Trade Name(s):

Rituxan

Available

10mg/mL solution, 10 and 50 mg vials

Dose

1,000 mg IV given at baseline and again in 2 weeks; this cycle is repeated every 6 months if additional doses are to be given

Indications

Currently indicated for the treatment of rheumatoid arthritis failing disease modifying drugs and TNF antagonists, but Rituxan is also being studied for use in other autoimmune diseases, such as lupus.

Side Effects

Infusion reactions may include fever, low blood pressure, hives or other skin reactions, swelling, coughing, wheezing, difficulty breathing, or less commonly dizziness, drowsiness, headaches, nausea, or blurred vision. Patients should tell their provider about any irregular heart rate or chest pain during infusions. Typically, corticosteroids and antihistamines are given prior to infusions to significantly reduce the risk of infusion reactions. Studies have indicated a slight increased risk of infection while taking Rituxan, particularly reactivation of Hepatitis B. Immunizations containing live viruses should not be given to patients receiving this medication.

Monitoring

Prior to receiving Rituxan, screening patients for TB and hepatitis is advisable. Lab abnormalities associated with this drug may include increased glucose levels, decreased calcium levels, or an increase in LDH (an enzyme from the liver). A blood count should be performed at least every six months or more frequently if patients are taking other medications with monitoring requirements. Patients prone to frequent infections should be monitored carefully.

Important Points to Know

The risk and severity of infusion reactions is much less in patients with rheumatoid arthritis than in patients with lymphoma, the setting in which Rituxan was originally used. Subsequent infusions are typically better tolerated compared with the first infusion. While used off-label for patients with refractory lupus, a rare central nervous system disorder (progressive multifocal leukoencephalopathy) was described in two patients also receiving Cytoxan . Regardless, the role of this medication in treating many other autoimmune diseases is expected to be better defined in the future.

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