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Rituxan (rituximab) Disease Interactions

There are 7 disease interactions with Rituxan (rituximab):

Major

Rituximab (Includes Rituxan) ↔ Autoimmune Diseases

Severe Potential Hazard, Moderate plausibility

Applies to: Autoimmune Disorder, Leukemia, Lymphoma, Multiple Myeloma, Myeloproliferative Disorders

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

Major

Rituximab (Includes Rituxan) ↔ Cardiac Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Arrhythmias, Ischemic Heart Disease

Cardiotoxicity has been reported in a few patients receiving rituximab infusion during clinical studies. Patients with a history of angina or arrhythmias have experienced recurrences of these conditions during administration of rituximab. Therapy with rituximab should be administered cautiously in patients with preexisting arrhythmias or coronary artery or ischemic heart disease. Clinical monitoring of cardiac function throughout infusion and immediately post-infusion is recommended.

References

  1. "Product Information. Rituxan (rituximab)." Genentech, South San Francisco, CA.
Major

Rituximab (Includes Rituxan) ↔ Hepatitis B

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Hepatitis

Rituximab, as other drugs classified as CD20-directed cytolytic antibodies can cause hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure and death. Cases have been reported in patients who are hepatitis B surface antigen (HBsAg) positive and also in patients who are HBsAg negative but are hepatitis B core antibody (anti-HBc) positive. Reactivation also has occurred in patients who appear to have resolved hepatitis B infection (i.e., HBsAg negative, anti-HBc positive and hepatitis B surface antibody [anti-HBs] positive). Screen all patients for HBV infection by measuring HBsAg and anti-HBc before initiating treatment with rituximab. Monitor patients with evidence of current or prior HBV infection for clinical and laboratory signs of hepatitis or HBV reactivation during and for several months following rituximab therapy. In patients who develop reactivation of HBV while on rituximab, immediately discontinue rituximab and any concomitant chemotherapy, and institute appropriate treatment.

Major

Rituximab (Includes Rituxan) ↔ Tls

Severe Potential Hazard, Moderate plausibility

Applies to: 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 rituximab in patients with Non-Hodgkin Lymphoma (NHL). Administer aggressive intravenous hydration and anti-hyperuricemic therapy in patients at high risk for Tumor Lysis Syndrome (TLS). Correct electrolyte abnormalities, monitor renal function and fluid balance, and administer supportive care, including dialysis as indicated.

Moderate

Rituximab (Includes Rituxan) ↔ Bone Marrow Suppression

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Myelosuppression has been reported during administration of rituximab. Leukopenia and thrombocytopenia occur more frequently than anemia. Severe myelosuppression has been reported rarely. Therapy with rituximab should be administered cautiously in patients with severe bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

References

  1. "Product Information. Rituxan (rituximab)." Genentech, South San Francisco, CA.
Moderate

Rituximab (Includes Rituxan) ↔ Infections

Moderate Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Rituximab can cause serious, including fatal, bacterial, fungal, and new or reactivated viral infections during and following the completion of rituximab-based therapy. Infections have been reported in some patients with prolonged hypogammaglobulinemia (defined as hypogammaglobulinemia >11 months after rituximab exposure). New or reactivated viral infections included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. The manufacturer recommends to discontinue rituximab for serious infections and institute appropriate anti-infective therapy.

Moderate

Rituximab (Includes Rituxan) ↔ Renal Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Severe, including fatal, renal toxicity can occur after rituximab administration in patients with Non-Hodgkin's Lymphoma (NHL). Renal toxicity has occurred in patients who experience tumor lysis syndrome and in patients with NHL administered concomitant cisplatin therapy during clinical trials. The combination of cisplatin and rituximab is not an approved treatment regimen. Monitor closely for signs of renal failure and discontinue rituximab in patients with a rising serum creatinine or oliguria. No formal studies have been conducted to examine the effects of renal impairment on the pharmacokinetics of rituximab.

Rituxan (rituximab) drug Interactions

There are 123 drug interactions with Rituxan (rituximab)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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