Rituximab can make it more difficult for your body to fight infections. Therefore, people with active infections should not take rituximab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of rituximab with their healthcare provider.
Also contact your healthcare provider if you are having surgery as you may need to stop rituximab until you are healed and there is no sign of infection.
Rituximab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. People that can become pregnant should use effective birth control methods during and for up to 12 months after treatment with rituximab. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.
If you have ever had a rare infection of the brain called progressive multifocal leukoencephalopathy (PML) or if you have had a previous allergic reaction to rituximab, you should not take the medication.
In rare cases, severe skin reactions have been reported in patients receiving rituximab. Get medical help right away if you have signs of redness, swelling, blistering or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.
Hepatitis B virus (HBV) reactivation has occurred in patients treated with rituximab, in some cases resulting in hepatic failure and death. All patients should be screened for HBV infection before treatment initiation and should be monitored for hepatitis during and after treatment with rituximab.
Rituximab has been associated with abnormal heart rhythms. Tell your doctor if you have any such cardiac issues.
Make sure that your vaccinations are up to date before starting rituximab. Your healthcare provider will likely recommend a number of vaccines (e.g., influenzae, pneumonia, RSV, shingles) to get beforehand. Because rituximab can stop your ability to react to vaccines, you should wait at least two to three weeks after your vaccine before starting rituximab. If you are already on rituximab and need a vaccination, try to space it as long as you can after your last dose. Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking rituximab, you should speak with your healthcare provider.