Rituxan (Rituximab): Uses in Cancer, Side Effects, Dosages, Expectations, and More

Side Effects in Non-Hodgkin’s Lymphoma Patients

Rituxan, while an effective treatment for NHL, comes with potential side effects that patients and healthcare providers should be aware of. In NHL patients, common side effects include infusion-related reactions such as fever, chills, nausea, and difficulty breathing, particularly during the initial infusion. Rituxan may also cause a decrease in blood cell counts, including white blood cells, red blood cells, or platelets, increasing the risk of infections, fatigue, and bleeding. Furthermore, patients are more susceptible to serious infections like pneumonia, and fatigue can significantly impact daily activities.

Side Effects in Chronic Lymphocytic Leukemia Patients

For CLL patients, infusion-related reactions mirror those in NHL, with similar symptoms of fever, chills, and difficulty breathing. Additionally, Rituxan may lead to neutropenia, a condition characterized by low white blood cell counts, which increases the risk of infections. Tumor Lysis Syndrome (TLS) is another serious side effect seen in some CLL patients, resulting from the rapid breakdown of cancer cells, which can cause kidney complications. Low immunoglobulin levels, or hypogammaglobulinemia, can also occur, leaving patients more vulnerable to infections.

Managing Long-Term Side Effects

To manage long-term side effects, regular blood tests are crucial to monitor blood cell counts and immune function. Infection prevention strategies, including vaccinations and maintaining good hygiene, are essential to reduce the risk of serious infections. Supportive medications, such as pre-infusion treatments, can help minimize infusion-related reactions, while CLL patients at risk for TLS may need hydration and medication. Additionally, managing fatigue through rest, physical therapy, and pacing daily activities can help improve patients’ quality of life throughout treatment.

Rituxan Dosage and Administration

Rituximab (Rituxan) is administered as an intravenous (IV) infusion by a healthcare professional in a controlled medical setting. Before each infusion, patients are premedicated with an antihistamine and acetaminophen to reduce the risk of infusion-related reactions. For rheumatoid arthritis (RA), Rituxan is given as two 1000 mg IV infusions spaced two weeks apart, with glucocorticoids administered 30 minutes prior. In chronic lymphocytic leukemia (CLL), Rituxan is given at 375 mg/m² in the first cycle, followed by 500 mg/m² in subsequent cycles, in combination with chemotherapy. For non-Hodgkin’s lymphoma (NHL), Rituxan is commonly used with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone), where it is administered at 375 mg/m² per cycle.

The infusion begins at a low rate of 50 mg/hour and is gradually increased every 30 minutes to a maximum of 400 mg/hour if no adverse reactions occur. The total volume of the infusion bag is infused using standard IV setups, and Rituxan should never be given as an IV push or bolus. Following induction therapy, maintenance infusions may be administered every six months or as clinically indicated. Healthcare providers must be prepared to manage potential infusion-related reactions, which can be serious or even fatal, necessitating immediate medical intervention.

What to Expect During Rituxan Treatment?

Starting Rituxan treatment can feel overwhelming, but understanding the process can help alleviate anxiety and ensure you’re well-prepared. Here’s a guide on what to expect during your Rituxan treatment, including pre-infusion preparations, the infusion procedure, and post-treatment monitoring.

The Initial Phase of Treatment

The initial phase of Rituxan treatment is critical for establishing the body’s response. Before starting, thorough evaluations, including blood tests, imaging, and possibly genetic testing, help tailor the treatment plan. To reduce infusion-related reactions, pre-treatment medications like antihistamines, corticosteroids, or fever reducers are often given. Rituxan is administered intravenously, with the first infusion typically lasting 3–4 hours to allow close monitoring of vital signs, such as heart rate and blood pressure. Mild reactions like fever or chills may occur, but the healthcare team manages symptoms and may adjust the infusion rate. Future infusions can often be given more quickly as the body adapts.

Routine Monitoring During Rituxan Therapy

Ongoing monitoring ensures Rituxan’s effectiveness and minimizes side effects. Regular blood tests check immune response, blood cell counts, liver function, and infection signs. Physical exams track progress, while imaging studies (e.g., CT or MRI) assess tumor reduction and cancer control. Due to immune suppression, patients are monitored for infections, with precautions like avoiding crowds or taking preventive measures. Long-term monitoring addresses risks of serious side effects, such as PML or hepatitis B reactivation, ensuring safety during treatment.

Tips for Maintaining a Healthy Lifestyle During Rituxan Treatment

While undergoing Rituxan treatment, maintaining a healthy lifestyle can help you manage side effects and improve your overall well-being.

Stay Hydrated

Drink plenty of fluids to stay hydrated, as this can help flush out toxins, prevent dehydration, and support your body’s overall health. Herbal teas, infused water, and electrolyte-rich drinks can be great alternatives to plain water, keeping you refreshed and energized throughout the day.

Eat a Balanced Diet

A nutritious diet can help support your immune system and energy levels. Include plenty of fruits, vegetables, whole grains, and lean proteins in your meals. Nutrient-dense foods not only strengthen your body but also help in managing treatment-related side effects like nausea and fatigue.

Exercise Regularly

Depending on how you feel, regular physical activity can improve circulation, reduce fatigue, and boost your mood. Talk to your doctor about an appropriate exercise plan. Even gentle activities like stretching, yoga, or short walks can enhance your overall well-being and keep your muscles and joints flexible.

Manage Stress

Stress can affect your overall health, so it’s important to incorporate stress-reducing activities such as yoga, meditation, or deep breathing exercises. Prioritize activities that promote relaxation and mental well-being. Listening to calming music, engaging in hobbies, or spending time in nature can also help ease stress and improve your mood.

Get Adequate Sleep

Rest is essential for your body to recover and cope with treatment. Aim for 7-9 hours of sleep each night to allow your immune system to function optimally. Establishing a bedtime routine, limiting screen time before bed, and creating a comfortable sleep environment can improve sleep quality and help you wake up feeling refreshed.

Prevent Infections

Rituxan can lower your immune function, so it’s vital to take extra precautions to avoid infections. Wash your hands regularly, avoid people who are sick, and keep up with vaccinations as advised by your healthcare provider. Staying mindful of hygiene, avoiding crowded places, and keeping your living space clean can further reduce your risk of illness.

Stay Connected

Keep in touch with your healthcare team and report any unusual symptoms or concerns promptly. Maintaining open communication is key to managing any side effects or complications that arise during treatment. Surround yourself with supportive friends, family, or a patient support group to stay emotionally strong and motivated throughout your journey.

What to Avoid During Rituxan Treatment?

While undergoing Rituxan treatment, it’s essential to be mindful of certain precautions that can help minimize side effects, avoid complications, and support the effectiveness of the therapy.

Avoid live vaccines

Rituxan suppresses the immune system, which makes it more difficult for your body to respond to live vaccines. You should avoid getting live vaccines during and for several months after your treatment. Examples include the MMR (measles, mumps, rubella) vaccine and the yellow fever vaccine

Consult your doctor before taking new medications

Inform your healthcare provider about any over-the-counter drugs, herbal supplements, or prescription medications you are considering. Some drugs may interact with Rituxan and lead to unwanted side effects, especially those that affect immune function or blood clotting.

Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) 

These medications, such as ibuprofen or aspirin, may increase the risk of bleeding and could interfere with Rituxan’s action. Always consult your doctor before taking these drugs.

Foods to Avoid

While there are no specific food restrictions during Rituxan treatment, it’s important to be cautious about certain dietary choices to reduce the risk of infections and support your treatment.

Raw or undercooked food

Avoid eating raw or undercooked meats, seafood, and eggs, as they may contain harmful bacteria or parasites that could be more dangerous while your immune system is suppressed.

Foods that can cause digestive issues

If you experience nausea or digestive upset due to Rituxan, try to avoid fatty, spicy, or greasy foods, which may worsen gastrointestinal symptoms.

Alcohol

It’s best to limit alcohol consumption during Rituxan treatment, as it can increase the risk of side effects such as liver damage, dehydration, and fatigue. Alcohol can also interfere with the medications you may need to take to manage side effects.

 Avoid High-Stress Activities

Rituxan can cause fatigue and affect your immune system, making you more susceptible to infections.

Intense physical activity

High-stress or intense physical activities, such as heavy workouts or strenuous sports, can further deplete your energy levels and weaken your immune system. Instead, opt for light activities like walking or gentle yoga.

Stressful environments

Managing stress is crucial, as high levels of stress can affect your immune function and overall well-being. Try to avoid emotionally or physically taxing situations. Consider engaging in relaxation techniques like deep breathing, meditation, or mindfulness to help keep stress levels under control.

Rituxan’s Effectiveness Over Time

Rituxan (rituximab) has demonstrated significant long-term effectiveness in treating various B-cell malignancies. The effectiveness of Rituxan can be influenced by patient-specific factors, including age, disease stage, and overall health. Adherence to the prescribed treatment regimen is crucial; patients who consistently follow their treatment plan tend to experience better outcomes. Regular monitoring and communication with healthcare providers are essential to manage potential side effects and to ensure the optimal long-term benefits of Rituxan therapy.

Rituxan’s Cost and Accessibility

In the United States, the price of Rituxan can range from approximately $5,000 to $7,000 per infusion, depending on the dosage and treatment schedule. For a full treatment cycle, which may involve multiple infusions, the total cost can range between $20,000 and $30,000. 

In many countries with public health systems, Rituxan may be covered by national health insurance or may have access to lower-cost alternatives, though availability and access may vary.

In Armenia, Rituximab is registered as a prescription medicine. It’s important to note that other immunotherapy agents are not officially registered in Armenia, which may limit treatment options for patients requiring alternative therapies.

Biosimilars and Alternatives to Rituxan

The introduction of biosimilars has provided more affordable alternatives to Rituxan. Biosimilars such as Truxima, Ruxience, and Riabni are available in the U.S. market and have been shown to be clinically equivalent to Rituxan. Switching between Rituxan and its biosimilars has not been associated with an increased risk of adverse events.

Written by Sergey Badalyan