Rituximab, Injection

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KEY POINTS

• This medicine is given by IV to treat lymphoma, leukemia, rheumatoid arthritis, and polyangiitis.
• You may get infections more easily when you are taking this medicine.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine increases your risk of brain infection and liver injury. It may cause other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antineoplastic (anticancer); monoclonal antibody

Generic and brand names: rituximab, injection; Rituxan

What is this medicine used for?

This medicine is given by IV infusion (slow drip through a needle into a large vein) to treat:

• Non-Hodgkin's lymphoma
• Chronic lymphocytic leukemia
• Granulomatosis with polyangiitis (Wegener’s) and microscopic polyangiitis
• Rheumatoid arthritis

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A weakened immune system from cancer treatment, diseases such as HIV/AIDS, or from taking steroid medicines or medicines to prevent organ transplant rejection
• Heart disease or problems with heart rhythm
• Liver disease
• Kidney disease
• Lung disease or breathing problems
• Virus infections such as hepatitis C, cytomegalovirus (CMV), herpes simplex virus, parvovirus, varicella zoster virus (chickenpox or shingles), or West Nile Virus

Tell your healthcare provider if you have ever had hepatitis B. If you have had hepatitis B or are a carrier of hepatitis B virus, receiving this medicine could cause the virus to become an active infection again. This may cause serious liver problems including liver failure, and death.

Tell your healthcare provider if you currently have an infection such as the flu or an open cut or sore, or if you often have infections that come back. Also tell your healthcare provider if you have recently had or are scheduled to have major surgery or any kind of vaccination.

Females of childbearing age: Tell your healthcare provider if you are pregnant or breast-feeding. It is not known whether this medicine will harm an unborn baby. Use effective birth control while you are receiving this medicine and for 12 months after stopping this medicine. Talk with your healthcare provider about effective birth control. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a treatment.

The infusions are given by your healthcare provider. Your healthcare provider may want you to take acetaminophen (Tylenol) and diphenhydramine (Benadryl) before each infusion to help reduce any side effects. You will be monitored closely while you are receiving this medicine. Keep all appointments for these infusions.

This medicine causes a temporary drop in blood pressure. If you are taking medicine for high blood pressure, your healthcare provider may tell you not to take it for 12 hours before receiving a dose of this medicine. Taking both medicines together could cause your blood pressure to become too low.

What should I watch out for?

You may have a severe reaction to the infusion. This can happen during your infusion or within 24 hours after an infusion of this medicine. Tell your healthcare provider right away if you have any of these symptoms during or after an infusion:

• Hives, rash, or Itching
• Swelling of your lips, tongue, throat, or face
• Sudden cough or shortness of breath
• Weakness, dizziness, or feeling faint
• Chest pain or irregular or fast heartbeat

A rare brain infection has been reported during or after treatment with this medicine. If you notice new or sudden changes in thinking, walking, talking, or seeing, or sudden weakness on one side of your body, contact your healthcare provider right away.

This medicine may cause severe skin problems or a problem called tumor lysis syndrome. Tell your healthcare provider right away if you get painful sores or ulcers on your skin, lips, or in your mouth, peeling skin, rash, or blisters.

If you have had hepatitis B, your healthcare provider will check you regularly for hepatitis B during treatment and for several months after you stop treatment. Your healthcare provider will also check you regularly to see how this medicine affects you. Keep all appointments.

You may get infections more easily when you are taking this medicine and for up to a year after stopping this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your healthcare provider's approval first.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you have received this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat); sudden weakness, numbness, or tingling, especially on one side of your body; sudden or severe headache; sudden trouble with vision, speech, balance, or walking.

Serious (Report these to your healthcare provider right away.): Chest pain; fast or irregular heartbeat; severe weakness, dizziness, or fainting; shortness of breath; fever; chills; stomach pain; blisters or sores on skin or mouth; itching; skin redness or peeling; unexplained swelling; unusual bruising or bleeding; unusual tiredness or weakness; painful urination; trouble urinating; unexplained cough, sore throat, or runny nose; yellowing of your skin or eyes; dark urine; light-colored bowel movements; severe nausea or vomiting; severe ongoing headache or earache.

Other: Mild nausea, vomiting, or diarrhea; mild tiredness; mild headache or dizziness; mild back pain, joint or muscle aches; loss of appetite.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), and terazosin
• Beta blockers such as acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), pindolol, and sotalol (Betapace, Sorine)
• Blood pressure medicines such as hydralazine, methyldopa, minoxidil, and reserpine
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat CC, Procardia), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan)
• Cisplatin
• Medicines to treat psoriasis, rheumatoid arthritis, and other immune disorders such as abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), and leflunomide (Arava)
• Natural remedies such as alfalfa, aloe, bilberry, bitter melon, burdock, celery, damiana, echinacea, fenugreek, garcinia, garlic, ginger, ginseng, gymnema, and stinging nettle
• Vaccines

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.