react abnormally and cause illness. Rituximab can be used to treat these conditions, often in combination with other medicines.

B cells are a type of white blood cell and part of your immune system. Rituximab works by removing B cells. Once you have received a course of rituximab it can take several months for the B cells to start repopulating. We will monitor the level of B cells in your blood.

Rituximab works slowly and may take several weeks to take effect.

How do I take rituximab?

Rituximab is given as an infusion into the veins. You will need to attend the Day Case Unit at Salford Royal Hospital to receive it.

The usual initial schedule is 1g given on day 1 and then 1g given on day 15. The infusion will take several hours to be given. We may give you a ‘top up’ dose 6-8 months after your initial dose.

Rituximab has the potential to cause reactivation of Hepatitis B. Prior to giving you the infusion we will check your Hepatitis B status.

Can rituximab cause side effects?

For most people, rituximab is safe and well-tolerated, and they have very few side effects. Over half a million patients worldwide have received rituximab and serious side effects are very rare.

Side effects can begin during the first dose of the drug and may continue for a few hours afterwards but are usually milder with further doses. We will give you some medicines before starting the infusion to help minimise the risk of you experiencing a reaction whilst receiving rituximab.

Reactions you may experience during the infusion may include:

• Nausea
• Itching
• Fever
• Headache
• Low blood pressure – you may be advised to not take your blood pressure medicines on the day of your infusion
• Allergic reactions, skin rashes and breathlessness (let the nurse or doctor know immediately if you experience any of these)

The infusion rate is increased gradually, if you begin to feel unwell inform the nurse immediately - they will reduce the rate to the previous level at which you felt comfortable.

After receiving the infusion there is a risk of infection. You should seek medical attention if you have any of the following:

• Sore throat
• Fever
• Feeling generally unwell
• Unexpected bruising or bleeding

You should inform to the team if you develop chickenpox or shingles or come into contact with someone who has developed these illnesses.

Rituximab may worsen heart problems for people who have significant heart disease. You may be required to have an ECG prior to receiving the infusion

Some common side effects to rituximab include the following:

• Headache
• Fever
• Night sweats
• Vomiting
• Low mood
• Constipation
• Cough

Very rarely, rituximab can cause a serious brain infection, Progressive Multifocal Leukoencephalopathy (PML). This can be fatal. Signs of PML include confusion, loss of balance, muscle weakness or blurred vision. Another rare but serious side effect is the appearance of blisters on your mucus membranes in your nose, mouth or around your genital area. If you experience any of these symptoms you must go to A&E immediately.

Does rituximab interfere with my other medicines?

Rituximab can interact with other medicines. You should tell your doctor which medicines you are taking before starting rituximab.

The effects of rituximab on the immune system can last for up to a year, ensure you tell any healthcare professionals you have received rituximab before you commence any new treatment or medication, even if your last dose was several months ago.

Your regular prescription medicines will be checked against rituximab, and any changes will be made if needed. If you buy any medication from the chemist such as 'over the counter' or herbal medicines, for example, you must talk to your pharmacist before taking them, as some medicines can affect how rituximab works.

• Always check with your doctor or pharmacist first before starting any new medication
• You should avoid ‘live’ vaccines but most travel vaccines and the ’flu jab are ok. Ideally vaccines should be given at least 2 weeks before receiving rituximab treatment
• We strongly recommend receiving flu, COVID and pneumococcal vaccines when offered. If receiving these after your infusion, please note they may not be as effective due to reduced immune response
• It is safe to drink alcohol in moderation while taking rituximab. Follow recommended guidelines

Can I have a family and breast feed while I’m receiving rituximab?

It is not known if rituximab harms an unborn baby. The recommendation is to wait for 12 months after receiving rituximab before conceiving and we recommend using effective contraception for this time. Please speak to the team if you are planning to try for a baby.

Breastfeeding should be avoided for 6 months after receiving rituximab.

It is considered safe for men to continue taking rituximab while trying to father a baby.

Tips to reduce your risk of infection

• Try to avoid close contact with people you know have an infection
• Wash your hands regularly and carry around a small bottle of antibacterial hand gel
• Keep your mouth clean by brushing your teeth regularly
• Stop smoking if you’re a smoker
• Make sure your food is stored and prepared properly
• Try to keep your house clean and hygienic, especially the kitchen, bathrooms and toilets

Contact details

Renal Outpatients - 0161 206 1478
Brooke Treatment Unit (BTU) - 0161 206 4884
Programmed Investigation Unit (PIU) - 01706 57488