Select a medication above to begin.
Truxima (rituximab-abbs)
rituximab
Black Box Warnings .
Infusion Reactions
serious, including fatal infusion reactions can occur; deaths reported within 24h of infusion; approximately 80% fatal infusion reactions occur with 1st infusion; monitor patients closely; D/C tx and treat severe infusion reactions
Severe Mucocutaneous Reactions
can occur, including fatal reactions
HBV Reactivation
can occur, including cases resulting in fulminant hepatitis, hepatic failure, and death; screen all patients for HBV infection before initial tx; monitor for signs/symptoms of HBV reactivation during tx and after D/C; D/C rituximab and concomitant drugs if HBV reactivation occurs
Progressive Multifocal Leukoencephalopathy
can occur, including fatal PML
Adult Dosing .
Dosage forms: INJ
Special Note
- [drug name clarification]
- Info: nonproprietary name = rituximab-abbs
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing including toxicity-related dose adjustments
CD20-positive B-Cell non-Hodgkin lymphoma, relapsed or refractory
- [monotherapy]
- Dose: 375 mg/m^2/dose IV qwk x4wk or x8wk; Info: for patients with low-grade or follicular disease; may give additional 4wk tx in patients who progress after initial tx; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [ibritumomab tiuxetan combo tx]
- Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for patients with low-grade or follicular disease; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
CD20-positive B-Cell non-Hodgkin lymphoma, previously untreated
- [follicular type, chemo combo tx]
- Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Info: give up to 8 cycles; if complete or partial response achieved, may give maintenance monotherapy 375 mg/m^2/dose IV x1 on day 1 of 56-day cycle x12 cycles starting 56 days after completion of 1st-line combo chemo; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [follicular type, ibritumomab tiuxetan combo tx]
- Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for patients with complete or partial response after completion of 1st-line combo chemo; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [diffuse large B-cell type, chemo combo tx]
- Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Info: give up to 8 cycles; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
CD20-positive B-Cell non-Hodgkin lymphoma, non-progressing
- [375 mg/m^2/dose IV x1 on days 1, 8, 15, 22 of 6-mo cycle]
- Start: after completion of 1st-line combo chemo; Info: for patients with low-grade disease; give up to 16 doses (4 cycles); give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
CD20-positive CLL/SLL
- [500 mg/m^2/dose IV x1 on day 1 of 28-day cycle, starting cycle 2]
- Start: 375 mg/m^2/dose IV x1 on the day before cycle 1; Info: give x6 cycles; part of multi-drug chemo regimen; give HSV and PCP prophylaxis during tx and up to 12mo after D/C; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
rheumatoid arthritis, moderate-severe
- [1000 mg IV q2wk x2 doses]
- Info: for patients with inadequate response to TNF antagonist; may repeat course q16-24wk; use with methotrexate; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
granulomatosis with polyangiitis (GPA)
- [induction tx]
- Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use with glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
- [subsequent tx]
- Dose: 500 mg IV q2wk x2 doses, then 500 mg IV q6mo; Start: 16-24wk after last induction tx with rituximab, or within 4wk of disease control achieved with other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
microscopic polyangiitis (MPA)
- [induction tx]
- Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use with glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
- [subsequent tx]
- Dose: 500 mg IV q2wk x2 doses, then 500 mg IV q6mo; Start: 16-24wk after last induction tx with rituximab, or within 4wk of disease control achieved with other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
pemphigus vulgaris, moderate-severe
- [500 mg IV q6mo]
- Start: 1000 mg IV q2wk x2 doses, then starting at mo 12, give 500 mg IV q6mo; Info: use with glucocorticoids; may give additional 1000 mg IV x1 if relapse; maintenance and relapse doses should be dosed at least 16wk apart; consider PCP prophylaxis; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
myasthenia gravis (off-label)
- [375 mg/m^2/dose IV qwk x4wk]
- Alt: 1000 mg IV q2wk x2 doses; Info: may repeat course or give maintenance doses q1-6mo
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [drug name clarification]
- Info: nonproprietary name = rituximab-abbs
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing including toxicity-related dose adjustments
CD20-positive B-Cell non-Hodgkin lymphoma (off-label)
- [previously untreated, 6 mo and older]
- Dose: 375 mg/m^2/dose IV on days -2 and 1 during induction tx x2 cycles, then 375 mg/m^2/dose IV on day 1 during consolidation tx x2 cycles (total of 6 doses); Info: for patients with advanced stage, diffuse large B-cell lymphoma, Burkitt lymphoma, Burkitt-like lymphoma, or mature B-cell acute leukemia; part of multi-drug chemo regimen (Lymphome Malin B); give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [retreatment, 2 yo and older]
- Dose: 375 mg/m^2/dose IV qwk x4wk, may repeat q6mo x2y; Info: give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [relapsed or refractory, 2 yo and older]
- Dose: 375 mg/m^2/dose IV x1 on day 1 of each cycle; Start: 375 mg/m^2/dose IV x1, give 48h before cycle 1; Info: give x3 cycles (4 doses); part of multi-drug chemo regimen; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
- [ibritumomab tiuxetan combo tx, 2 yo and older]
- Dose: 250 mg/m^2/dose IV x1 on day 1, then on days 7, 8, or 9 of regimen; Info: for patients with relapsed or refractory low-grade, follicular or transformed disease; give HBV prophylaxis before tx start, during tx, and for up to 12mo after D/C in anti-HBc positive patients
B-cell precursor ALL, relapsed or refractory (off-label)
- [2 yo and older]
- Dose: 375 mg/m^2/dose IV on days 1 and 3 of cycles 1 and 2, and on day 3 only of cycle 3; Info: give up to 3 cycles; part of multi-drug chemo regimen
granulomatosis with polyangiitis (GPA) (off-label)
- [induction tx, 2 yo and older]
- Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use with glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
- [subsequent tx, 2 yo and older]
- Dose: 250 mg IV q2wk x2 doses, then 250 mg IV q6mo; Start: 16-24wk after last induction tx with rituximab, or within 4wk of disease control achieved with other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
microscopic polyangiitis (MPA) (off-label)
- [induction tx, 2 yo and older]
- Dose: 375 mg/m^2/dose IV qwk x4wk; Info: use with glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
- [subsequent tx, 2 yo and older]
- Dose: 250 mg IV q2wk x2 doses, then 250 mg IV q6mo; Start: 16-24wk after last induction tx with rituximab, or within 4wk of disease control achieved with other standard of care immunosuppressants; Info: give PCP prophylaxis during tx and for at least 6mo after D/C; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
pemphigus vulgaris, moderate-severe (off-label)
- [9 yo and older]
- Dose: 500 mg IV q2wk x2 doses; Alt: 375 mg/m^2/dose IV q2wk x2 doses; Info: consider PCP prophylaxis; give HBV prophylaxis before tx start, during tx, and for at least 12mo after D/C in anti-HBc positive patients
autoimmune hemolytic anemia, refractory (off-label)
- [4 mo and older]
- Dose: 375 mg/m^2/dose IV qwk x2-4wk
chronic immune thrombocytopenia (off-label)
- [3 mo and older]
- Dose: 375 mg/m^2/dose IV qwk x4wk
post-transplant lymphoproliferative disorder (off-label)
- [11 mo and older]
- Dose: 375 mg/m^2/dose IV qwk x3-4wk
SLE, refractory (off-label)
- [8 yo and older]
- Dose: 375 mg/m^2/dose IV qwk x2-4wk; Alt: 750 mg/m^2/dose IV x1 on day 1 and 15 of regimen; Max: 1000 mg/dose
nephrotic syndrome, refractory (off-label)
- [11 mo and older]
- Dose: 375 mg/m^2/dose IV qwk x1-4wk; Max: 500 mg/dose
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to murine protein
- infection, active severe
- avoid: breastfeeding during tx and x6mo after D/C
- caution: patients of childbearing potential
- caution: elderly patients
- caution: infection, latent
- caution: infection, chronic
- caution: HBV carriers
- caution: cardiovascular disease
- caution: cardiovascular disease history
- caution: angina
- caution: angina history
- caution: arrhythmia history
- caution: pulmonary disease
- caution: tumor burden, high
Drug Interactions .
Overview
rituximab
CD20 antigen inhibitor
- hyperuricemic effects
- immunomodulatory effects
- myelosuppressive effects
- myelosuppressive oncologic agent
- nephrotoxicity
Contraindicated
Avoid/Use Alternative
Monitor/Modify Tx
Caution Advised
Adverse Reactions .
Serious Reactions
- infusion reaction, severe
- tumor lysis syndrome
- hypersensitivity reaction, severe
- anaphylaxis
- mucocutaneous reaction, severe
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- pyoderma gangrenosum
- lymphopenia
- hypogammaglobulinemia, including prolonged
- neutropenia, including prolonged
- pancytopenia, including prolonged
- infection, serious
- sepsis
- PML
- HBV reactivation
- hepatitis, fulminant
- hepatic failure
- pulmonary toxicity
- cardiotoxicity
- ventricular fibrillation
- nephrotoxicity
- GI obstruction
- GI perforation
- posterior reversible encephalopathy syndrome
Common Reactions
- fever
- lymphopenia
- febrile neutropenia
- nausea
- rigors
- stomatitis
- asthenia
- infection
- headache
- arthralgia
- HTN
- rash
- abdominal pain
- leukopenia
- cough
- rhinitis
- night sweats
- diarrhea
- pruritus
- neutropenia
- URI
- anemia
- peripheral edema
- ALT or AST incr.
- pain
- thrombocytopenia
- dizziness
- urticaria
- angioedema
- enteritis
- infusion reaction
- hypotension
- myalgia
- vomiting
- dyspnea
- hyperglycemia
- sepsis
- anxiety
- bronchospasm
- hypokalemia
Safety/Monitoring .
Monitoring Parameters
Non-Hodgkin Lymphoma or CLL/SLL: HBV screening, pregnancy test at baseline; CBC with diff prior to each cycle if monotherapy or q1-4wk if combo tx; BUN/Cr; signs/symptoms of infusion reaction especially during 1st infusion; ECG during infusion and immediate post-infusion if cardiac conditions or history including arrhythmias and angina; HBV DNA at baseline, qmo during tx, then q3mo x18-24mo after D/C if current or prior HBV infection; signs/symptoms of hepatitis or HBV reactivation during tx and x18-24mo after D/C if current or prior HBV infection
RA or GPA or MPA or PV: HBV screening, pregnancy test at baseline; CBC with diff at baseline, then q2-4mo; BUN/Cr; signs/symptoms of infusion reaction especially during 1st infusion; ECG during infusion and immediate post-infusion if cardiac conditions or history including arrhythmias and angina; ALT, HBV DNA at baseline if current or prior HBV infection; ALT, HBsAg, HBV DNA q3mo during tx and x18-24mo after D/C if current or prior HBV infection; signs/symptoms of hepatitis or HBV reactivation during tx and x18-24mo after D/C if current or prior HBV infection
Look/Sound-Alike Drug Names
riTUXimab confused with: inFLIXimab
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no known risk of teratogenicity, though risk of transient B-cell depletion based on limited human data and on animal data
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and x12mo after D/C in patients of childbearing potential
Lactation
Clinical Summary
avoid breastfeeding during tx and x6mo after D/C; inadequate human data available to assess risk of infant harm; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for rituximab: other; CYP450: unknown
Excretion: for rituximab: other; Half-life: 18-32 days
Subclass: DMARDs, B-cell Depletion Agents ; Immunotherapy, CD20 Inhibitors ; Immunotherapy, Post-Transplant Lymphoproliferative Disease ; Myasthenia Gravis
Mechanism of Action
for rituximab: binds to B-lymphocyte CD20 surface antigens, inducing cell lysis of CD20-expressing cells via antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC)
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.