Rituxan Hycela
Rituxan Hycela is a combination medication that includes rituximab (an anti-CD20 monoclonal antibody) and hyaluronidase (a protein that helps your body better absorb rituximab). This medication is injected under the skin to treat certain types of blood cancers, such as chronic lymphocytic leukemia. Rituxan Hycela (rituximab / hyaluronidase) is typically given once weekly to once every 3 weeks, depending on your condition. This medication is only for people who've tried and are able to safely receive rituximab intravenous (IV) infusions. Rituxan Hycela (rituximab / hyaluronidase) might cause side effects such as allergic reactions, infections, or skin problems.
What is Rituxan Hycela (rituximab / hyaluronidase)?
What is Rituxan Hycela (rituximab / hyaluronidase) used for?
Follicular lymphoma (FL) in adults, given by itself or together with chemotherapy
Diffuse large b-cell lymphoma (DLBCL) in adults, given together with chemotherapy
Chronic lymphocytic leukemia (CLL) in adults, given together with chemotherapy
How Rituxan Hycela (rituximab / hyaluronidase) works
Rituxan Hycela (rituximab / hyaluronidase) is made up of 2 parts:
Rituximab is an anti-CD20 monoclonal antibody. It targets specific cells in your immune system called B cells that have turned into cancer cells. Rituximab attaches to a specific protein in B cells called CD20, and this signals the body to attack and kill that cell. As a result, these abnormal B cells can’t grow or spread as well.
Hyaluronidase is an enzyme (protein) that helps your body better absorb rituximab when it’s injected under the skin.
Drug Facts
What are the side effects of Rituxan Hycela (rituximab / hyaluronidase)?
Common Side Effects
- Lower white blood cell count (up to 65%)
- Nausea (up to 38%)
- Fever (up to 32%)
- Redness around injection site (26%)
- Constipation (up to 25%)
- Hair loss (up to 24%)
- Lower platelet count (up to 24%)
- Cough (23%)
- Lower red blood cell count (up to 23%)
- Vomiting (up to 21%)
- Tiredness (up to 20%)
- Diarrhea (up to 18%)
- Weakness (up to 17%)
- Numbness and tingling (16%)
- Pain at injection site (16%)
Other Side Effects
- Rash
- Infection
- Headache
- Joint pain
- Back pain
- Itching
- Trouble catching your breath
- Respiratory infections
Serious Side Effects
- Infusion-related reaction: swelling, trouble breathing, chest pain, low blood pressure, red skin
- Serious skin reaction: painful blisters, skin wounds, peeling skin, fever, sore throat, body aches
- Tears in the gut: sudden and severe stomach pain, fever, chills, and nausea or vomiting that won’t go away
- Infection: fever, chills, cough, muscle aches, very fast heartbeat, severe tiredness
- Serious heart problems: tiredness, weakness, dizziness, feeling faint, trouble breathing, pressure on the chest, pounding heart, irregular heart beat, sweating, feeling anxious, nausea
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Bowel blockage—stomach cramping, unable to have a bowel movement or pass gas, loss of appetite, vomiting
- Dizziness, loss of balance or coordination, confusion or trouble speaking
- Fever, chills, unusual weakness or fatigue, loss of appetite, nausea, headache, dizziness, feeling faint or lightheaded, shortness of breath, fast or irregular heartbeat, which may be signs of cytokine release syndrome
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Stomach pain that is severe, does not go away, or gets worse
- Tumor lysis syndrome (TLS)—nausea, vomiting, diarrhea, decrease in the amount of urine, dark urine, unusual weakness or fatigue, confusion, muscle pain or cramps, fast or irregular heartbeat, joint pain
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Fatigue
- Hair loss
- Nausea
- Pain, redness, or irritation at injection site
Pros and cons of Rituxan Hycela (rituximab / hyaluronidase)
Pros
Injected under the skin over 5-7 minutes, so more convenient than rituximab infusions that can take hours
Works in a more targeted, specific way than chemotherapy
Doesn’t typically cause hair loss when taken by itself
Cons
Might cause pain and swelling around injection site
Higher risk of infections can last a year after your last dose (sometimes longer)
Can cause pain sores and blisters in mouth or lips
Pharmacist tips for Rituxan Hycela (rituximab / hyaluronidase)
Rituxan Hycela (rituximab / hyaluronidase) is given as a shot underneath your skin, and is typically given in your stomach. Each injection is given slowly, usually over 5-7 minutes, depending on your dose. Keep in mind that the clinic staff will ask you to stay after your appointment for at least 15 minutes to see if you have any serious side effects, so plan accordingly for this time.
Before you can start Rituxan Hycela (rituximab / hyaluronidase), your oncology team will ask you to get one full dose of rituximab. It’s important you tolerate an intravenous infusion first, meaning you don’t have a serious allergic reaction, before you can start taking Rituxan Hycela (rituximab / hyaluronidase).
How often you need a Rituxan Hycela (rituximab / hyaluronidase) infusion depends on your medical condition and how your body responds to the medication. Make sure you know when your infusions are scheduled and mark the dates on your calendar so you don’t miss a treatment. There are also several apps for your phone that can help you keep track.
Your oncologist will give you premedications, such as steroids, acetaminophen (Tylenol), and antihistamines, before each Rituxan Hycela (rituximab / hyaluronidase) infusion. These medications can help lower the risk of an infusion-related reaction, which can be very serious.
Check your temperature regularly, such as once a day, when you’re receiving Rituxan Hycela (rituximab / hyaluronidase) treatment. Call your care team immediately if your temperature is 100.4 degrees Fahrenheit or higher; this means you have a fever. It’s important for your oncologist to know if you get sick, and sometimes a fever might be the only sign that you’re sick.
If you experience nausea and vomiting while receiving Rituxan Hycela (rituximab / hyaluronidase), contact your oncologist. There are several antiemetic medications, such as ondansetron (Zofran) or promethazine (Phenergan), your oncologist might prescribe to help manage it.
We don’t know if Rituxan Hycela (rituximab / hyaluronidase) passes into human milk. But, because of the risks to a nursing infant, you shouldn’t breastfeed while taking Rituxan Hycela (rituximab / hyaluronidase) and for 6 months after the last dose.
Frequently asked questions about Rituxan Hycela (rituximab / hyaluronidase)
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What are the risks and warnings for Rituxan Hycela (rituximab / hyaluronidase)?
Rituxan Hycela (rituximab / hyaluronidase) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious skin problems
Some people taking rituximab products have experienced serious and sometimes life-threatening skin problems, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Tell your oncology team right away if you develop painful blisters, skin wounds, peeling skin, or fever as these are signs of a serious skin reaction that need immediate medical attention.
Hepatitis B reactivation
Risk factors: History of hepatitis B viral infection
Some people who had hepatitis B in the past experienced a new infection (hepatitis B reactivation) after starting medications like rituximab. Your oncologist will test you for hepatitis B virus before you start taking Rituxan Hycela (rituximab / hyaluronidase). If you test positive, you might need treatment for hepatitis B before you start taking Rituxan Hycela (rituximab / hyaluronidase). If you develop a hepatitis B infection during treatment, you’ll need to stop taking Rituxan Hycela (rituximab / hyaluronidase) while your oncologist treats it. Let your oncologist know right away if you experience symptoms of an active hepatitis B infection, such as fever, tiredness, or yellowing of the skin.
Progressive multifocal leukoencephalopathy
Risk factors: Taking Rituxan Hycela (rituximab / hyaluronidase) with chemotherapy | Taking Rituxan Hycela (rituximab / hyaluronidase) for stem cell transplant
Rarely, people taking Rituxan Hycela (rituximab / hyaluronidase) have developed a serious brain condition called progressive multifocal leukoencephalopathy (PML). PML is caused by a virus called JC virus and can lead to brain damage. Let your oncologist know if you have PML symptoms while taking Rituxan Hycela (rituximab / hyaluronidase), such as weakness, clumsiness, difficulty speaking, and difficulty walking.
Hypersensitivity reactions
Sometimes, people taking rituximab products have experienced serious infusion-related reactions, such as rash, swelling, trouble breathing, and fever. Because these reactions can be serious, everyone must take their first rituximab treatment as an intravenous infusion. This is required because if you have symptoms of a reaction, the infusion can be stopped or slowed down. If you finish a full intravenous rituximab treatment without a serious reaction, your oncologist might recommend you switch to Rituxan Hycela (rituximab / hyaluronidase) so you can take the medication as a faster injection under your skin.
Reactions are still possible after taking Rituxan Hycela (rituximab / hyaluronidase), so even if you switch to Rituxan Hycela (rituximab / hyaluronidase), your oncologist will give you premedications, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl) before each dose. You should be monitored in the infusion center or doctor’s office for 15 minutes after each injection, and you should tell your nurse right away if you have symptoms of a reaction.
Some people also had local skin reactions after their Rituxan Hycela (rituximab / hyaluronidase) injection, including pain, swelling, redness, and itching around the injection site. These reactions typically happen within 24 hours of an injection and should go away on their own. But your oncologist might recommend a warm or cold compress to help manage it.
Tumor lysis syndrome
Risk factors: People taking Rituxan Hycela (rituximab / hyaluronidase) for lymphoma
Some people taking medications like Rituxan Hycela (rituximab / hyaluronidase) to treat cancer developed a complication called tumor lysis syndrome (TLS) that can cause damage in multiple areas of the body. TLS happens when cancer cells are destroyed and release what’s inside them, such as potassium and uric acid, into your blood. TLS is most common during the first treatment cycle, and symptoms can appear within 24 hours of the Rituxan Hycela (rituximab / hyaluronidase) infusion. Your oncologist will closely monitor you with lab tests, and might give you extra fluids or a medication such as allopurinol (Zyloprim) to prevent TLS. Let your oncology care team know if you experience symptoms of TLS, such as nausea, tiredness, and no appetite.
Serious infections
Risk factors: Taking Rituxan Hycela (rituximab / hyaluronidase) with chemotherapy
People who take rituximab products like Rituxan Hycela (rituximab / hyaluronidase) can develop serious infections, including viral, bacterial, and fungal infections. If you do get sick, you might need to pause taking Rituxan Hycela (rituximab / hyaluronidase) and start taking other medications to treat the infection. If you develop a serious infection you might have to stop taking Rituxan Hycela (rituximab / hyaluronidase) altogether. Contact your oncologist if you develop signs and symptoms of an infection such as fever, chills, muscle aches, or severe tiredness or weakness.
Serious heart problems
Serious heart problems have happened during treatment with medications like Rituxan Hycela (rituximab / hyaluronidase). These include heart rhythm changes and heart attacks. If your heart rhythm changes during your treatment, your oncologist might recommend closer monitoring with a test called an electrocardiogram (EKG) during your infusions. If you develop serious heart problems during treatment, your oncologist might stop your Rituxan Hycela (rituximab / hyaluronidase) infusion.
Kidney problems
Risk factors: Tumor lysis syndrome | Taking cisplatin
Some people taking medications like Rituxan Hycela (rituximab / hyaluronidase) experienced kidney problems. This was more common in people who developed tumor lysis syndrome or who were taking Rituxan Hycela (rituximab / hyaluronidase) together with a chemotherapy medication called cisplatin. Your oncologist will monitor your kidney health with a blood test while you’re taking Rituxan Hycela (rituximab / hyaluronidase). Let your oncologist know if you have trouble making urine, notice swelling in your hands and feet; these might be symptoms of kidney problems.
Gut blockage and tears
Some people have reported stomach pain, intestinal blockage, and tears in the lining of the gut after starting medications like Rituxan Hycela (rituximab / hyaluronidase) together with chemotherapy for NHL. For some people, these side effects appeared 2 months after the start of treatment. Contact your oncologist right away if you have sudden and severe stomach pain, fever, chills, and nausea or vomiting that won’t go away.
Vaccines
Make sure you’re up-to-date with your vaccines before starting Rituxan Hycela (rituximab / hyaluronidase). We don’t know if it’s safe to take live virus vaccines while taking Rituxan Hycela (rituximab / hyaluronidase). You should avoid live vaccines during treatment. And you need to receive any non-live vaccines at least 4 weeks before Rituxan Hycela (rituximab / hyaluronidase) treatment. Talk to your oncologist before getting any vaccine while you’re taking Rituxan Hycela (rituximab / hyaluronidase), even if it’s an inactivated vaccine.
Harm to unborn baby
Based on data from human pregnancies, Rituxan Hycela (rituximab / hyaluronidase) can cause harm to an unborn baby. If you’re a female who's able to have babies, you should use effective birth control while taking Rituxan Hycela (rituximab / hyaluronidase) and for 12 months after the last dose. Contact your oncologist right away if you become pregnant while taking Rituxan Hycela (rituximab / hyaluronidase).
Rituxan Hycela (rituximab / hyaluronidase) dosage forms
Typical dosing for Rituxan Hycela (rituximab / hyaluronidase)
Before you can start Rituxan Hycela, your oncologist will give you at least one full dose of a rituximab intravenous infusion to see if you experience any serious allergic reactions.
Follicular lymphoma: The typical dose is Rituxan Hycela 1,400 mg/23,400 units (rituximab / hyaluronidase) injected under the skin. How often you’ll receive a dose usually ranges from weekly to every 8 weeks, depending on the type of NHL you have and where you are in the treatment process.
Diffuse large B-cell lymphoma: The typical dose is Rituxan Hycela 1,400 mg/23,400 units (rituximab / hyaluronidase) injected under the skin, typically once every 3 weeks. Treatment usually lasts about 6 months.
Chronic lymphocytic leukemia: The typical dose is Rituxan Hycela 1,600 mg/26,800 units (rituximab / hyaluronidase) injected under the skin, typically given once every 4 weeks. Treatment usually lasts 6 months.
Your oncologist might also give you other anticancer medications, as well as premedications to help prevent an allergic reaction, with each Rituxan Hycela dose.
What are alternatives to Rituxan Hycela (rituximab / hyaluronidase)?
Follicular lymphoma (FL) in adults, given by itself or together with chemotherapy
Diffuse large b-cell lymphoma (DLBCL) in adults, given together with chemotherapy
Chronic lymphocytic leukemia (CLL) in adults, given together with chemotherapy
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References
Best studies we foundAdeyinka, A., et al. (2022). Tumor lysis syndrome. StatPearls.
American Cancer Society. (2024). Fevers.
American Cancer Society. (2024). Infusion or immune reactions.
Fouda, G. E., et al. (2020). Rituximab hypersensitivity: From clinical presentation to management. Frontiers in Pharmacology.
Genentech, Inc. (2024). Rituxan Hycela- rituximab and hyaluronidase injection, solution [package insert]. DailyMed.
Gupta, A., et al. (2018). Tumor lysis syndrome. Journal of the American Medical Association Oncology.
Hafner, J., et al. (2023). Intestinal perforation. StatPearls.
Hanif, N., et al. (2024). Rituximab. StatPearls.
Leukemia & Lymphoma Society. (n.d.). Diffuse large B-cell lymphoma (DLBCL).
Leukemia & Lymphoma Society. (n.d.). Follicular lymphoma (FL).
National Comprehensive Cancer Network. (2021). Anemia and neutropenia: Low red and white blood cell counts.
National Institute of Neurological Disorders and Stroke. (2024). Progressive multifocal leukoencephalopathy.
Saribas, A. S., et al. (2010). JC virus-induced progressive multifocal leukoencephalopathy. Future Virology.
Smith, D. A., et al.(2023). Bowel obstruction. StatPearls.
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