Rituximab, Injection ri-TUK-si-mab

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

It may also be used along with methotrexate to treat rheumatoid arthritis.

It may be used for 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
• heart disease or problems with heart rhythm
• liver disease
• kidney disease
• lung disease or breathing problems

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 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. 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 over several weeks. Your healthcare provider may want you to take acetaminophen (Tylenol) and diphenhydramine (Benadryl) before each infusion to help reduce any side effects.

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 develop a fever, chills, trouble breathing, or stiffness in your muscles during your first infusion. Tell your healthcare provider if you are having these reactions.

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, contact your healthcare provider immediately.

This medicine may cause severe skin problems or a problem called tumor lysis syndrome. Report any side effects to your provider immediately.

You will need to have regular blood tests during treatment with this medicine. Keep all your appointments for these tests.

You may get infections more easily when you are taking 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.

If you need emergency care, surgery, 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).

Serious (report these to your healthcare provider right away): New or sudden change in thinking, walking, talking, or seeing; fast or irregular heartbeat; shortness of breath; fever; chills; abdominal pain; blisters or sores on skin or mouth; unexplained swelling; unusual bleeding or bruising; painful urination; trouble urinating; unexplained cough or sore throat.

Other: Nausea, vomiting, diarrhea, itching, tiredness, headache, dizziness, runny nose, back pain, joint or muscle aches, night sweats, 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:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• angiotensin receptor II blockers such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• beta blockers such as atenolol (Tenormin), acebutolol (Sectral), betaxolol (Kerlone), carteolol, bisoprolol (Zebeta), pindolol, metoprolol (Lopressor, Toprol XL), timolol, sotalol (Betapace), nadolol (Corgard), propranolol (Inderal), labetalol (Normodyne, Trandate), and carvedilol (Coreg)
• calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiamate, Tiazac), nicardipine (Cardene), nifedipine (Procardia, Adalat), isradipine (DynaCirc), felodipine, amlodipine (Norvasc), and verapamil (Calan, Isoptin, Verelan)
• cisplatin
• clonidine (Catapres)
• diuretics such as amiloride, bumetanide, chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• hydralazine (Apresoline)
• live vaccines
• methyldopa
• minoxidil
• natural remedies such as alfalfa, aloe, bilberry, bitter melon, burdock, celery, damiana, echinacea, fenugreek, garcinia, garlic, ginger, ginseng, gymnema, and stinging nettle

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.

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.