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Truxima

rituximab

Used for Rheumatoid Arthritis, Leukemia, Non-Hodgkin Lymphoma

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.

Reviewed by:

Allison Baxley, PharmD, BCOP

Connie Zheng, PharmD

Last reviewed on May 20, 2024

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Alternatives Latest news Images Prices Medicare

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.

Are you looking for information on Rituxan (rituximab) instead?

Drug Facts

Common BrandsTruxima

Drug ClassAnti-CD20 monoclonal antibody

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

What are the 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%)

Other Side Effects

Trouble sleeping
Stomach pain
Cough
Itching
Vomiting
Joint stiffness
Nosebleeds
Runny nose
Tiredness

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

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
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.

Frequently asked questions about Truxima (rituximab)

Is Truxima (rituximab) chemotherapy or immunotherapy?

Truxima (rituximab) works more like an immunotherapy than a chemotherapy. Chemotherapy works by attacking all cells that grow very quickly, while immunotherapy works by using your own immune system to target cancer cells. But there are actually many types of immunotherapy for cancer and they affect your immune system differently. For example, some medications activate all of your immune cells to fight cancer. But other medications, like Truxima (rituximab), only target specific immune cells. So while Truxima (rituximab) is sometimes referred to as immunotherapy in the broad sense of the term, it's more often considered a targeted therapy.

How long are you immunocompromised after taking Truxima (rituximab)?

You might be at higher risk for infections (immunocompromised) for as long as a year after the last Truxima (rituximab) dose. But there have been reports of serious infections up to 2 years after the last dose of medications like Truxima (rituximab). Your oncology care team might prescribe antibiotics or antivirals to help protect you from infections during and after Truxima (rituximab) treatment, depending on what condition you have and what other medications you’re taking. To lower your risk of infections, wash your hands often and avoid or limit your interactions with people who are sick. It’s a good idea to check your temperature regularly, and contact your oncology team right away if you have a fever.

Does Truxima (rituximab) cause infusion reactions?

People taking Truxima (rituximab) might experience infusion reactions. These reactions are most common during the first infusion. Symptoms might include rash and red skin, chest pain, swelling, and trouble breathing. Some people have reported life-threatening reactions, such as throat swelling, anaphylaxis, or heart attacks. Your oncologist will give you several medications, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl), before your Truxima (rituximab) dose to lower your risk of a reaction. Your nurse will also monitor you very closely, especially during your first dose. You should tell your nurse right away if you have symptoms of a reaction during your treatment.

How long do Truxima (rituximab) side effects last?

How long the side effects of Truxima (rituximab) last can differ depending on what side effects you’re experiencing. For example, fever, rash, muscle pain from infusion-related reactions can appear quickly, often times within 2 hours of a Truxima (rituximab) infusion. But these side effects are short-lived because your care team can help you manage them quickly with other medications. Other side effects of Truxima (rituximab), such as having a weaker immune system (from lower white blood cell counts), can last for months after your last dose. Talk to your oncologist if you have questions about a specific side effect.

What does it mean that Truxima (rituximab) is a biosimilar?

Truxima (rituximab) is a biosimilar to Rituxan (rituximab). A biosimilar is a biologic medication that’s very similar to the original biologic that was first approved by the FDA. Biosimilars are as safe and work similarly as well as the original biologic medication. Keep in mind that Truxima (rituximab) isn’t approved to treat all the same conditions or all the same age groups as Rituxan (rituximab). Talk to your oncologist if you have questions about biosimilars.

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What are the 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 forms

Typical dosing 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).

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.
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.

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.
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.