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Medications > Rituximab | Rituxan > Rituximab (Rituxan) – Detailed Information


What is Rituximab (Rituxan)?

Rituximab is a biologic.  It is currently used for the treatment of Rheumatoid arthritis.

How does Rituximab (Rituxan) work?

In some people with inflammatory arthritis the cells of the immune system become confused and mistake the cells of the body’s joints for foreign invaders and decide to “attack” the joints (autoimmune).  The B-cell, an immune cell, is partly responsible for this attack.  Rituximab is a protein which binds to the surface of B-cells resulting in their destruction.  By deleting B-cells, rituximab works by suppressing a part of the body’s immune system.  Although this suppression may make it slightly harder for you to fight off infections, it also helps to stabilize an overactive immune system.

Why am I taking Rituximab (Rituxan)?

Your doctor has prescribed this medicine to help with the following:

  • Reduce the pain and swelling (inflammation) in your joints.
  • Improve your day to day function.
  • Prevent long-term damage from the joint inflammation.

What is the usual dose of Rituximab (Rituxan)?

  • Rituximab is given by an intravenous (IV) infusion.  The normal dose is 1000 mg in each infusion.
  • A steroid called methylprednisolone (Solumedrol) is usually given 30 minutes before the rituximab infusion to help prevent reactions to the rituximab.
  • Methotrexate is commonly used in combination with rituximab and may improve your response to the medication.

How often do I take Rituximab (Rituxan)?

  • You will receive your first dose of rituximab on week 0.  The second dose is given two weeks later.  This cycle may be repeated again anytime after 6 months depending on your response.
  • The preparation, infusion, and observation period may take anywhere from 4-8 hours.

Who should NOT take Rituximab (Rituxan)?

  1. Patients who have had a previous serious allergic reaction to rituximab.
  2. Women who are pregnant, planning on becoming pregnant, or breast feeding.
  3. Patients with active infections (such as tuberculosis or hepatitis B).

When will I start to feel the effects of Rituximab (Rituxan)?

Rituximab may take up to 3 months before you start to feel the effects.

What should I AVOID while taking Rituximab (Rituxan)?

You should discuss all vaccinations with your doctor as some vaccines are not advisable while you are taking rituximab. (If you are not up to date on your vaccinations these should be done before you start rituximab)

If you are scheduled for surgery, please tell your doctor.


You should contact your doctor before missing any infusion of rituximab.  In the following situations, it would be advisable to contact your doctor:

  • If you have a fever.
  • If you have or think you have an infection.
  • If you think you are pregnant.
  • If you are scheduled for surgery

Which Medications are safe to take with Rituximab (Rituxan)?

Your rheumatologist may decide to add other medications to treat your arthritis.

Many medications are safe to take with rituximab (except some of the other biologic agents).  As an example, some of the other medications which may be safely added to rituximab include: Acetaminophen (Tylenol), Prednisone, anti-inflammatory medications (NSAIDs), and methotrexate.

What are the side-effects of Rituximab (Rituxan)?

MORE COMMON side-effects include:

  • Abdominal pain, nausea, and diarrhea
  • Sore muscles or joints
  • Rash, hives, or itchiness
  • Headaches, dizziness, or tingling
  • Sore throat, fever, chills, & general weakness
  • Increase in blood pressure

RARE side-effects include:

  • Infusion Reaction – Many patients will react to the medication during or shortly after the infusion, most likely during the first infusion and less so with future infusions.   Most of these reactions are not severe.
  • Infection – As is the case with many medications used in the treatment of arthritis there is an increased risk of serious infections associated with the use of rituximab.  Any infections or fevers should be taken very seriously and reviewed by your doctor.
  • Skin – Severe skin reactions have been reported with rituximab.
  • Heart – Rituximab has been associated with abnormal heart rhythms.  Patients who have known heart rhythm problems should discuss with their doctor.
  • Blood Counts – Rituximab can cause a drop in the numbers of white blood cells (which are needed to fight infection) or red blood cells (which carry oxygen).  This is very rare and it is unusual for this to be a serious problem.

How can I help to minimize the side-effects of Rituximab (Rituxan)?

All patients should have hepatitis B testing before starting rituximab.

Do I need to have regular blood tests while taking Rituximab (Rituxan)?

Blood tests are not routinely required while you are taking rituximab.  However, your doctor will likely order periodic blood tests to check your blood counts and follow the activity of your arthritis, especially if you are on other arthritis medications.

What should I do if I miss a dose of Rituximab (Rituxan)?

If you miss your rituximab infusion contact your doctor to find out when to reschedule for your next infusion.

Is Rituximab (Rituxan) safe in pregnancy?

  • Rituximab is a new medication and it is unknown if it is safe to use in pregnancy.  Therefore, you should AVOID PREGNANCY while on rituximab.  All women of child bearing potential taking rituximab must use reliable contraception.
  • If you become pregnant while taking rituximab NOTIFY YOUR DOCTOR IMMEDIATELY.
  • There is no safety information on breast feeding while taking rituximab so breast feeding can not recommended in the first few months after it is infused.