rituximab, Rituxan

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GENERIC NAME: rituximab

BRAND NAME: Rituxan

DRUG CLASS AND MECHANISM: 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. Rituximab was approved by the FDA in 1997. 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.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Injection: 100 mg/10 ml and 500 mg/50 ml

STORAGE: Rituximab should be stored at 2-8 C (36-36 F) and protected from sunlight.

PRESCRIBED FOR: Rituximab is used for treating non-Hodgkin's B-cell lymphomas that have CD20 receptors on their surface. It is used when lymphomas recur following other types of therapy or are unresponsive to other types of therapy. It is approved for treatment of chronic lymphocytic leukemia, Wegener's granulomatosis, and microscopic polyangiitis. Rituximab also is combined with methotrexate (Rheumatrex, Trexall) to treat rheumatoid arthritis in patients who have failed other biologic medications, such as infliximab, etanercept, or adalimumab.

DOSING: Rituximab is administered by intravenous infusion. Patients should receive acetaminophen (Tylenol) and an antihistamine prior to the infusion to reduce the severity of infusion reactions.

Patients with rheumatoid arthritis also should receive methylprednisolone  (Medrol, Depo-Medrol) 100 mg or a similar drug 30 minutes prior to the infusion to reduce the severity of infusion reactions.

Non-Hodgkin's B-cell lymphomas: 375 mg/m2 weekly for 4 to 8 weeks or longer.

Chronic lymphocytic leukemia: 375 mg/m2 for the first cycle then 500 mg/m2 every 28 days for cycles 2 to 6.

Wegener's granulomatosis or microscopic polyangiitis: 375 mg/m2

Rheumatoid arthritis: Two 1000 mg infusions are administered two weeks apart and then are repeated every 16 to 24 weeks.

DRUG INTERACTIONS: There have been no studies of drug interactions with rituximab.

PREGNANCY: There are not enough studies to draw conclusions about the safety of rituximab in pregnant women. Contraceptive methods are recommended if rituximab is used in women of childbearing age and for up to 12 months after stopping therapy.

NURSING MOTHERS: Since rituximab is an antibody that can be secreted into breast milk and absorbed by the infant, it has the potential for harming nursing infants. Women who are breastfeeding should avoid rituximab therapy and not begin nursing until rituximab is no longer present in the blood.




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