Truxima
Truxima (rituximab or rituximab-abbs) is an anti-CD20 monoclonal antibody. It treats certain types of blood cancers (e.g., non-Hodgkin lymphoma) and autoimmune conditions (e.g., rheumatoid arthritis) by targeting specific immune cells. Truxima (rituximab) is given as an infusion through the vein (IV), typically at an infusion center. Some common side effects of this medication include fever and chills. It can also cause more serious infusion-related reactions, like trouble breathing. Truxima (rituximab) is a biosimilar to Rituxan (rituximab), but it’s not yet FDA-approved to treat all conditions Rituxan (rituximab) is approved for.
What is Truxima (rituximab)?
What is Truxima (rituximab) used for?
Blood cancers
- Certain types of CD20-positive non-Hodgkin’s lymphoma (NHL) in adults
- CD20-positive chronic lymphocytic leukemia (CLL) in adults
Autoimmune conditions
- Moderate-to-severe rheumatoid arthritis (RA) in adults
- Granulomatosis with polyangitis (GPA) and microscopic polyangitis (MPA) in adults
How Truxima (rituximab) works
Truxima (rituximab) is an anti-CD20 monoclonal antibody. It targets specific cells in your immune system called B cells. B cells are involved in many different health conditions. For example, sometimes they can turn into cancer cells, and other times they become too active, which can cause autoimmune conditions.
Truxima (rituximab) works by attaching to a specific protein in B cells called CD20. When it attaches to this protein, it signals the body to attack and kill that cell. As a result, these abnormal or overactive B cells can’t grow, spread, or work as well.
Drug facts
Side effects of Truxima (rituximab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Fever (up to 53%)
- Lower white blood cell count (48%)
- Chills (up to 33%)
- Infection (31%)
- Weakness (up to 26%)
- Nausea (up to 23%)
- Headache (up to 19%)
- -Diarrhea (up to 17%)
- Muscle spasms (up to 17%)
- Lower red blood cell count (up to 16%)
- Swelling (up to 16%)
- Night sweats (15%)
- Rash (15%)
Less Common Side Effects
- Trouble sleeping
- Stomach pain
- Cough
- Itching
- Vomiting
- Joint stiffness
- Nosebleeds
- Runny nose
- Tiredness
Truxima (rituximab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
- Tumor lysis syndrome: seizures, hallucinations, nausea, tiredness, no appetite, dark-colored urine, muscle cramps, numbness
- Serious heart problems: tiredness, weakness, dizziness, feeling faint, trouble breathing, pressure on the chest, pounding heart, irregular heart beat, sweating, feeling anxious, nausea
The following Truxima (rituximab) 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
- 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
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- 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 to your care team if they continue or are bothersome):
- Headache
- Joint pain
- Nausea
- Runny or stuffy nose
- Unusual weakness or fatigue
Pros and cons of Truxima (rituximab)
Pros
- Works in a more targeted, specific way than chemotherapy
- Might only need a dose once every 6 months for certain conditions
- Doesn’t typically cause hair loss
Cons
- Each infusion can last over 3 hours, so can be inconvenient
- Might cause infusion-related reactions
- Higher risk of infections can last a year after your last dose (sometimes longer)
Pharmacist tips for Truxima (rituximab)
- How often you need a Truxima (rituximab) 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.
- Each Truxima (rituximab) infusion appointment can last almost the full day because of the time it takes to receive premedications and Truxima (rituximab) infusion. Please plan accordingly for this time. Make sure you dress comfortably, bring water and food, and have something to help you pass the time, such as a book or music.
- Your oncologist will give you premedications, such as steroids, acetaminophen (Tylenol), and antihistamines, before each Truxima (rituximab) 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 Truxima (rituximab) 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 Truxima (rituximab), 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 Truxima (rituximab) passes into human milk. But, because of the risks to a nursing infant, you shouldn’t breastfeed while taking Truxima (rituximab) and for 6 months after the last dose.
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Risks and warnings for Truxima (rituximab)
Truxima (rituximab) 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.
Infusion-related reactions
People taking rituximab products might experience infusion-related reactions. These reactions are most common within the first two hours of the first infusion. Symptoms include rash and red skin, swelling, trouble breathing, chest pain, irregular heartbeat, and low blood pressure. Sometimes, these reactions can be very serious and cause throat swelling, anaphylaxis, or heart attacks. This can be life threatening.
You’ll take several medications before each treatment, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl) to help prevent a reaction. Your nurse will watch you closely during your first treatment, but you should tell them right away if you experience any symptoms during your treatment. If you have a severe reaction to Truxima (rituximab), you might not be able to continue taking the medication.
Serious skin reactions
Some people receiving rituximab products have experienced serious and sometimes life-threatening skin problems, such as Stevens-Johnson syndrome (SJS), paraneoplastic pemphigus, toxic epidermal necrolysis (TEN), and others. Tell your provider 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 Truxima (rituximab). If you test positive, you might need treatment for hepatitis B before you start taking Truxima (rituximab). If you develop a hepatitis B infection during treatment, you’ll need to stop taking Truxima (rituximab) 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 Truxima (rituximab) with chemotherapy | Taking Truxima (rituximab) for stem cell transplant
Rarely, people taking Truxima (rituximab) 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’ve PML symptoms while taking Truxima (rituximab), such as weakness, clumsiness, difficulty speaking, and difficulty walking.
Tumor lysis syndrome
- Risk factors: People taking Truxima (rituximab) for lymphoma
Some people taking medications like Truxima (rituximab) 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 Truxima (rituximab) 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 Truxima (rituximab) with chemotherapy
People who take rituximab products like Truxima (rituximab) can develop serious infections, including viral, bacterial, and fungal infections. If you do get sick, you might need to pause taking Truxima (rituximab) and start taking other medications to treat the infection. If you develop a serious infection you might have to stop taking Truxima (rituximab) 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 Truxima (rituximab). 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 Truxima (rituximab) infusion.
Kidney problems
Risk factors: Tumor lysis syndrome | Taking cisplatin Some people taking medications like Truxima (rituximab) experienced kidney problems. This was more common in people who developed tumor lysis syndrome or who were taking Truxima (rituximab) together with a chemotherapy medication called cisplatin. Your oncologist will monitor your kidney health with a blood test while you’re taking Truxima (rituximab). 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 Truxima (rituximab) 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 Truxima (rituximab). We don’t know if it’s safe to take live virus vaccines while taking Truxima (rituximab). You should avoid live vaccines during treatment. And you need to receive any non-live vaccines at least 4 weeks before Truxima (rituximab) treatment. Talk to your oncologist before getting any vaccine while you’re taking Truxima (rituximab), even if it’s an inactivated vaccine.
Harm to unborn baby
Based on data from human pregnancies, Truxima (rituximab) 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 Truxima (rituximab) and for 12 months after the last dose. Contact your oncologist right away if you become pregnant while taking Truxima (rituximab).
Combination treatment for people with autoimmune conditions
Risk factors: People taking Truxima (rituximab) for autoimmune conditions We don’t know if it’s safe to take other biologic medications or disease-modifying antirheumatic drugs (DMARDs) together with Truxima (rituximab). Because taking these medications together might raise your risk for infection, your provider will closely monitor you if they recommend a combination treatment.
Truxima (rituximab) dosage
Typical dosage for Truxima (rituximab)
Blood cancers
Your oncologist will determine your dose of Truxima (rituximab) based on your body surface area (BSA) in m². Your oncologist might also give you other anticancer medications along with Truxima (rituximab).
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Non-Hodgkin’s lymphoma
- Adults: The typical dose is 375 mg/m² given as an intravenous infusion. 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.
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Chronic Lymphocytic Leukemia (CLL)
- Adults: The typical dose is to receive one 375 mg/m² intravenous infusion before the start of chemotherapy. Then, your oncologist will raise your dose to 500 mg/m² infused on Day 1 of a 28-day chemotherapy cycle, for up to 6 cycles.
Autoimmune conditions
Your HCP might also give you other medications along with Truxima (rituximab) to treat your condition.
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RA
- Adults: The typical starting dose is 1,000 mg infused IV for 2 doses, given 2 weeks apart. The typical maintenance dose is 1,000 mg infused once every 4 to 6 months, depending on your condition.
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GPA and MPA
- Adults: Your HCP will determine your dose of Truxima (rituximab) based on your body surface area (BSA) in m². The typical starting dose is 375 mg/m² given as an intravenous infusion weekly for 4 weeks. The typical maintenance dose is 500 mg given as 2 doses 2 weeks apart, then 500 mg every 6 months.
What are alternatives to Truxima (rituximab)?
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