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(ri tux' i mab)You may experience a serious reaction while you receive or within 24 hours after receiving a dose of rituximab injection. These reactions usually happen during the first dose of rituximab injection and may cause death. You will receive each dose of rituximab in a medical facility, and a doctor or nurse will monitor you carefully while you are receiving the medication. You will receive certain medications to help prevent an allergic reaction before you receive each dose of rituximab. Tell your doctor if you have ever had a reaction to rituximab or if you have or have ever had an irregular heartbeat, chest pain, other heart problems, or lung problems. If you experience any of the following symptoms, tell your doctor or other healthcare provider immediately: hives; rash; itching; swelling of the lips, tongue, or throat; difficulty breathing or swallowing; dizziness; fainting; shortness of breath, wheezing; headache; pounding or irregular heartbeat; fast or weak pulse; loss of consciousness; pale or bluish skin; pain in the chest that may spread to other parts of the upper body; weakness; excessive tiredness; or heavy sweating. Rituximab has caused severe skin and mouth reactions. These reactions have caused death. If you experience any of the following symptoms, tell your doctor immediately: painful sores or ulcers on the skin, lips, or mouth; blisters; rash; or peeling skin. You may already be infected with hepatitis B (a virus that infects the liver and may cause severe liver damage) but not have any symptoms of the disease. In this case, receiving rituximab injection may increase the risk that your infection will become more serious or life-threatening and you will develop symptoms. Tell your doctor if you have or ever had a severe infection, including hepatitis B virus infection. Your doctor will order a blood test to see if you have an inactive hepatitis B infection. If necessary, your doctor may give you medication to treat this infection before and during your treatment with rituximab. Your doctor will also monitor you for signs of hepatitis B infection during and for several months after your treatment. If you experience any of the following symptoms during or after your treatment, call your doctor immediately: excessive tiredness, yellowing of the skin or eyes, loss of appetite, nausea or vomiting, muscle aches, stomach pain, or dark urine. Some people who received rituximab developed progressive multifocal leukoencephalopathy (PML; a rare infection of the brain that cannot be treated, prevented, or cured and that usually causes death or severe disability) during or after their treatment. If you experience any of the following symptoms, call your doctor immediately: new or sudden changes in thinking or confusion; difficulty talking or walking; loss of balance; loss of strength; new or sudden changes in vision; or any other unusual symptoms that develop suddenly. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to rituximab. Talk to your doctor about the risks of using rituximab injection.
Before using rituximab,
- tell your doctor and pharmacist if you are allergic to rituximab, any other medications, or any of the ingredients in rituximab injection or rituximab and hyaluronidase human injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medication in the IMPORTANT WARNING section and either of the following: adalimumab (Humira); certolizumab (Cimzia); cisplatin; etanercept (Enbrel); golimumab (Simponi); infliximab (Remicade); medications for high blood pressure; other medications for rheumatoid arthritis; and medications that suppress the immune system such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune, Torisel), and tacrolimus (Envarsus, Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section and if you have or have ever had hepatitis C or other viruses such as chicken pox, herpes (a virus that may cause cold sores or outbreaks of blisters in the genital area), shingles, West Nile virus (a virus that is spread through mosquito bites and may cause serious symptoms), parvovirus B19 (fifth disease; a common virus in children that usually only causes serious problems in some adults), or cytomegalovirus (a common virus that usually only causes serious symptoms in people who have weakened immune systems or who are infected at birth), or kidney disease. Also tell your doctor if you have any type of infection now or if you have or have ever had an infection that would not go away or an infection that comes and goes.
- tell your doctor if you are pregnant or if you plan to become pregnant. You should use birth control to prevent pregnancy during your treatment with rituximab and for 12 months after your final dose. Talk to your doctor about types of birth control that will work for you. If you become pregnant while using rituximab, call your doctor. Rituximab may harm the fetus.
- tell your doctor if you are breastfeeding. You should not breastfeed during your treatment with rituximab or with rituximab and hyaluronidase human injection and for 6 months after your final dose.
- ask your doctor whether you should receive any vaccinations before you begin your treatment with rituximab. Do not have any vaccinations during your treatment without talking to your doctor.
- back or joint pain
- night sweats
- feeling unusually anxious or worried
- hair loss
- pain, irritation, swelling, redness or itching in the place where the injection was given (rituximab and hyaluronidase human injection)
- unusual bruising or bleeding
- sore throat, runny nose, cough, fever, chills, or other signs of infection
- painful urination
- redness, tenderness, swelling or warmth of area of skin
- chest tightness