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Rituximab: Brands, Price & Uses in Bangladesh
Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen on B-lymphocytes.
About Rituximab
Indications of Rituximab
Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen on B-lymphocytes. It is used, alone or in combination with other agents, for the following conditions:
FDA-approved / established indications
- Non-Hodgkin's Lymphoma (NHL): Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent; also used in combination with chemotherapy for previously untreated follicular NHL and diffuse large B-cell lymphoma (DLBCL), and as single-agent maintenance therapy.
- Chronic Lymphocytic Leukemia (CLL): Previously untreated and previously treated CD20-positive CLL, in combination with fludarabine and cyclophosphamide.
- Rheumatoid Arthritis (RA): Moderately to severely active RA in adults with an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies — must be used in combination with methotrexate.
- Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA): Induction and maintenance of remission in adult and pediatric patients (2 years and older), in combination with glucocorticoids.
- Pemphigus Vulgaris (PV): Moderate-to-severe disease in adults.
- Pediatric B-cell malignancies: Previously untreated, advanced-stage CD20-positive diffuse large B-cell lymphoma, Burkitt lymphoma, Burkitt-like lymphoma, or mature B-cell acute leukemia in pediatric patients 6 months of age and older, in combination with chemotherapy.
Guideline-supported / commonly used off-label indications
Guidelines and clinical experience also support use of Rituximab (off-label with respect to the original FDA label) in certain B-cell-mediated or autoantibody-mediated conditions, such as refractory idiopathic thrombocytopenic purpura (ITP), certain forms of vasculitis-associated glomerulonephritis, and select autoimmune cytopenias, generally reserved for cases refractory to first-line therapy and under specialist supervision.
All uses of Rituximab require administration by a healthcare professional in a setting equipped to manage severe infusion reactions.
Dosage & Administration of Rituximab
Rituximab must be administered by, or under the direct supervision of, a qualified healthcare professional, with full resuscitation equipment immediately available, because of the risk of severe infusion reactions. Rituximab is given only as an intravenous infusion — never as an intravenous push or bolus.
| Indication | Typical Adult Dose |
|---|---|
| Non-Hodgkin's Lymphoma | 375 mg/m² IV once weekly for 4 to 8 doses, alone or combined with chemotherapy per regimen; maintenance schedules vary by protocol |
| Chronic Lymphocytic Leukemia | 375 mg/m² on Day 0/1 of cycle 1, then 500 mg/m² on Day 1 of cycles 2–6 (28-day cycles), combined with fludarabine and cyclophosphamide |
| Rheumatoid Arthritis | Two 1,000 mg IV infusions separated by 2 weeks, combined with methotrexate; re-treatment courses no more often than every 24 weeks based on clinical evaluation |
| GPA / MPA | 375 mg/m² IV once weekly for 4 weeks (induction), combined with glucocorticoids, followed by maintenance dosing per protocol |
| Pemphigus Vulgaris | Two 1,000 mg IV infusions separated by 2 weeks, with maintenance infusions at month 12 and thereafter per response |
Premedication with an antipyretic (e.g., paracetamol) and an antihistamine is recommended before every infusion; glucocorticoid premedication is required for the RA, GPA/MPA, and PV indications. The first infusion is started at a slow rate and increased gradually if tolerated; subsequent infusions may be given at a faster initial rate if the prior infusion was well tolerated. See Administration and Precautions and Warnings for full detail.
Side Effects of Rituximab
Adverse effects associated with Rituximab vary by indication but commonly include:
- Infusion-related reactions (most common, especially with the first infusion): fever, chills, rigors, pruritus, urticaria, angioedema, hypotension, bronchospasm, dyspnea, and headache — see Precautions and Warnings for the serious/fatal form of this reaction.
- Hematologic: lymphopenia, neutropenia, thrombocytopenia, anemia.
- Infections: upper respiratory tract infections, urinary tract infections, nasopharyngitis, bronchitis, sinusitis; serious infections including reactivation of viral infections (see Precautions and Warnings for hepatitis B reactivation and PML).
- General: fatigue, nausea, diarrhea, arthralgia, muscle spasms.
- Mucocutaneous reactions: rash and, rarely, severe/fatal mucocutaneous reactions (see Precautions and Warnings).
Contraindications of Rituximab
Rituximab is contraindicated in patients with a known history of severe hypersensitivity (e.g., anaphylaxis) to Rituximab or to murine (mouse) proteins, or to any component of the formulation.
Frequently Asked Questions about Rituximab
What is Rituximab used for?
Rituximab is a monoclonal antibody used to treat certain B-cell blood cancers (non-Hodgkin's lymphoma, chronic lymphocytic leukemia), moderate-to-severe rheumatoid arthritis (with methotrexate) when other treatments have not worked well enough, certain forms of vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis), and pemphigus vulgaris, a serious autoimmune skin condition.
How is Rituximab given?
Rituximab is given only as a slow intravenous (IV) infusion by a healthcare professional in a clinic or hospital equipped to manage allergic and infusion reactions. It is never taken by mouth or injected quickly, and each infusion can take several hours, especially the first one.
What are the most serious risks of Rituximab?
Rituximab carries boxed warnings for severe, sometimes fatal, infusion reactions (especially with the first dose), severe skin reactions, reactivation of hepatitis B virus in prior carriers, and a rare but serious brain infection called progressive multifocal leukoencephalopathy (PML). Your doctor will screen you for hepatitis B and monitor you closely, particularly during your first infusion.
Can Rituximab be used during pregnancy or breastfeeding?
Rituximab should be used in pregnancy only if clearly necessary, since it can cross the placenta and reduce B-cells in the baby; effective contraception is recommended during and for 12 months after treatment. Breastfeeding is generally not recommended during and for some months after treatment with Rituximab. Always consult your physician before use in pregnancy or while breastfeeding.
Can Rituximab be given to children?
Rituximab is approved for certain B-cell cancers in children 6 months and older and for a type of vasculitis in children 2 years and older, always combined with other medicines and under specialist care. It is not established as safe and effective for other pediatric uses, such as rheumatoid arthritis.
What should I tell my doctor before starting Rituximab?
Tell your doctor about any history of hepatitis B, heart disease, active infections, recent or planned vaccinations, and any allergy to Rituximab or mouse-derived proteins, since these affect whether and how Rituximab can be safely given to you.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.