Drug information of Rituximab
Rituximab is a genetically engineered chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes . Rituximab is composed of two heavy chains of 451 amino acids and two light chains of 213 amino acids
Mechanism of effect
Rituximab is a monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes.
Rituximab binds to the CD20 antigen, which is predominantly expressed on mature B cells and on >90% of B-cell non-Hodgkin's lymphoms. The antibody leads to selective killing of B-cells.
Most likely removed by opsonization via the reticuloendothelial system when bound to B lymphocytes, or by human antimurine antibody production Half life: 0.8 hours (mammalian reticulocytes, in vitro
CLL Adults IV 375 mg/m 2 the day prior to the initiation of fludarabine and cyclophosphamide chemotherapy, then 500 mg/m 2 on day 1 of cycles 2 to 6 (every 28 days- RA Adults IV 2 infusions of 1,000 mg separated by 2 wk in combination with methotrexate. Subsequent doses should be administered every 24 wk, but no sooner than every 16 wk.
Drug contraindicationshypersensitivity to drug or its components. , Hypersensitivity to murine proteins
Side effectsnausea , Headache , insomnia , abdominal pain , dizziness , vomiting , fatigue , rash , flushing , Depression , Diarrhea , asthenia , Chills , Night sweats , urticaria , pruritus , Hypertension , hypotension , fatal cardiac failure , uveitis , Throat irritation , severe mucocutaneous reactions , marrow hypoplasia , thrombocytopenia , neutropenia , lymphopenia , leukopenia , decreased immunoglobulin M and immunoglobulin G s , anemia
InteractionsTrastuzumab , Telmisartan , Spironolactone , Deferiprone , Fingolimod , Interferon beta-1a , Phentolamine Mesylate , Bisoprolol , Adenovirus types 4 and 7 live, oral , Barictinib , Hydrochlorothiazide , Valsartan , Verapamil
Fatal infusion reactions Deaths within 24 h of infusion have been reported. Approximately 80% of fatal infusion reactions occurred in association with the first infusion. Carefully monitor patients during infusion. Discontinue infusion and provide medical treatment for grade 3 or 4 infusion reactions. Tumor lysis syndrome Acute renal failure requiring dialysis with instances of fatal outcome have been reported in the setting of tumor lysis syndrome following treatment in patients with NHL. Severe mucocutaneous reactions Severe, including fatal, mucocutaneous reactions can occur in patients receiving rituximab.
Points of recommendation
Obtain CBC and platelet counts at regular intervals and more frequently in patients developing cytopenias. Perform cardiac monitoring during and after all infusions of rituximab for patients who develop clinically significant arrhythmias or who have a history of arrhythmia or angina. Monitor RA patients throughout the infusion. Monitor renal function and fluid balance, and monitor for infusion reactions and infection.