This page tells you about the biological therapy rituximab and its possible side effects. There is information about
Rituximab (pronounced rit-ux-i-mab) is a monoclonal antibody, which is a type of biological therapy. It is also known by its brand name, Mabthera.
Rituximab is a treatment for chronic lymphocytic leukaemia and some types of non Hodgkin lymphoma. It is also used for some non cancer related illnesses.
Rituximab targets a protein called CD20 on the surface of the leukaemia and lymphoma cells. The antibody sticks to all the CD20 proteins it finds. Then the cells of the immune system pick out the marked cells and kill them.
You usually have rituximab through a drip into a vein (infusion). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having cancer drugs into a vein.
You have the first treatment in hospital, over a few hours. You may have to stay in hospital overnight because some people have a reaction to it. If you don’t have problems, you can have later treatments as an outpatient.
Some people may also change to have it as an injection under the skin.
For non Hodgkin lymphoma
You usually have initial treatment with rituximab once a week for 4 weeks. If you have the rituximab in combination with other medicines you may have treatment every 3 weeks. Rituximab is often given with CHOP chemotherapy to make R-CHOP. You usually have 8 of the treatments, so the treatment lasts 6 months.
Read about R-CHOP.
If the initial treatment works well, you may then go on to have further rituximab treatment as maintenance therapy. You have this treatment every 2 or 3 months for 2 years.
For chronic lymphocytic leukaemia
You usually have rituximab treatment alongside chemotherapy once a month for 6 months.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with rituximab. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having rituximab with other medicines.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Feeling weak affects about 1 in 4 people (25%)
- Feeling or being sick affects 1 in 5 people (20%) but is usually well controlled with anti sickness medicines
- Night sweats happen in about 3 in 20 people (15%)
- A skin rash, which may be itchy
- Low blood pressure affects about 1 in 10 people (10%) and more rarely, raised blood pressure
- Stomach pains
- A runny nose (rhinitis) – this is usually mild and goes away within an hour of having the drip
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Bald areas on the scalp
Between 1 and 10 in every 100 people have one or more of these.
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- A reaction to rituximab may happen during the infusion, causing flu like symptoms such as a fever, chills and shivering (rigors). You may also have a headache and feel sick. Your nurse will give you medicines beforehand to try to prevent a reaction. If you have a reaction, your nurse will slow or stop your drip for a while
- A cough and breathlessness – the rituximab can cause irritation of the lungs. Tell your doctor or nurse if this continues
- A mild effect on the liver, which does not cause symptoms. It usually goes back to normal when the treatment ends
- Loss of appetite and weight loss
- Diarrhoea is usually mild but tell your doctor or nurse, as you can have medicines to control it
- About 1 in 20 people (5%) have a sudden feeling of warmth and reddening of the face during the drip. Tell your nurse straight away if this happens to you
- A higher level of sugar in the blood – you may have blood tests to check for this
- Numbness or tingling in the fingers and toes – you may have trouble with fiddly tasks such as doing up buttons. This can start a few days or weeks after treatment. It usually goes away within a few months of the treatment finishing
- Difficulty sleeping
- Red, sore eyes or watery eyes
- A ringing sound in the ears (tinnitus)
- Changes in heart rate, which are usually temporary but for a small number of people may be permanent. You will have heart tests before and after your treatment
- Soreness or pain in the muscles or joints
- Swelling in the face and body due to fluid build up – let your doctor or nurse know if you have this
- Low calcium levels in the blood – let your doctor or nurse know if you have painful muscle spasms and cramps. Also tell them if you have muscle twitching, and numbness or tingling in your feet and hands or around the mouth
- A red face or red skin patches in other areas of the body
- A sore mouth and throat
- Difficulty swallowing
- Increased sweating
Fewer than 1 in 100 people have these.
- Damage to the kidneys caused by chemicals from the dying cancer cells collecting in the blood (tumour lysis syndrome). You may have tablets to take
- About 1 in 20 people (5%) have a severe allergic reaction, with wheezing, an itchy rash and a drop in blood pressure. Your doctor or nurse will give you medicines beforehand to try to prevent a reaction. If you do have a reaction, your nurse will slow or stop your drip for a while
- Sadness or depression
- Taste changes
- Swollen or enlarged lymph nodes
- A swollen tummy (abdomen)
- A viral infection that damages areas of brain tissue – it can cause confusion, difficulty thinking, memory loss, eyesight changes, weakness, loss of control or sensation in an arm or leg, difficulty walking, or loss of balance. This condition can be very serious and even life threatening. Let your doctor or nurse know straight away if you have any of these changes. Your family or carers should also look out for them. The changes are called progressive multifocal leukoencephalopathy (PML)
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and any over the counter remedies. Some drugs can react together.
Hepatitis and rituximab
Hepatitis means inflammation (swelling) of the liver. It can be due to a viral infection or because the liver comes into contact with harmful substances such as alcohol. Rituximab can make hepatitis infection active again. So you should let your doctor know if you have had hepatitis in the past. Your doctor or nurse will do tests to check whether you currently have hepatitis. They call this hepatitis screening.
People with active hepatitis B infection should not have rituximab treatment. People with other types of hepatitis need to see a liver disease expert before starting treatment. The doctor advises on how to prevent damage to the liver during treatment.
Pregnancy and contraception
Rituximab could harm a developing baby, so talk about contraception to your doctor or nurse before having treatment. You need to use reliable contraception during treatment with rituximab and for a year afterwards.
Breastfeeding is not advisable during this treatment and for a year afterwards. The drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.
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