Warnings and Precautions
Tumor Lysis Syndrome: Acute renal failure, hyperkalemia, hypocalcemia, hyperuricemia, or hyperphosphatemia from tumor lysis, some fatal, can occur within 12−24 hours after the first infusion of Rituxan in patients with NHL. Administer aggressive intravenous hydration, anti-hyperuricemic agents, monitor renal function
Infections: Serious, including fatal, bacterial, fungal, and new or reactivated viral infections can occur during and following the completion of Rituxan-based therapy. Withhold Rituxan and institute appropriate anti-infective therapy. Rituxan is not recommended for use in patients with severe, active infections
Cardiovascular Adverse Reactions: Discontinue infusions in case of serious or life-threatening events
Renal Toxicity: Severe, including fatal, renal toxicity can occur after Rituxan administration in patients with NHL. Discontinue in patients with rising serum creatinine or oliguria
Bowel Obstruction and Perforation: Abdominal pain, bowel obstruction and perforation, in some cases leading to death, can occur in patients receiving Rituxan in combination with chemotherapy. Consider and evaluate for abdominal pain, vomiting, or related symptoms
Immunization: Live virus vaccinations prior to or during Rituxan treatment not recommended
Embryo-Fetal Toxicity: Can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and use of effective contraception.
Concomitant Use With Biologic Agents and DMARDs Other Than Methotrexate: Patients with RA should be closely observed for signs of infection if biologic agents and/or DMARDs other than methotrexate are used concomitantly. Use of concomitant immunosuppressants other than corticosteroids has not been studied in GPA, MPA, or PV patients exhibiting peripheral B-cell depletion following treatment with Rituxan
Use in Patients With RA Who Had No Prior Inadequate Response to TNF Antagonists: The use of Rituxan in patients with RA who have not had prior inadequate response to one or more TNF antagonists is not recommended.