rituximab, Rituxan

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is rituximab, and how does it work (mechanism of action)?

  • Rituximab is an intravenous drug that is used to treat rheumatoid arthritis and B-cell non-Hodgkin's lymphoma. It belongs to a class of drugs called monoclonal antibodies. Other monoclonal antibodies include trastuzumab (Herceptin) and gemtuzumab ozogamicin (Mylotarg). Tumor cells (like most normal cells) have receptors on their surfaces. Many kinds of chemicals, proteins, etc., on the outside of the cell can attach to these receptors. When they do, they can cause changes to occur within the cells. One receptor, present in more than 90% of B-cell non-Hodgkin's lymphomas, is called CD20. Molecules that attach to CD20 can affect the growth and development of the tumor cells and, sometimes, the production of new tumor cells. Rituximab is a man-made antibody that was developed using cloning and recombinant DNA technology from human and murine (mice or rat) genes. Rituximab is thought to attach to the CD20 receptor and cause the tumor cells to disintegrate (lyse). In some non-Hodgkin's lymphomas, it also prevents the production of more tumor cells.
  • In the treatment of rheumatoid arthritis, rituximab is used when other biologic medications (TNF-blockers, such as infliximab, [Remicade] etanercept [Enbrel], or adalimumab [Humira]) have failed to be effective. The effectiveness of rituximab is a result of it temporarily depleting the number of B-cells, cells of the immune system that are important in promoting inflammation in rheumatoid arthritis.
  • Rituximab was approved by the FDA in 1997.

What brand names are available for rituximab?

Rituxan

Is rituximab available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for rituximab?

Yes

What are the uses for rituximab?

What are the side effects of rituximab?

  • The most common side effect of rituximab is a constellation of symptoms (fever, rigors and chills) that occur during administration of the first dose of drug. More than 80% of patients experience these side effects, and it is severe in 4-7 out of every 10,000 patients. The side effects appear only 40% of the time with the second dose of drug and become less frequent with the last two doses.
  • Other common side effects related to rituximab are:
  • After rituximab is administered, large numbers of tumor cells are immediately destroyed (lysed) and eliminated from the body. In 4-5 out of every 10,000 patients the products from the dead cells cannot be eliminated quickly enough and a syndrome called tumor lysis syndrome occurs. This is characterized by a rapid decline in kidney function and a sudden accumulation or decrease in minerals such as potassium, calcium and phosphate to dangerous levels. Tumor lysis syndrome occurs when the size of the tumor or the number of tumor cells circulating in the blood is large, usually within 12-24 hours after the first dose of rituximab.
  • Irregular heart rhythms and infection are two other rarely-occurring side effects that may be severe. The irregular heart rhythm usually begins soon after the administration of the drug, while infection may develop from 30 days to 11 months after the end of therapy. Severe decreases in red or white blood cells and platelets (thrombocytopenia) may occur rarely with rituximab therapy. Rituximab suppresses the immune system. Therefore, serious fungal, bacterial, and new or reactivated viral infections (for example, hepatitis B or C, shingles) can occur during or after treatment with rituximab. Generally, rituximab is avoided in the presence of active, significant infections. Rituximab may also cause severe skin reactions within 1 to 13 weeks after treatment is started. Rituximab therapy is not recommended if there is an allergy to mice or rats since rituximab is made in mice or rats and may contain minute amounts of rat or mice proteins that can lead to severe allergic reactions.
Medically Reviewed by a Doctor on 6/20/2016

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