Rituximab
RITUXAN
Pronunciation: ri-TUX-i-mab (ri-TUK-san)
“The Right tux”
What it isCD20-directed monoclonal antibody depleting B cells; B-cell malignancies, rheumatoid arthritis, and ANCA vasculitis.
Why this oneIt remains a backbone of B-cell lymphoma therapy while also treating antibody-mediated autoimmune disease.
What limits it⚑ Hepatitis B reactivation can be fatal, so screen before treatment; infusion reactions, PML, and hypogammaglobulinemia also matter.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Non-Hodgkin's lymphoma (CD20+ B-cell) | Adult | 375 mg/m² IV | weekly ×4–8 or on day 1 of each chemo cycle (per regimen) | |
| Mature B-cell NHL / mature B-cell acute leukemia (with chemotherapy) | Peds ≥6 mo | 375 mg/m² IV | 6 infusions with LMB chemotherapy | |
| Chronic lymphocytic leukemia (CD20+, with fludarabine/cyclophosphamide) | Adult | 375 mg/m² IV cycle 1 | 500 mg/m² IV cycles 2–6 (every 28 days) | |
| Rheumatoid arthritis (with methotrexate) | Adult | 1,000 mg IV ×2 separated by 2 weeks | repeat every 24 weeks (no sooner than every 16 weeks) | |
| Granulomatosis with polyangiitis / microscopic polyangiitis (with glucocorticoids) | Adult | 375 mg/m² IV weekly ×4 (induction) | follow-up two 500 mg IV 2 weeks apart, then 500 mg every 6 months | |
| Granulomatosis with polyangiitis / microscopic polyangiitis (with glucocorticoids) | Peds ≥2 yr | 375 mg/m² IV weekly ×4 (induction) | follow-up two 250 mg/m² IV 2 weeks apart, then 250 mg/m² every 6 months | |
| Pemphigus vulgaris (moderate to severe) | Adult | 1,000 mg IV ×2 separated by 2 weeks (with tapering glucocorticoids) | 500 mg IV at Month 12 and every 6 months thereafter |
Renal Undefined
Hepatic Undefined
Dose and frequency are indication-specific (see indications).
Instructions
- Give as IV infusion only — do not give as IV push or bolus; administered by a healthcare professional with support to manage severe infusion reactions
- Premedicate with acetaminophen and an antihistamine before each infusion (add methylprednisolone 100 mg IV or equivalent for RA, GPA/MPA, and PV)
- Screen all patients for HBV (HBsAg and anti-HBc) and obtain CBC with platelets before starting; monitor during and after therapy
- PCP and herpesvirus prophylaxis for CLL (and PCP prophylaxis for GPA/MPA); avoid live virus vaccines
- Females of reproductive potential: use effective contraception during and for 12 months after the last dose
Available strengths
- inj 10 mg/mL
Cautions
- Infusion-related reactions (can be fatal)
- Severe mucocutaneous reactions (some fatal)
- Hepatitis B virus reactivation
- Progressive multifocal leukoencephalopathy (PML)
- Tumor lysis syndrome
- Serious bacterial, fungal, and new/reactivated viral infections
- Cardiovascular reactions (arrhythmia, MI, cardiogenic shock)
- Renal toxicity
- Bowel obstruction and perforation
- Avoid live virus vaccines
- Embryo-fetal toxicity
Adverse reactions
- infusion-related reactions
- fever
- lymphopenia
- chills
- infection
- asthenia
- neutropenia (CLL)
- upper respiratory tract infection (RA)
- nausea/diarrhea/headache/muscle spasms (GPA/MPA)
Pregnancy Can cause fetal harm — B-cell lymphocytopenia in infants exposed in utero (human data). Advise of risk; effective contraception for 12 months after the last dose.
Lactation Limited data; low levels reported in human milk. Advise not to breastfeed during treatment and for 6 months after the last dose.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg/mL | inj | per unit | not offered |
⚠ BOXED WARNINGS
- Fatal infusion reactions
- Severe mucocutaneous reactions
- Hepatitis B reactivation
- Progressive multifocal leukoencephalopathy
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityFatal infusion reactions, infection and prolonged B-cell depletion
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