rituximab at a glance
Medicine class
Anti-CD20 monoclonal antibody and biological therapy
Main licensed roles
Selected B-cell cancers, severe rheumatoid arthritis, ANCA-associated vasculitis and pemphigus vulgaris
Administration
Given by trained healthcare professionals as an intravenous infusion or, for selected adult lymphomas, an abdominal subcutaneous injection
Important screening
Active infection and hepatitis B status must be assessed before treatment
What is rituximab used for?
The licensed indication depends on the formulation, age and accompanying treatment.
Non-Hodgkin lymphoma, including follicular lymphoma and CD20-positive diffuse large B-cell lymphoma
Chronic lymphocytic leukaemia in adults
Selected advanced B-cell lymphomas in children
Severe active rheumatoid arthritis in adults when specified previous treatments have been inadequate or unsuitable
Severe active granulomatosis with polyangiitis or microscopic polyangiitis in adults and eligible children
Moderate-to-severe pemphigus vulgaris in adults
The selected subcutaneous formulation is licensed only for specified adult non-Hodgkin lymphomas
How does rituximab work?
Rituximab binds to CD20, a protein on normal and malignant B cells. This recruits immune mechanisms that remove these cells, helping control B-cell cancers and diseases driven by harmful immune activity. Blood-forming stem cells do not express CD20, so B cells can later repopulate.
rituximab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 100 mg, 500 mg
Injection
Route: Parenteral
Strengths: 1400 mg
How to take rituximab
Rituximab is administered in a clinical setting with monitoring and access to emergency treatment. Food does not determine its administration.
The intravenous concentrate is diluted and given through a drip.
Medicines to reduce fever and allergic or administration-related reactions are usually given beforehand.
The selected subcutaneous formulation is injected into the abdominal wall by a healthcare professional and must not be injected into a vein.
Subcutaneous treatment can begin only after a full intravenous administration has been completed successfully.
Tell staff immediately if you feel unwell during administration.
rituximab side effects
Common or expected effects
- Administration-related symptoms such as fever, chills, headache, nausea, itching, rash, breathlessness or altered blood pressure
- Infections, including respiratory infections
- Changes in blood-cell counts
- Tiredness or weakness
- With subcutaneous treatment: pain, redness, swelling, itching or rash at the injection site
Get urgent medical advice
- Severe allergic, cytokine-release or breathing reaction
- Serious infection or reactivation of hepatitis B
- Progressive multifocal leukoencephalopathy, a very rare serious brain infection
- Severe blistering or peeling skin reaction
- Serious heart rhythm, heart failure or cardiac events
- Tumour lysis syndrome in susceptible people
rituximab in pregnancy
Rituximab may be considered during pregnancy when a specialist judges that its benefits outweigh potential risks. Exposure later in pregnancy may temporarily reduce the baby's B cells and affect the timing of live vaccines. Anyone planning pregnancy or becoming pregnant during treatment should contact their specialist rather than stopping treatment independently.
rituximab while breastfeeding
Only very small amounts have been measured in breast milk, but evidence and long-term infant follow-up remain limited. The selected product information advises against breastfeeding during treatment and for a period afterwards, so this requires individual discussion with the specialist team.
rituximab interactions
Formal interaction data are limited. The treating team should review all medicines and vaccines before rituximab is given.
Live vaccines
They are not recommended during rituximab treatment or while B cells remain depleted; vaccine plans should be agreed with the clinical team.
Non-live vaccines
They may be given when appropriate, but the immune response can be reduced.
Blood-pressure-lowering medicines
Because rituximab can lower blood pressure during administration, the specialist team may give medicine-specific instructions beforehand.
Common questions about rituximab
Answers are fully visible for fast scanning and source review.
Is rituximab chemotherapy?
It is a targeted monoclonal antibody rather than conventional chemotherapy, although it is often combined with chemotherapy when treating B-cell cancers.
Why is hepatitis B testing needed before rituximab?
Rituximab can reactivate a previous hepatitis B infection, occasionally causing severe liver disease. All patients should therefore be screened before treatment.
Can I have vaccines while receiving rituximab?
Live vaccines are generally avoided while B cells are depleted, and responses to non-live vaccines may be weaker. Ask the treating team before any vaccination.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.