Rituxan is a brand-name prescription medication. It’s FDA-approved to treat the following in adults:

  • Non-Hodgkin lymphoma. Rituxan treats some forms of a cancer called non-Hodgkin lymphoma (NHL) that are CD20-positive and affect cells known as B cells. The drug can be used alone or with other medications:
    • Rituxan for NHL when used alone. For this use, the cancer must be either low grade (slow spreading) or a kind called follicular lymphoma (FL). Also, the cancer must be relapsed or refractory. “Relapsed” means that the cancer came back after previous treatment. And “refractory” means that the cancer hasn’t gotten better with other treatments. For this purpose, Rituxan is used alone.
    • Rituxan for NHL when used with chemotherapy. For this use, the cancer must be FL that hasn’t been treated before. Also for this use, Rituxan is used with chemotherapy. If you have this treatment and have a partial or complete response* to it, your doctor may have you then use Rituxan alone.
    • Rituxan for NHL when used after CVP chemotherapy. For this use, the cancer must be low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with the drugs cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, Rituxan is used alone.
    • Rituxan for diffuse large B-cell lymphoma. For this use, the diffuse large B-cell lymphoma (DLBCL)must not have been treated before. Also for this use, Rituxan is used with the medications cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy drugs called anthracyclines.
  • Chronic lymphocytic leukemia. Chronic lymphocytic leukemia (CLL) is a type of blood cancer. Rituxan is used for CLL that’s CD20-positive and has or hasn’t been previously treated. For this purpose, Rituxan is used with the drugs fludarabine and cyclophosphamide.
  • Rheumatoid arthritis. With rheumatoid arthritis (RA), your body mistakenly attacks its own joints. For this purpose, Rituxan is used with methotrexate (Trexall) to treat RA that’s moderate to severe and active. “Active” means that you currently have symptoms. You must have tried a drug known as a tumor necrosis factor (TNF) antagonist, but you weren’t able to tolerate its side effects or the medication didn’t relieve your symptoms.
  • Granulomatosis with polyangiitis.† Granulomatosis with polyangiitis (GPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Microscopic polyangiitis.† Like GPA, microscopic polyangiitis (MPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Pemphigus vulgaris. Pemphigus vulgaris is a condition in which your skin and mucous membranes develop serious and painful blisters. (Mucous membranes line areas such as the mouth and are protected with mucus.) For this use, Rituxan treats pemphigus vulgaris that’s moderate to severe.

* When you have a partial response, the treatment lowered the level of cancer cells to some degree. When you have a complete response, the treatment lowered cancer cells to a level that blood tests couldn’t detect.
† Rituxan is used to treat GPA and MPA in adults as well as children ages 2 years and older.

Rituxan active ingredient and form

Rituxan contains the active ingredient rituximab and belongs to a group of medications called monoclonal antibodies.

Rituxan comes as a liquid solution that’s available in two strengths: 100 milligrams (mg) per 10 milliliters (mL) of solution and 500 mg/50 mL. The medication is given as an intravenous (IV) infusion. (An infusion is an injection into a vein that’s given over a period of time.) A healthcare provider will give you Rituxan infusions in a doctor’s office, clinic, or hospital.

Effectiveness

For information on the effectiveness of Rituxan, see the “Rituxan uses” section below.

Rituxan is a brand-name medication. It has two biosimilar versions: rituximab-pvvr (Ruxience) and rituximab-abbs (Truxima).

A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Rituxan is a biologic medication, which is also called a biologic. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Rituxan contains one active drug ingredient: rituximab.

Rituxan can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Rituxan. These lists don’t include all possible side effects.

Because Rituxan can be used for many different conditions, side effects may vary. Talk with your doctor if you have any side effects while you’re taking Rituxan.

For more information on the possible side effects of Rituxan, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Rituxan, you can do so through MedWatch.

Mild side effects

Mild side effects of Rituxan can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Rituxan. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Rituxan’s Medication Guide.

Serious side effects

Serious side effects from Rituxan aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* Rituxan has boxed warnings for these side effects. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Another serious side effect, explained in more detail below in “Side effect details,” is:

Side effects in children

The only conditions Rituxan is approved to treat in children is granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). GPA and MPA are conditions in which blood vessels become swollen and damaged in areas such as the kidneys, lungs, skin, and nose.

In clinical trials, children who took Rituxan for GPA or MPA had side effects that were the same as those that occurred in adults who took Rituxan for GPA or MPA.

Side effect details

You may wonder how often certain side effects occur with this drug,. Here’s some detail on some of the side effects this drug may cause.

Boxed warnings

Rituxan has several boxed warnings about possible risks of taking the medication:

  • infusion reactions
  • severe reactions of the skin or mucous membranes
  • hepatitis B virus reactivation
  • progressive multifocal leukoencephalopathy (PML)

A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Rituxan. It’s not known how many people who took Rituxan in clinical trials experienced an allergic reaction.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

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
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Rituxan. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Cough

Cough is a side effect that may occur with Rituxan use. However, only two groups of people who took Rituxan reported having a cough.

Cough occurred in adults with GPA or MPA:

  • In clinical trials, 13% of adults who took Rituxan for GPA or MPA had coughing as a side effect.
  • In comparison, 11% of adults who took a different medication called cyclophosphamide also had a cough.

Cough also occurred in people with relapsed or refractory follicular lymphoma (FL) or low-grade (slow spreading) non-Hodgkin lymphoma (NHL):*

  • In clinical trials of people with FL or low-grade NHL, 13% of people had a cough while taking Rituxan.
  • It’s not known how many people who took a placebo or a different medication had a cough. (The placebo was an infusion with no active drug in it.)

While you’re taking Rituxan, if you develop a cough that doesn’t go away or is bothersome to you, talk with your doctor. They may give you tests to see what’s causing the cough. You doctor may also be able to recommend ways to help ease your coughing.

* For this purpose, Rituxan is used alone to treat B-cell NHL. The cancer must be CD20-positive and either low grade or FL. Also, the cancer must be relapsed or refractory. “Relapsed” means that the cancer came back after previous treatment. And “refractory” means that the cancer hasn’t gotten better with other treatments. For more about this use of Rituxan, see the “Rituxan uses” section below.

Hair loss

Hair loss is a possible side effect of Rituxan. However, in clinical trials, hair loss occurred only in people who took Rituxan for pemphigus vulgaris (PV). PV is a condition in which your skin and mucous membranes develop serious and painful blisters. Mucous membranes line areas such as the mouth.

Hair loss occurred in 13% of people who took Rituxan along with prednisone (Rayos) for PV. No one who took prednisone alone had hair loss.

If you’re using Rituxan and begin to notice hair loss, talk with your doctor. They may be able to suggest ways to help decrease this side effect.

Weight gain or weight loss

Weight gain is a side effect that may occur with Rituxan. Weight gain was reported only in people who took the drug for NHL.*

In one study, people with low-grade, B-cell NHL had chemotherapy with the drugs cyclophosphamide, vincristine, and prednisone. Some people took Rituxan afterward and some people didn’t take any medication.

  • Of the people who took Rituxan after chemotherapy, 11% gained weight.
  • In comparison, 4% of people who didn’t take medication after chemotherapy gained weight.

Weight loss

Weight loss wasn’t a side effect that was seen in clinical trials of Rituxan. The drug itself shouldn’t cause you to lose weight. However, nausea and diarrhea (side effects of Rituxan) may cause weight loss. Infection is another side effect of the medication that may cause you to lose weight. This is because certain infections can lead to dehydration and eating less.

Talking with your doctor

If you have any changes in your weight while you’re taking Rituxan, talk with your doctor. They may give you tests to determine what’s causing the weight change. They may also be able to recommend ways to help you manage your weight.

* For this purpose, Rituxan is used to treat B-cell NHL. The cancer must be CD20-positive and low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone. For more about this use of Rituxan, see the “Rituxan uses” section below.

Rash

Rash is a common side effect of Rituxan. Clinical trials showed that:

  • Rashes occurred in 10% to 17% of people who took Rituxan for GPA, MPA, or NHL.*
  • In comparison, rashes also occurred in 5% to 17% of people who took other medications for their GPA, MPA, or NHL. The medications included cyclophosphamide, vincristine, and prednisone.

In some rare cases, a rash may be severe and may cause peeling skin.† This can occur with conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Infusion reactions may also cause rashes to occur.

If you’re taking Rituxan and develop a rash that’s severe, not getting better, or spreading, tell your doctor right away. They’ll help determine how severe the rash is and the best way to treat it. In some cases, your doctor may recommend that you stop treatment with Rituxan.

* For this purpose, Rituxan is used to treat B-cell NHL. The cancer must be CD20-positive and either low grade or FL. Also, the cancer must be relapsed or refractory. For more about this use of Rituxan, see the “Rituxan uses” section below.
† Rituxan has a boxed warning for severe reactions of the skin or mucous membranes. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Fatigue

Rituxan may cause a lack of energy called fatigue. Researchers found the following:

  • Fatigue is a common side effect that occurred in about 8% to 39% of people who took Rituxan for GPA, MPA, NHL,* or PV in clinical trials.
  • In comparison, between 6% and 21% of people who took other medications or stopped treatment altogether felt fatigued. The other medications included prednisone, cyclophosphamide, and vincristine.

If you notice that you have a lack of energy while taking Rituxan, talk with your doctor. They may be able to recommend ways to help ease this side effect.

* For this purpose, Rituxan is used to treat B-cell NHL. The cancer must be CD20-positive and low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone. For more about this use of Rituxan, see the “Rituxan uses” section below.

Diarrhea

Diarrhea is a possible side effect of Rituxan. Researchers found the following:

  • Diarrhea occurred in 10% to 17% of people who took Rituxan for GPA, MPA, or NHL.*
  • In comparison, 12% of people who took cyclophosphamide for GPA or MPA also had diarrhea. Rituxan wasn’t compared with a placebo or different drug in people with NHL.

Diarrhea may also be a sign of another Rituxan side effect, such as an infection or tumor lysis syndrome.

If you develop diarrhea that’s frequent, bothersome, or severe while taking Rituxan, talk with your doctor. They may test your blood to help see what’s causing the diarrhea. Your doctor may also be able to recommend ways to relieve this side effect.

* For this purpose, Rituxan is used to treat B-cell NHL. The cancer must be CD20-positive and either low grade or FL. Also, the cancer must be relapsed or refractory. For more about this use of Rituxan, see the “Rituxan uses” section below.

The Food and Drug Administration (FDA) approves prescription drugs such as Rituxan to treat certain conditions. Rituxan may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Rituxan for rheumatoid arthritis (RA)

Rituxan is approved to be used in adults with moderate to severely active rheumatoid arthritis. For this purpose, Rituxan is used with methotrexate (Trexall).

Before taking Rituxan for your RA, you must have tried a type of drug known as a tumor necrosis factor (TNF) antagonist. However, you weren’t able to tolerate the side effects of the TNF antagonist or the medication didn’t relieve your symptoms. Examples of TNF antagonists include adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel).

RA explained

RA is an autoimmune disease, which means it causes your immune system to mistakenly attack your own body. RA specifically damages joints, causing them to become painful and swollen. RA can attack any joints, but it often affects feet and hands.

Rituxan is for RA that’s moderate to severely active. “Moderate to severe” means that the cartilage between your joints has become affected and may become damaged. When RA is “active,” you’re currently having symptoms, such as painful or swollen joints.

Effectiveness for RA

Clinical trials used American College of Rheumatology (ACR) criteria to determine how well People who had a score of ACR50 showed at least a 50% improvement in their RA symptoms. After 24 weeks, an ACR50 was reported in:

  • 27% of people who took Rituxan and methotrexate
  • 5% of people who took methotrexate and a placebo (an infusion with no active drug in it)

Rituxan for chronic lymphocytic leukemia (CLL)

Rituxan is approved to treat chronic lymphocytic leukemia in adults. The drug is used for CLL that’s CD20-positive and has or hasn’t been previously treated. For this purpose, Rituxan is used with the drugs fludarabine and cyclophosphamide.

CLL explained

CLL is a type of blood cancer that affects white blood cells called lymphocytes. CLL occurs when the cells grow out of control or don’t grow properly. CLL starts in the bone marrow (the tissue inside bones that makes blood cells) and then travels into the blood.

Rituxan is used in people with a certain type of CLL known as CD20-positive CLL. CD20 is a protein that’s found on your blood cells. Rituxan works by acting on that CD20 protein.

To treat CD20-positive CLL, Rituxan is used along with both fludarabine and cyclophosphamide. Rituxan can be used:

  • in people who have never been treated for their CLL before, or
  • in people who have already tried other medications to treat their CLL

Effectiveness for CLL

In clinical trials, people took fludarabine and cyclophosphamide with or without Rituxan. At least 50% of people who had never been treated for their CLL:

  • went 39.8 months without their cancer getting worse when they took Rituxan, fludarabine, and cyclophosphamide
  • went 31.5 months without their cancer getting worse when they took fludarabine and cyclophosphamide alone

Rituxan was also studied in people who had already tried other medications for their CLL. At least 50% of people who had been treated in the past for their CLL:

  • went 26.7 months without their cancer getting worse when they took Rituxan, fludarabine, and cyclophosphamide
  • went 21.7 months without their cancer worsening when they took fludarabine and cyclophosphamide alone

Rituxan for non-Hodgkin lymphoma (NHL)

Rituxan is approved to treat certain forms of non-Hodgkin lymphoma in adults. This is a type of blood cancer that affects white blood cells called lymphocytes. There are several different kinds of NHL. Rituxan is approved to treat NHL that affects your B cells. These are a specific sort of lymphocyte.

Rituxan is also approved to treat NHL that is CD20-positive. CD20 is a protein on blood cells. Rituxan works by acting on that CD20 protein.

Rituxan can be used to treat many different types of NHL. In each case, you may take Rituxan alone or with other medications.

Rituxan for NHL when used by itself

Rituxan is approved to treat NHL that’s low grade or a kind called follicular lymphoma (FL). “Low grade” means that the cancer spreads slowly over time. With FL, cancer cells form follicles (groups of cells) in your lymph nodes.

Rituxan is used to treat these conditions if your NHL has relapsed or is refractory. “Relapsed” means that the cancer came back after previous treatment. And “refractory” means that the cancer hasn’t gotten better with other treatments.

For this purpose, Rituxan is used alone.

Effectiveness for NHL when Rituxan is used by itself

In clinical trials, Rituxan was an effective medication to treat NHL that was low grade or FL, and relapsed or refractory. Between 36% and 57% of people who took Rituxan alone responded to treatment. This means that their cancer improved or got completely better after taking the medication. Rituxan wasn’t compared with a different medication or a placebo.

Rituxan for NHL when used with chemotherapy or by itself as maintenance treatment

Rituxan is used to treat follicular lymphoma (FL) that hasn’t been treated before. For this purpose, Rituxan is used with chemotherapy. If you have this treatment and have a partial or complete response to it, your doctor may have you then use Rituxan alone. This is referred to as maintenance treatment, and the goal is to decrease the risk of the cancer coming back.

When you have a partial response, the treatment lowered the level of cancer cells to some degree. When you have a complete response, the treatment lowered cancer cells to a level that blood tests couldn’t detect.

Effectiveness for NHL when Rituxan is used with chemotherapy

In one clinical trial, at least 50% of people who took:

  • Rituxan along with cyclophosphamide, vincristine, and prednisone (Rayos) survived for 2.4 years without their cancer getting worse
  • only cyclophosphamide, vincristine, and prednisone survived for 1.4 years without their cancer getting worse

Effectiveness for NHL when Rituxan is used as maintenance treatment

In one clinical trial, cancer didn’t get worse in:

  • 74.9% of people who took Rituxan
  • 57.6% of people who took no maintenance medication

Also in this study, at least 50% of people who:

  • took Rituxan alone as maintenance treatment survived for 10.5 years without their cancer getting worse
  • didn’t receive any maintenance treatment survived for 4.1 years without their cancer getting worse

Rituxan for NHL after treatment with CVP chemotherapy

Rituxan is approved to treat NHL that’s low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with the drugs cyclophosphamide, vincristine, and prednisone (CVP). For this purpose, Rituxan is used alone.

Effectiveness for NHL when Rituxan is used after treatment with CVP chemotherapy

In one clinical trial, at least 50% of people who:

  • took Rituxan alone as maintenance treatment survived for about 37 months without their cancer getting worse
  • didn’t receive any maintenance treatment survived for about 31 months without their cancer getting worse

After 2 years, cancer didn’t get worse in:

  • 74% of people who took Rituxan
  • 42% of people who took no medication

After 4 years, cancer didn’t get worse in:

  • 58% of people who took Rituxan
  • 34% of people who took no medication

Rituxan for NHL when used with CHOP or anthracycline chemotherapy

Rituxan is approved to treat diffuse large B-cell lymphoma (DLBCL) that hasn’t been treated before. DLBCL is a type of NHL that’s fast growing. For this purpose, Rituxan is used along with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), or with other chemotherapy drugs called anthracyclines.

Effectiveness for NHL when Rituxan is used with CHOP or anthracycline chemotherapy

In clinical trials, at least 50% of people survived:

  • between 2.9 and 3.1 years without their cancer getting worse when they took Rituxan and CHOP
  • between 1.1 and 1.6 years without their cancer getting worse when they took CHOP alone

Rituxan for pemphigus vulgaris (PV)

Rituxan is approved to treat pemphigus vulgaris in adults that’s moderate to severe.

PV is a condition in which your skin and mucous membranes develop serious and painful blisters. (Mucous membranes line areas such as the mouth and are protected with mucus.) PV is a type of autoimmune disease. Your body mistakenly attacks your skin and causes blistering to occur.

Effectiveness for PV

After 24 months of treatment in clinical trials:

  • PV symptoms went away and no new blistering occurred in 89% of people who took Rituxan and short-term prednisone.
  • This same outcome occurred in 34% of people who took prednisone alone.

Rituxan for granulomatosis with polyangiitis (GPA)

Rituxan is approved to treat a condition known as granulomatosis with polyangiitis in adults as well as children ages 2 years and older. The GPA must be moderate to severe. For this purpose, Rituxan is used with drugs called glucocorticoids, such as prednisone.

GPA explained

GPA causes vasculitis (swelling of the blood vessels) and especially affects the lungs and kidneys. The swelling can cause granulomas, which are pockets of cells that can grow and damage organs. GPA may also be called Wegener’s granulomatosis.

GPA belongs to a rare group of diseases called ANCA vasculitis. (ANCA stands for antineutrophil cytoplasmic antibody.) ANCA vasculitis causes swelling in your blood vessels. Symptoms of GPA include swelling in the nose, trouble breathing, coughing, kidney damage, and increased blood pressure.

Effectiveness for GPA

After 6 months of treatment in a clinical trial, symptoms disappeared in:

  • 64% of people who took Rituxan and methylprednisolone for either GPA or microscopic polyangiitis (MPA)
  • 53% of people who took cyclophosphamide and methylprednisolone for either GPA or MPA

Rituxan for microscopic polyangiitis (MPA)

Rituxan is approved to treat a condition known as microscopic polyangiitis in adults as well as children ages 2 years and older. For this purpose, Rituxan is used with drugs called glucocorticoids, such as prednisone.

MPA explained

Like GPA, MPA is a condition that causes vasculitis (swelling of the blood vessels). MPA can affect many different organs, including the kidneys, lungs, and joints. Symptoms of the condition depend on where your body is affected, but they may include trouble breathing, cough, belly pain, and joint pain.

MPA also belongs to a rare group of diseases called ANCA vasculitis. (ANCA stands for antineutrophil cytoplasmic antibody.) ANCA vasculitis causes swelling in your blood vessels.

Effectiveness for MPA

After 6 months of treatment in a clinical trial, symptoms disappeared in:

  • 64% of people who took Rituxan and methylprednisolone for either MPA or GPA
  • 53% of people who took cyclophosphamide and methylprednisolone for either MPA or GPA

Off-label uses for Rituxan

In addition to the uses listed above, Rituxan may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one or more uses is prescribed for a different one that’s not approved. Below are examples of off-label uses for Rituxan.

Rituxan for multiple sclerosis (MS)

At this time, Rituxan isn’t FDA-approved to treat multiple sclerosis. However, in some cases the drug may be used off-label for this purpose.

MS is a condition in which your body mistakenly attacks the covering of your brain and spinal cord. This causes a disruption in the communication between your brain and the rest of your body. Symptoms of MS include numbness of the face and body, loss of vision, and trouble walking.

Rituxan may be useful in treating MS. Studies show that Rituxan can be used to decrease the effects of MS that are seen on brain scans. Another study also shows that Rituxan can be used safely and effectively long term to treat MS.

If you’re interested in using Rituxan for MS, talk with your doctor.

Rituxan for thrombocytopenia, including immune thrombocytopenia purpura (ITP)

Rituxan isn’t FDA-approved to treat thrombocytopenia, including immune thrombocytopenia purpura. But the drug may be used off-label for these purposes.

Thrombocytopenia is a blood disorder in which you don’t have enough platelets (blood cells that help your blood clot). When you have thrombocytopenia, blood doesn’t clot well, so you may experience symptoms such as:

  • easy bleeding or bruising
  • bleeding from the gums or nose
  • developing a rash with reddish-purple spots

ITP is a type of thrombocytopenia in which your body mistakenly attacks your platelets.

A study shows that Rituxan may be an effective option to treat thrombocytopenia (including ITP) in some people.

Because Rituxan hasn’t been approved for use in this condition, other treatments that have been approved may be tried first. However, Rituxan may be an option for some people, especially in early stages of thrombocytopenia.

If you’d like to learn more about Rituxan and thrombocytopenia, talk with your doctor.

Rituxan for myasthenia gravis

Rituxan isn’t FDA-approved to treat myasthenia gravis, but the drug may be used as an off-label option for this purpose in some cases.

Myasthenia gravis is a condition that causes weakness in your muscles. The disease doesn’t allow for normal communication to occur between your muscles and nerves. Symptoms of myasthenia gravis include trouble speaking, trouble swallowing, and eyelid drooping.

In a study, Rituxan appeared to be a safe and effective medication to treat myasthenia gravis.

For more information about taking Rituxan for myasthenia gravis, talk with your doctor.

Rituxan for dermatomyositis

Rituxan isn’t FDA-approved to treat dermatomyositis. But in some cases, the drug may be used off-label for this purpose.

Dermatomyositis is a disease that causes weakness of your muscles as well as a rash on your skin. The condition also causes a purple or red rash on your eyelids or joints, such as your knees or elbows.

In a study of people with dermatomyositis who tried other treatments that didn’t work, researchers suggest that the people may benefit from taking Rituxan.

For more information about Rituxan and dermatomyositis, talk with your doctor.

Rituxan for rheumatoid arthritis (RA) without methotrexate

Rituxan isn’t FDA-approved to treat rheumatoid arthritis without the additional use of methotrexate. But Rituxan may be used off-label for this purpose.

Rituxan is FDA-approved for the treatment of RA only with the medication methotrexate. However, in some cases, people may have allergies to methotrexate or are unable to tolerate the drug.

A study looked at people who took Rituxan with or without methotrexate for RA. The results showed that both groups had symptom relief and that Rituxan was a safe and effective option for RA, with or without methotrexate.

If you have questions about taking Rituxan without methotrexate for your RA, talk with your doctor.

Rituxan for kidney disease

At this time, Rituxan isn’t FDA-approved to treat kidney disorders. But the drug may be used off-label for certain kidney disorders, including lupus that affects the kidneys, as well as kidney transplants.

Studies show that Rituxan may be an effective medication to treat kidney disorders.

To learn more about using Rituxan for kidney disorders, talk with your doctor.

Rituxan for anemia

Rituxan isn’t FDA-approved to treat anemia. However, the drug may be used off-label to treat anemia that’s caused by the immune system (your body’s defense against infection). This is called autoimmune anemia. Rituxan may be used after other treatments have been tried but haven’t worked.

Anemia is a decrease in the level of red blood cells. In some cases, anemia may be caused by your immune system mistakenly attacking your red blood cells.

Some studies show that Rituxan may be used short term or long term to treat autoimmune anemia.

For more information about Rituxan and anemia, talk with your doctor.

Rituxan for Sjogren’s syndrome

Rituxan isn’t FDA-approved to treat Sjogren’s syndrome. But the drug may be used off-label for this purpose.

Sjogren’s syndrome is a condition in which your immune system mistakenly attacks the glands in your eyes and mouth that produce tears and saliva. This causes your mouth and eyes to become very dry. Symptoms include burning or itchy eyes or dry mouth, as well as swollen salivary glands and dry skin.

Some studies have shown that Rituxan can be an effective treatment for Sjogren’s syndrome, but others show that the medication may not work well to treat the condition.

If other treatments for Sjogren’s syndrome haven’t worked for you and you’re interested in taking Rituxan, talk with your doctor.

Rituxan and children

Rituxan is approved for use in children ages 2 years and older with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). The drug isn’t approved for any other uses in children.

For details about GPA and MPA, see the “Rituxan for granulomatosis with polyangiitis (GPA)” and “Rituxan for microscopic polyangiitis (MPA)” sections above.

Effectiveness for GPA and MPA in children

In a clinical trial of children with GPA or MPA:

  • 56% of children who took Rituxan had no disease after 6 months
  • 92% of children who took Rituxan had no disease after 12 months
  • 100% of children who took Rituxan had no disease after 18 months

Rituxan use with drugs

In some cases, Rituxan is used with other drugs to treat your condition:

Premedications

Before each dose of Rituxan, you’ll likely take medications to help prevent infusion reactions from occurring. (For information on infusion reactions, see the “Serious side effects” section above.) These drugs are called premedications, and they usually include acetaminophen (Tylenol) and an antihistamine, such as diphenhydramine (Benadryl).

Drugs to help prevent infections

You may also be given medications to help prevent infections, such as herpes virus and Pneumocystis jirovecci pneumonia. For details, see the “Rituxan dosage” section above.

If you have any questions about which medications you should be taking and when, talk with your doctor or pharmacist.

Here are answers to some frequently asked questions about Rituxan.

Is Rituxan chemotherapy?

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

Chemotherapy affects all the cells in your body. Because of this, it can cause many more side effects than other treatments.

Immunotherapy, on the other hand, works with your immune system to treat your condition. (Your immune system is your body’s defense against infection.) Rituxan affects a specific protein in your immune system called CD20. Because the drug works on a certain part of your body, Rituxan causes fewer side effects than chemotherapy. For more about Rituxan’s side effects, see the “Rituxan side effects” section above.

In some cases, Rituxan may be used along with chemotherapy to treat your condition. If you have questions about any medications that you’re taking, talk with your doctor or pharmacist.

Do I need to avoid getting certain types of vaccines during my Rituxan treatment?

Yes. You should avoid getting any live vaccines before and while you’re taking Rituxan. This is because live vaccines have a milder version of the bacterium or virus they’re meant to fight off. Rituxan may weaken your immune system, so your body may not be able to fight the bacterium or virus in a live vaccine. This could lead to an infection.

Rituxan may also decrease how well your body responds to non-live (inactive) vaccines. These are vaccines without a live bacterium or virus in them, and they require that your immune system is working properly. But if you’re taking Rituxan, your immune system may not work as well as it should, so the non-live vaccine may not protect you.

For examples of live and non-live vaccines, see the “Rituxan and vaccines” section below.

Before you start taking Rituxan, talk with your doctor about any vaccines that you may need. You should get any non-live vaccines at least 4 weeks before you start Rituxan treatment.

Will I be able to use other medications on the same day I have a Rituxan infusion?

Yes, you can still take other medications on the same day as your Rituxan infusion. In fact, you’ll usually be given drugs to help prevent you from having an infusion reaction on the day of your Rituxan dose. (For information about these drugs, see the “Rituxan use with other drugs” section above.)

Be sure to keep taking your other medications as directed by your doctor, even if it’s on a day that you’re having an infusion. Always talk with your doctor before you stop or start taking medication.

Why do Rituxan infusions take so long?

Rituxan must be given slowly over time to decrease the risk of an infusion reaction occurring. Infusion reactions can include rash, decreased blood pressure, trouble breathing, and swelling of the face and lips. In rare cases, these reactions can cause death, so they should always be taken seriously.

Rituxan infusions can take hours. The exact amount of time that your infusion takes depends on your body size and if you’ve had a reaction to Rituxan in the past. Your first dose of medication will be given slowly to see if you react well. If you don’t have an infusion reaction, your next dose can be given more quickly.

To help pass the time while you’re receiving your infusion, you may be able to bring a book or game with you. You may also be able to bring snacks to have during your infusion.

Talk with your doctor about the best ways to pass time while you’re receiving your doses of Rituxan.

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

How to prepare for Rituxan infusions

Rituxan infusions can take hours, so be sure to bring something to help keep you busy while you’re receiving your dose. This can include a book to read or games to play. You may also want to pack some snacks in case you get hungry while you’re having your treatment.

Before your infusion, you’ll be given medications to help decrease your risk for having an infusion reaction when you get your dose. (To learn more, see the “Rituxan use with other drugs” section above.) Some of these medications may cause you to feel dizzy or tired, so you shouldn’t drive yourself home from treatment. Try to schedule someone to bring you home from your treatment in case you aren’t feeling well.

Talk with your doctor about any questions you have about receiving Rituxan.

When to have Rituxan infusions

How often you have your Rituxan infusions depends on what condition you have. (For information on dosing, see the “Rituxan dosage” section below.) You can also talk with your doctor about how often you can expect to have infusions.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. It may also be helpful to put your treatment schedule in a calendar.

B cells are a type of white blood cell in your body. In non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), some B cells are cancerous.

Rituxan affects a specific protein called CD20, which is located on B cells. By binding to CD20, Rituxan causes your B cells to be destroyed. This decreases the number of cancer cells in your body.

In other conditions, such as rheumatoid arthritis (RA), pemphigus vulgaris, granulomatosis with polyangiitis, and microscopic polyangiitis, it’s believed that B cells lead to swelling and inflammation. By binding to and destroying these cells, Rituxan helps ease the symptoms you experience from your condition.

How long does it take to work?

Rituxan begins working after your first dose.

However, depending on what condition you have, you may not notice symptom relief for weeks afterward. For example, in the treatment of RA, many people see results within 8 weeks of taking Rituxan.

However, with other conditions, such as cancer, you may not notice a difference. This is because although the drug is reducing the number of cancer cells in your body, it may not get rid of them all.

Talk with your doctor about your condition and what to expect from taking Rituxan. They’ll be able to tell you how long it may be before your symptoms ease or your condition improves.

How long does Rituxan stay in your system?

After taking Rituxan, the medication can stay in your body for months. In one study of people with NHL, Rituxan remained in their blood for 3 to 6 months after their last dose. So the drug may actually keep working for months after your last dose.

However, the length of time a medication stays in the body is different for each person. If you have questions about how long Rituxan will last for you or when you need another dose, talk with your doctor or pharmacist.

The Rituxan dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Rituxan to treat
  • your height and weight
  • other medical conditions you may have

Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Rituxan comes as a liquid solution that’s available in two strengths: 100 milligrams (mg) per 10 milliliters (mL) of solution and 500 mg/50 mL. The medication is given as an intravenous (IV) infusion. (An infusion is an injection into a vein that’s given over a period of time.) A healthcare provider will give you Rituxan infusions in a doctor’s office, clinic, or hospital.

Premedications

Before each dose of Rituxan, you’ll likely take medications to help prevent infusion reactions from occurring. (For information on infusion reactions, see the “Serious side effects” section above.) These drugs are called premedications, and they usually include acetaminophen (Tylenol) and an antihistamine, such as diphenhydramine (Benadryl).

Dosage for rheumatoid arthritis (RA)

For rheumatoid arthritis, you’ll receive a 1,000-mg infusion of Rituxan, followed by another 1,000-mg infusion 2 weeks later. After that, you’ll need to have an infusion every 24 weeks. But if you’re still having symptoms, your doctor may schedule you for an infusion more frequently. For treating RA, Rituxan can be given as often as every 16 weeks.

In addition to premedications (see the “Premedications” section above), you’ll be given a glucocorticoid, such as methylprednisolone (Medrol), about 30 minutes before your dose of Rituxan. A glucocorticoid is a type of steroid, and it helps decrease your risk for having an infusion reaction from the medication. You’ll receive 100 mg of methylprednisolone as an IV injection.

For RA, Rituxan is given along with methotrexate (Trexall), so be sure to keep taking your dose of methotrexate as prescribed by your doctor.

Dosage for chronic lymphocytic leukemia (CLL)

For chronic lymphocytic leukemia, your Rituxan dose is based on your height and weight. The first dose will be an infusion of 375 milligrams per square meter (mg/m2). For example, if you’re 5 feet 8 inches tall and weigh 150 pounds (about 68 kilograms), your dose would be about 678 mg.

You’ll have your first infusion on the day before you start treatment with fludarabine and cyclophosphamide.

After the first dose of Rituxan, you’ll receive your next infusion on day 1 of your second cycle of chemotherapy. Your second dose will be 500 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 905 mg.

You’ll keep receiving this dose of Rituxan on day 1 of treatment cycles 3 through 6.

Other medications

In addition to premedications (see the “Premedications” section above), you may be given medications to help prevent infections such as herpes virus and Pneumocystis jirovecci pneumonia.

Dosage for non-Hodgkin lymphoma (NHL)

Here’s some information on the Rituxan dosages for non-Hodgkin lymphoma.

Dosage for NHL that hasn’t been previously treated with Rituxan

For NHL that hasn’t been treated before with Rituxan, the dose of Rituxan is based on your height and weight. So each dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg. You’ll receive an infusion once a week for 4 to 8 weeks.

Dosage for NHL when used as retreatment

To treat NHL again, the dose of Rituxan is based on your height and weight. So each dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg. You’ll receive an infusion once a week for 4 weeks.

Dosage for NHL when used with chemotherapy

To treat NHL with Rituxan and chemotherapy, the dose of Rituxan is based on your height and weight. Each dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg.

You’ll receive a dose of Rituxan on day 1 of each cycle of chemotherapy treatment for a maximum of eight doses. If your cancer improves or goes away while you’re taking Rituxan, you’ll keep taking Rituxan for 8 weeks after you stop chemotherapy. At this time, the Rituxan treatment is considered “maintenance treatment” and needs to be given only every 8 weeks for a total of 12 doses.

Dosage for NHL after treatment with CVP chemotherapy

For NHL after you’ve first had CVP chemotherapy with cyclophosphamide, vincristine, and prednisone (Rayos), the dose of Rituxan is based on your height and weight. Each dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg.

You’ll receive a dose once a week for four doses. After 6 months, you’ll have another series of four doses. You can receive a maximum of 16 doses in total.

Dosage for diffuse large B-cell lymphoma (DLBCL)

For diffuse large B-cell lymphoma, the dose of Rituxan is based on your height and weight. Each dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg.

You’ll receive a dose of Rituxan on day 1 of each chemotherapy cycle for a maximum of eight doses.

Dosage for NHL when used with Zevalin

Rituxan can also be used with a chemotherapy medication called ibritumomab tiuxetan (Zevalin). The dose for Rituxan when it’s used with Zevalin is an infusion of 250 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 452 mg.

If you have questions about how often you’d need a dose of Zevalin or Rituxan to treat your NHL, talk with your doctor or pharmacist.

Dosage for pemphigus vulgaris (PV)

For pemphigus vulgaris, the Rituxan dose would be a 1,000-mg infusion, followed by another 1,000-mg infusion 2 weeks later. Then you’ll need to have a dose of 500 mg at 12 months, and 500 mg every 6 months after that.

If your PV comes back in between doses, you may receive a 1,000-mg dose when the relapse begins. Your Rituxan infusions should always be spaced at least 16 weeks apart.

In addition to premedications (see the “Premedications” section above), you’ll be given a glucocorticoid, such as methylprednisolone, about 30 minutes before your dose of Rituxan. A glucocorticoid is a type of steroid, and it helps decrease your risk for having an infusion reaction from the medication. You’ll receive 100 mg of methylprednisolone as an IV injection.

Also, you may be given medication to help prevent an infection called Pneumocystis jirovecci pneumonia.

Dosage for granulomatosis with polyangiitis (GPA)

Here’s some information on the Rituxan dosage for granulomatosis with polyangiitis.

Starting dosage

For GPA, you’ll first have what’s known as a starting dosage (induction treatment). This dosage helps get the drug in your body at high enough levels for it to begin working quickly. Your starting dose of Rituxan is based on your height and weight. The first dose will be an infusion of 375 mg/m2. For example, if you’re 5 feet 8 inches tall and weigh 150 lb (about 68 kg), your dose would be about 678 mg. You’ll receive this dose once a week for 4 weeks.

In addition to premedications (see the “Premedications” section above), you’ll be given a glucocorticoid, such as methylprednisolone, about 30 minutes before your dose of Rituxan. A glucocorticoid is a type of steroid, and it helps decrease your risk for having an infusion reaction from the medication.

You’ll receive 100 mg of methylprednisolone as an IV injection on days 1 to 3. Then you’ll switch to prednisone, which you take by mouth.

Also, you may be given medication to help prevent an infection called Pneumocystis jirovecci pneumonia.

Note: Your doctor may decide that using a medication other than Rituxan for induction treatment may be best for you. In this case, you’ll start taking Rituxan after finishing your induction treatment (see below).

Follow-up dosage

After you’ve completed the starting doses of Rituxan above, you can begin taking the follow-up doses.

The follow-up dose is a 500-mg infusion, and then another 500-mg infusion 2 weeks later. After that, you’ll need to have a dose of 500 mg every 6 months.

You’ll likely begin having the follow-up doses 24 weeks after your last starting dose. But you may begin having the follow-up doses as soon as 16 weeks after your last starting dose.

If your doctor decided to treat your induction phase with a different medication, you’ll start taking Rituxan within 4 weeks of finishing your induction treatment. You’ll have a 500-mg infusion, and then another 500-mg infusion 2 weeks later. After that, you’ll need to have a dose of 500 mg every 6 months.

Dosage for microscopic polyangiitis (MPA)

The dosage for microscopic polyangiitis is the same as the dosage for GPA. See the section “Dosage for granulomatosis with polyangiitis (GPA)” above for details.

Pediatric dosage

Rituxan is approved for use in children ages 2 years and older with either GMA or MPA. Like adults, children have two phases of treatment.

Starting dosage

Rituxan doses for children are based on their height and weight. The starting infusion dose is 375 mg/m2. For example, a child who is 4 feet tall and weighs 50 lb (about 23 kg) would have a dose of about 330 mg. Your child would receive this dose once a week for 4 weeks. The starting dosage may also be called “induction treatment.”

In addition to premedications (see the “Premedications” section above), children will be given a steroid, such as methylprednisolone. This helps decrease the risk of having an infusion reaction from the medication.

The steroid is given as an IV injection, and the dose is based on your child’s weight. They’ll receive it once a day for 3 days. After the first 3 days, your child will be given a different steroid (such as prednisone) that they can take by mouth.

Note: Your child’s doctor may decide that using a medication other than Rituxan for induction treatment may be best for them. In this case, your child will start taking Rituxan after finishing their induction treatment (see below).

Follow-up dosage

After your child has completed the starting doses of Rituxan above, they can begin taking the follow-up doses.

The follow-up dose is 250 mg/m2, then another 250 mg/m2 infusion 2 weeks later. (So for a child with the same height and weight mentioned above, the dose would be 220 mg.) After that, your child will receive a dose of 250 mg/m2 every 6 months.

Your child will likely begin having follow-up doses 24 weeks after their last starting dose. But they may begin having the follow-up doses as soon as 16 weeks after their last starting dose.

If your doctor decided to treat your child’s induction phase with a medication other than Rituxan, your child will start taking Rituxan within 4 weeks of finishing their induction treatment.

What if I miss a dose?

If you miss an appointment to receive a dose of Rituxan, call your doctor’s office right away. The staff will try to schedule a new visit as soon as possible so that you don’t get behind on your treatments.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. It may also be helpful to put your treatment schedule in a calendar.

Will I need to use this drug long term?

It depends on what condition you’re taking Rituxan for. With some conditions, such as RA, you may use Rituxan as a long-term treatment. If you and your doctor determine that the drug is safe and effective for you, you’ll likely take Rituxan long term.

However, with other conditions, such as NHL, you may need to take Rituxan for only four or eight doses.

If you have questions about how long you’ll need to take Rituxan for, talk with your doctor.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Rituxan, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for rheumatoid arthritis (RA)

Examples of other drugs that may be used to treat rheumatoid arthritis include:

Alternatives for chronic lymphocytic leukemia (CLL)

Examples of other drugs that may be used to treat chronic lymphocytic leukemia include:

Alternatives for non-Hodgkin lymphoma (NHL)

Examples of other drugs that may be used to treat non-Hodgkin lymphoma include:

  • cyclophosphamide
  • doxorubicin
  • prednisone (Rayos)
  • vincristine
  • brentuximab vedotin (Adcetris)
  • polatuxumab vedotin-piiq (Polivy)
  • acalabrutinib (Calquence)
  • copanlisib (Aliqopa)
  • ibrutinib (Imbruvica)
  • bendamustine (Treanda)

Alternatives for pemphigus vulgaris (PV)

Examples of other drugs that may be used to treat pemphigus vulgaris include:

  • azathioprine (Imuran)
  • mycophenolate (Cellcept)
  • cyclophosphamide
  • cyclosporine (Sandimmune)
  • intravenous immunoglobulin (IVIG)
  • prednisone (Rayos)

Alternatives for granulomatosis with polyangiitis (GPA)

Examples of other drugs that may be used to treat granulomatosis with polyangiitis include:

  • azathioprine (Imuran)
  • mycophenolate (CellCept)
  • cyclophosphamide
  • methotrexate (Trexall)

Alternatives for microscopic polyangiitis (MPA)

Microscopic polyangiitis is very similar to GPA. So alternatives for both conditions are the same. Examples of other drugs that may be used to treat MPA are listed above in the section “Alternatives for granulomatosis with polyangiitis (GPA).”

You may wonder how Rituxan compares with other medications that are prescribed for similar uses. Here we look at how Rituxan and Rituxan Hycela are alike and different.

Ingredients

Rituxan has one active ingredient: rituximab. Rituxan Hycela contains two active ingredients: rituximab and hyaluronidase. Hyaluronidase helps rituximab work better.

Uses

Both Rituxan and Rituxan Hycela are approved to treat certain forms of:

Rituxan uses

Here’s some more detail about the specific uses of Rituxan. The drug is used for:

  • NHL. Rituxan treats some forms of NHL that are CD20-positive and affect cells known as B cells. The drug can be used alone or with other medications:
    • Rituxan for NHL when used alone. The cancer must be either low grade (slow spreading) or FL. Also, the cancer must be relapsed or refractory. “Relapsed” means that the cancer came back after previous treatment. And “refractory” means that the cancer hasn’t gotten better with other treatments. For this purpose, Rituxan is used alone.
    • Rituxan for NHL when used with chemotherapy. The cancer must be FL that hasn’t been treated before. For this purpose, Rituxan is used with chemotherapy. If you have this treatment and have a partial or complete response* to it, your doctor may have you then use Rituxan alone.
    • Rituxan for NHL when used after CVP chemotherapy. The cancer must be low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with the drugs cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, Rituxan is used alone.
    • Rituxan for DLBCL. The DLBCL must not have been treated before. For this purpose, Rituxan is used with the medications cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy drugs called anthracyclines.
  • CLL. CLL is a type of blood cancer. Rituxan is used for CLL that’s CD20-positive and has or hasn’t been previously treated. For this purpose, Rituxan is used with the drugs fludarabine and cyclophosphamide.
  • Rheumatoid arthritis. With rheumatoid arthritis (RA), your body mistakenly attacks its own joints. For this purpose, Rituxan is used with methotrexate (Trexall) to treat RA that’s moderate to severe and active. “Active” means that you currently have symptoms. You must have tried a drug known as a tumor necrosis factor (TNF) antagonist, but you weren’t able to tolerate its side effects or the medication didn’t relieve your symptoms.
  • Granulomatosis with polyangiitis.†Granulomatosis with polyangiitis (GPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Microscopic polyangiitis.† Like GPA, microscopic polyangiitis (MPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Pemphigus vulgaris. Pemphigus vulgaris (PV) is a condition in which your skin and mucous membranes develop serious and painful blisters. (Mucous membranes line areas such as the mouth and are protected with mucus.) For this use, Rituxan treats pemphigus vulgaris that’s moderate to severe.

* When you have a partial response, the treatment lowered the level of cancer cells to some degree. When you have a complete response, the treatment lowered cancer cells to a level that blood tests couldn’t detect.
† Rituxan is used to treat GPA and MPA in adults as well as children ages 2 years and older.

Rituxan Hycela uses

Here’s some more detail about the specific uses of Rituxan Hycela.* The drug is used for:

  • FL. Rituxan Hycela is used for the following forms of FL:
    • FL that’s relapsed or refractory. For this purpose, Rituxan Hycela is used alone.
    • FL that hasn’t been treated before. For this purpose, Rituxan Hycela is used with chemotherapy. If you have a partial or complete response to this treatment, you may go on to use Rituxan Hycela alone.
    • FL that’s non-progressing, and this includes stable disease. For this purpose, Rituxan Hycela is used alone after treatment with cyclophosphamide, vincristine, and prednisone chemotherapy.
  • DLBCL. Rituxan Hycela is used for DLBCL that hasn’t been treated before. For this purpose, Rituxan Hycela is used with cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy drugs called anthracyclines.
  • CLL. Rituxan Hycela is used for CLL that has or hasn’t been treated before. For this purpose, Rituxan Hycela is used with fludarabine and cyclophosphamide.

* Rituxan Hycela should be used only after you’ve received an infusion of one or more full doses of rituximab. Also, Rituxan Hycela is used only for cancerous conditions.

Drug forms and administration

Rituxan comes as a liquid solution that’s given as an intravenous (IV) infusion over the course of hours. (An infusion is an injection into a vein that’s given over a period of time.) A healthcare provider will give you Rituxan infusions in a doctor’s office, clinic, or hospital.

Rituxan Hycela is a liquid solution that’s given as a subcutaneous injection. (This is an injection given just under your skin.) A healthcare provider will give you the medication in a doctor’s office, clinic, or hospital. It takes only 5 to 7 minutes to receive a Rituxan Hycela dose.

Before you receive Rituxan Hycela, you must first have at least one full dose of Rituxan as an IV infusion.

Side effects and risks

Rituxan and Rituxan Hycela both contain rituximab. In addition, Rituxan Hycela also contains hyaluronidase. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Rituxan, with Rituxan Hycela, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Rituxan, with Rituxan Hycela, or with both drugs (when taken individually).

* Rituxan has boxed warnings for these side effects. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.
† Before you receive your first dose of Rituxan Hycela, you must have at least one infusion of rituximab (Rituxan).
‡ Rituxan Hycela has boxed warnings for these side effects.

Effectiveness

Rituxan and Rituxan Hycela have different FDA-approved uses, but they’re both used to treat certain forms of FL, DLBCL, and CLL.

The use of Rituxan and Rituxan Hycela has been directly compared in clinical studies.

Follicular lymphoma

In clinical trials, Rituxan was compared with Rituxan Hycela in treating FL. Researchers found:

  • 85% of people who took Rituxan had a response to the medication
  • 84% of people who took Rituxan Hycela had a response to the medication

A “response” means that while the people took the medication, their cancer either got better or disappeared completely. Rituxan had a slightly higher response rate than Rituxan Hycela.

Diffuse large B-cell lymphoma (DLBCL)

In clinical trials, Rituxan was compared with Rituxan Hycela in treating DLBCL. Researchers found:

  • 42% of people who took Rituxan had a complete response
  • 47% of people who took Rituxan Hycela had a complete response

A “complete response” means that after treatment, there were no more signs of cancer in the people’s bodies. Rituxan had a slightly lower complete response rate than Rituxan Hycela.

Chronic lymphocytic leukemia (CLL)

A clinical trial compared Rituxan with Rituxan Hycela in treating CLL. Researchers found:

  • 81% of people who took Rituxan responded to treatment
  • 85% of people who took Rituxan Hycela had a response to treatment

A “response” means that their cancer either got better or went away completely while they took the medication. Rituxan had a slightly lower response rate than Rituxan Hycela did in this study.

Costs

The costs of Rituxan and Rituxan Hycela will vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan and your location.

Rituxan and Rituxan Hycela are both brand-name drugs. Rituxan has two biosimilar versions: rituximab-pvvr (Ruxience) and rituximab-abbs (Truxima). Rituxan Hycela has no biosimilar versions.

A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Rituxan is a biologic medication, which is also called a biologic. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Like Rituxan Hycela (above), the drug Treanda has uses similar to those of Rituxan. Here’s a comparison of how Rituxan and Treanda are alike and different.

Ingredients

Rituxan contains the active medication rituximab. Treanda contains the active drug bendamustine.

Uses

Both Rituxan and Treanda are approved to treat certain forms of:

Rituxan uses

Here’s some more detail about the specific uses of Rituxan. The drug is used for:

  • NHL. Rituxan treats some forms of NHL that are CD20-positive and affect cells known as B cells. The drug can be used alone or with other medications:
    • Rituxan for NHL when used alone. The cancer must be either low grade (slow spreading) or a kind called follicular lymphoma (FL). Also, the cancer must be relapsed or refractory. “Relapsed” means that the cancer came back after previous treatment. And “refractory” means that the cancer hasn’t gotten better with other treatments. For this purpose, Rituxan is used alone.
    • Rituxan for NHL when used with chemotherapy. The cancer must be FL that hasn’t been treated before. For this purpose, Rituxan is used with chemotherapy. If you have this treatment and have a partial or complete response* to it, your doctor may have you then use Rituxan alone.
    • Rituxan for NHL when used after CVP chemotherapy. The cancer must be low grade. The cancer must also be non-progressing, which means that it didn’t worsen after you tried chemotherapy with the drugs cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, Rituxan is used alone.
    • Rituxan for diffuse large B-cell lymphoma. The diffuse large B-cell lymphoma (DLBCL)must not have been treated before. For this purpose, Rituxan is used with the medications cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy drugs called anthracyclines.
  • Chronic lymphocytic leukemia. Chronic lymphocytic leukemia (CLL) is a type of blood cancer. Rituxan is used for CLL that’s CD20-positive and has or hasn’t been previously treated. For this purpose, Rituxan is used with the drugs fludarabine and cyclophosphamide.
  • Rheumatoid arthritis. With rheumatoid arthritis (RA), your body mistakenly attacks its own joints. For this purpose, Rituxan is used with methotrexate (Trexall) to treat RA that’s moderate to severe and active. “Active” means that you currently have symptoms. You must have tried a drug known as a tumor necrosis factor (TNF) antagonist, but you weren’t able to tolerate its side effects or the medication didn’t relieve your symptoms.
  • Granulomatosis with polyangiitis.† Granulomatosis with polyangiitis (GPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Microscopic polyangiitis.† Like GPA, microscopic polyangiitis (MPA) is a condition in which your blood vessels become swollen and damaged. For this purpose, Rituxan is used with drugs called glucocorticoids.
  • Pemphigus vulgaris. Pemphigus vulgaris (PV) is a condition in which your skin and mucous membranes develop serious and painful blisters. (Mucous membranes line areas such as the mouth and are protected with mucus.) For this use, Rituxan treats pemphigus vulgaris that’s moderate to severe.

* When you have a partial response, the treatment lowered the level of cancer cells to some degree. When you have a complete response, the treatment lowered cancer cells to a level that blood tests couldn’t detect.
† Rituxan is used to treat GPA and MPA in adults as well as children ages 2 years and older.

Treanda uses

Here’s some more detail about the specific uses of Treanda. The drug is used for:

  • CLL. Treanda is approved to treat CLL.
  • NHL. Treanda is approved to treat NHL that’s indolent, meaning that the cancer is slow growing and may not cause symptoms. The NHL must have spread or grown within 6 months of using rituximab or a treatment that included rituximab.

Drug forms and administration

Rituxan and Treanda both come as a liquid solution that’s given as an intravenous (IV) infusion over the course of hours. (An infusion is an injection into a vein that’s given over a period of time.) Both medications are given by a healthcare provider in a doctor’s office, clinic, or hospital.

Side effects and risks

Rituxan and Treanda both contain drugs to treat CLL or NHL. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Rituxan, with Treanda, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Rituxan, with Treanda, or with both drugs (when taken individually).

* Rituxan has boxed warnings for these side effects. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Effectiveness

Rituxan and Treanda have different FDA-approved uses, but they’re both used to treat CLL and NHL.

These drugs haven’t been directly compared in clinical studies, but studies have found both Rituxan and Treanda to be effective for treating CLL and NHL.

Rituxan and Treanda are being studied to be used together to treat certain types of NHL.

There is also a study looking at the use of these drugs together to treat CLL. They aren’t currently approved to be used together, but the combination may be used in the future.

Costs

The cost of Rituxan and Treanda will vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan and your location.

Rituxan and Treanda are both brand-name drugs. Rituxan has two biosimilar versions: rituximab-pvvr (Ruxience) and rituximab-abbs (Truxima). Treanda has no generic versions.

A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Rituxan is a biologic medication, which is also called a biologic. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Taking Rituxan while you’re pregnant may harm a developing fetus. This can include a decreased amount of B cells in the baby’s immune system when they’re born, meaning that their immune system is weak. (B cells are a type of white blood cell.)

If you’re pregnant or planning to become pregnant, talk with your doctor before taking Rituxan. They may recommend a different medication to treat your condition.

Rituxan can be harmful to a developing fetus. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Rituxan.

For women using Rituxan

If you can become pregnant, you should use birth control while taking Rituxan and for at least 12 months after you complete your last dose.

For men using Rituxan

The manufacturer of Rituxan hasn’t provided any birth control recommendations for men who take the medication. But if you’re a man who’s using Rituxan and your sexual partner can become pregnant, talk with your doctor. They can review your birth control needs during and after your Rituxan treatment.

For more information about taking Rituxan during pregnancy, see the “Rituxan and pregnancy” section above.

You shouldn’t breastfeed while taking Rituxan and for at least 6 months after your last dose of the medication.

It’s not known if Rituxan is safe to take while breastfeeding. But because the drug was present in the breast milk of breastfeeding animals, it’s not recommended that you use Rituxan while breastfeeding.

If you’re breastfeeding or are planning to breastfeed, talk with your doctor before taking Rituxan. They can advise you on healthy ways to feed your child and the right treatment options for you.

Rituxan isn’t known to interact with any medications, herbs, supplements, or foods.

However, to be on the safe side, tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about interactions that may affect you, ask your doctor or pharmacist.

Rituxan and vaccines

You shouldn’t get any live vaccines before and while you’re taking Rituxan. This is because live vaccines have a milder version of the bacterium or virus they’re meant to fight off. Rituxan may weaken your immune system, so your body may not be able to fight the bacterium or virus in a live vaccine. This could lead to an infection.

Examples of live vaccines include:

Rituxan may also decrease how well your body responds to non-live (inactive) vaccines. These are vaccines without a live bacterium or virus in them, and they require that your immune system is working properly. But if you’re taking Rituxan, your immune system may not work as well as it should, so the non-live vaccine may not protect you.

Examples of non-live vaccines include:

Before you start taking Rituxan, talk with your doctor about any vaccines that you may need. You should get any non-live vaccines at least 4 weeks before you start Rituxan treatment.

Rituxan and alcohol

There are no interactions between Rituxan and alcohol. However, if you’re taking other medications, such as methotrexate (Trexall), along with Rituxan, you should talk with your doctor. This is because medications such as methotrexate and alcohol may both affect your liver.

Before you start to take Rituxan, ask your doctor how much, if any, alcohol is safe to drink during your treatment.

As with all medications, the cost of Rituxan can vary. The actual price you’ll pay depends on your insurance plan and your location.

Before approving coverage for Rituxan, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Rituxan, contact your insurance plan.

Financial and insurance assistance

If you need financial support to pay for Rituxan, or if you need help understanding your insurance coverage, help is available.

Genentech, Inc., the manufacturer of Rituxan, offers programs based on the conditions the drug treats. For more information and to find out if you’re eligible for support, see below.

Biosimilar version

Rituxan is available in two biosimilar versions: Ruxience (rituximab-pvvr) and Truxima (rituximab-abbs).

A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Rituxan is a biologic medication, which is also called a biologic. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

If your doctor has prescribed Rituxan and you’re interested in using Ruxience and Truxima instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Infusion reactions. Rituxan can cause serious infusion reactions while or after you receive your dose. (An infusion is an injection into a vein that’s given over a period of time.) Severe infusion reactions often occur with the first dose of Rituxan. Symptoms can include rash, decreased blood pressure, trouble breathing, and swelling of the face and lips. In rare cases, these reactions can lead to death, so they should always be taken seriously.

To help prevent infusion reactions, your doctor will give you medication before you start your infusion. And you’ll be monitored for any symptoms while you receive your dose. If you develop any symptoms of an infusion reaction afterward, tell your doctor right away. They may pause or stop your use of Rituxan.

Severe reactions of the skin or mucous membranes. In rare cases, peopletaking Rituxan can develop serious reactions on the skin or mucous membranes. (These membranes line areas such as the mouth and are protected with mucus.) The reactions include severe conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis that can be fatal.

Symptoms of these conditions include fever, a blistering rash, and peeling skin. You may develop a reaction as soon as your first day of taking Rituxan. Tell your doctor or get medical help right away if you develop any reactions. You’ll likely need to stop taking the drug if your reaction is severe.

Hepatitis B virus reactivation. If you have a history of hepatitis B virus (HBV) or a current HBV infection, taking Rituxan may cause the virus to become active again. This can cause liver failure or in rare cases, death. It’s possible to develop HBV reactivation for up to 24 months after stopping Rituxan use. Your doctor will test you for HBV before you start taking Rituxan. If you do have HBV, they may treat it before or during your Rituxan use.

Symptoms of HBV reactivation include yellowing of the skin or eyes, belly pain, or dark urine. Be sure to tell your doctor about any symptoms of HBV reactivation that you develop. They’ll likely have you stop taking Rituxan and treat you for HBV.

Progressive multifocal leukoencephalopathy. A rare disease called progressive multifocal leukoencephalopathy (PML) may occur up to 12 months after your last dose of Rituxan. PML is serious and can be fatal.

Symptoms of PML include weakness, trouble speaking, and changes in personality. If you develop symptoms of PML, tell your doctor right away. They may have you stop taking Rituxan and adjust other medications you’re using.

Other precautions

Before taking Rituxan, talk with your doctor about your health history. Rituxan may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Heart problems. Rituxan can increase your risk for heart problems, such as a heart attack. If you already have heart problems, you may be at a higher risk for developing these side effects when taking the drug. Tell your doctor about any heart problems that you’ve had. They’ll be able to determine if Rituxan is a safe medication for you to take.
  • Infections or a weakened immune system. If you have a history of serious infections, such as herpes simplex or hepatitis C, tell your doctor before starting Rituxan treatment. You should also tell your doctor if you’re immunocompromised (have a weak immune system). Rituxan can weaken your immune system, so if you take the medication, these infections could come back or you may be at a higher risk for new infections. Your doctor will likely treat you for any infections before you take Rituxan. They’ll also test you for infections during your treatment.
  • Kidney problems. Rituxan can cause kidney problems, such as kidney failure. If you already have a history of kidney problems, such as chronic kidney disease, you may be at an increased risk for developing kidney problems while taking Rituxan. Before you start taking the medication, tell your doctor if you have a history of kidney problems. They may give you blood tests to make sure that Rituxan is a safe medication for you to take.
  • Lung problems. Since being approved, Rituxan has very rarely been linked to lung damage that can be fatal. If you have a history of lung problems or lung disease, be sure to tell your doctor before taking Rituxan. They can review your treatment options with you.
  • 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.
  • Pregnancy. Rituxan may harm a developing baby. For more information, please see the “Rituxan and pregnancy” section above.
  • Breastfeeding. You shouldn’t breastfeed while taking Rituxan and for at least 6 months after your last dose of the medication. For more information, please see the “Rituxan and breastfeeding” section above.

Note: For more information about the potential negative effects of Rituxan, see the “Rituxan side effects” section above.

The following information is provided for clinicians and other healthcare professionals.

Indications

Rituxan is used to treat the following:

Administration

Rituxan is given as an intravenous (IV) infusion over the course of several hours. It should be given into a vein in the arm. The medication should be administered in a doctor’s office, clinic, or hospital.

Mechanism of action

Rituxan binds to the CD20 protein on B cells, causing B-cell death. In PV, MPA, GPA, and RA, B cells are believed to cause inflammation and propagate the disease. So by destroying the B cells, Rituxan works to decrease symptoms of these conditions.

In CLL and NHL, B cells reproduce incorrectly or at high rates. Rituxan works in this case to decrease the number of cancerous B cells in the body.

Pharmacokinetics and metabolism

After taking Rituxan, the drug was still present in the blood of patients with NHL 3 to 6 months post-dose. Half-life was estimated in these patients to be about 22 days.

In patients with CLL, half-life was estimated to be about 32 days.

In patients with RA, clearance was about 0.335 liters (L) per day and half-life was estimated at 18 days. Volume of distribution was 3.1 L.

In patients with GPA or MPA, half-life was about 25 days in adults and 22 days in children. Clearance was 0.279 L per day in adults and 0.222 L per day in children. Volume of distribution was 3.12 L in adults and 2.28 L in children.

Contraindications

There are no contraindications to using Rituxan.

Storage

Rituxan should be stored in the refrigerator, between 36°F to 46°F (2°C and 8°C). It should be protected from direct sunlight. The medication should not be frozen.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Rituxan Images