Rituxan Side Effects

Generic name: rituximab

Medically reviewed by Drugs.com. Last updated on Mar 16, 2025.

Note: This document provides detailed information about Rituxan Side Effects associated with rituximab. Some dosage forms listed on this page may not apply specifically to the brand name Rituxan.

Applies to rituximab: intravenous solution.

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. If you are a woman who can get pregnant, your doctor may do tests to make sure you are not pregnant before giving you this medicine. Use an effective form of birth control to keep from getting pregnant during treatment with this medicine and for at least 12 months after the last dose. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

This medicine may cause infusion-related reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you start to have a fever, chills or shaking, dizziness, trouble breathing, itching or rash, lightheadedness or fainting after receiving this medicine.

This medicine can cause a hepatitis B infection to come back. Check with your doctor right away if you have any symptoms of liver problems, including skin and eyes turning yellow, dark brown-colored urine, right-sided abdominal or stomach pain, fever, or severe tiredness.

Serious skin and mouth reactions (eg, paraneoplastic pemphigus, Stevens-Johnson syndrome, lichenoid dermatitis, vesiculobullous dermatitis, and toxic epidermal necrolysis) can occur during treatment with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness while you are receiving this medicine.

This medicine may cause a rare and serious brain infection called progressive multifocal leukoencephalopathy (PML). The risk for getting this infection is higher if you have rheumatoid arthritis. Talk to your doctor about the benefits of receiving this medicine and the risk for this infection. Check with your doctor right away if you have vision changes, loss of coordination, clumsiness, memory loss, difficulty speaking or understanding what others say, and weakness in the legs.

This medicine may cause a serious type of reaction called tumor lysis syndrome (TLS). Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

This medicine may increase your risk of developing infections (eg, viral, bacterial, or fungal) during or after treatment with this medicine. Avoid being near people who are sick or have infections while you are using this medicine. Wash your hands often. Tell your doctor if you have lupus or if you have any kind of infection before you start using this medicine. Also tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

Call your doctor right away if you start to have a cough that won't go away, weight loss, night sweats, fever, chills, flu-like symptoms (eg, runny or stuffy nose, headache, blurred vision, or feeling generally ill), painful or difficult urination, or sores, ulcers, or white spots in the mouth or on the lips. These may be signs that you have an infection.

While you are being treated with rituximab (the active ingredient contained in Rituxan) and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. You may receive non live vaccines at least 4 weeks before starting treatment with this medicine. Rituximab may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not get live vaccines (eg, nasal flu virus vaccine). Try to avoid persons who have taken live vaccines. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should wear a protective face mask that covers the nose and mouth.

This medicine may cause heart and heart rhythm problems (eg, heart attack, arrhythmia, cardiogenic shock). Check with your doctor if you have chest pain or discomfort, pain or discomfort in the arms, jaw, back, or neck, dizziness, fainting, fast, slow, or irregular heartbeat, cool, sweaty skin, or trouble breathing.

Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

This medicine may cause serious stomach and bowel problems, especially when used with other cancer medicines. Check with your doctor right away if you start having stomach pain while being treated with this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of Rituxan

Along with its needed effects, rituximab may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking rituximab:

Other side effects of Rituxan

Some side effects of rituximab may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to rituximab: intravenous solution.

Cardiovascular adverse events

• Very common (10% or more): Hypotension (10%)
• Common (1% to 10%): Hypertension, orthostatic hypotension, myocardial infarction, arrhythmia, atrial fibrillation, tachycardia
• Uncommon (0.1% to 1%): Left ventricular failure, supraventricular tachycardia, ventricular tachycardia, angina, myocardial ischemia, bradycardia
• Very rare (less than 0.01%): Heart failure, vasculitis (predominately cutaneous), leukocytoclastic vasculitis^[Ref]

Dermatologic

• Very common (10% or more): Night sweats (15%), rash (15%), pruritus (14%), angioedema (11%), alopecia
• Common (1% to 10%): Flushing, urticaria, skin disorder
• Very rare (less than 0.01%): Severe bullous skin reactions, Stevens-Johnson Syndrome, toxic epidermal necrolysis (Lyell's Syndrome)
• Postmarketing reports: Severe mucocutaneous reactions^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (23%), abdominal pain (14%), diarrhea (10%), vomiting (10%)
• Common (1% to 10%): Throat irritation, dysphagia, stomatitis, constipation, dyspepsia, anorexia
• Uncommon (0.1% to 1%): Abdominal enlargement
• Frequency not reported: GI perforation
• Postmarketing reports: Bowel obstruction^[Ref]

Hematologic

• Very common (10% or more): Lymphopenia (48%), leukopenia (14%), neutropenia (14%), thrombocytopenia (12%)
• Common (1% to 10%): Blood lactate dehydrogenase (LDH) increased, pancytopenia, granulocytopenia
• Uncommon (0.1% to 1%): Anemia, coagulation disorders, aplastic anemia, hemolytic anemia, lymphadenopathy, transient aplastic anemia, hemolytic anemia
• Postmarketing reports: Late neutropenia, marrow hypoplasia, Grade 3 to 4 prolonged or late-onset neutropenia, hyperviscosity syndrome in Waldenstrom's macroglobulinemia, prolonged hypogammaglobulinemia^[Ref]

Hepatic

• Very common (10% or more): Increased ALT (13%)
• Frequency not reported: Hepatitis B reactivation with fulminant hepatitis, hepatic failure^[Ref]

Hypersensitivity

• Common (1% to 10%): Hypersensitivity
• Rare (0.01% to 0.1%): Anaphylaxis
• Very rare (less than 0.01%): Tumor lysis syndrome, cytokine release syndrome, serum sickness^[Ref]

Immunologic

• Very common (10% or more): Infection (bacterial, viral) (31%)
• Common (1% to 10%): Sepsis, febrile infection, herpes zoster, fungal infections, infections of unknown etiology, acute bronchitis, sinusitis
• Rare (less than 0.1%): Serious viral infections
• Postmarketing reports: Lupus-like syndrome, serum sickness, increase in fatal infections in HIV-associated lymphoma, increased incidence of Grade 3 and 4 infections^[Ref]

Local

• Very common (10% or more): Acute infusion reactions (e.g., pain, fever, chills, rigors, pruritus, urticaria/rash, angioedema, sneezing, throat irritation, cough, and/or bronchospasm, with or without associated hypotension or hypertension) (27%)^[Ref]

Metabolic

• Very common (10% or more): Hypophosphatemia (12%)
• Common (1% to 10%): Hyperglycemia, peripheral edema, hyperuricemia, weight decrease, peripheral edema, face edema, increased LDH, hypocalcemia^[Ref]

Musculoskeletal

• Very common (10% or more): Back pain (10%), myalgia (10%), arthralgia (10%)
• Common (1% to 10%): Neck pain, hypertonia
• Frequency not reported: Polyarticular arthritis^[Ref]

Nervous system

• Very common (10% or more): Headache (19%), dizziness (10%)
• Common (1% to 10%): Pyrexia, paresthesia, hypoesthesia
• Uncommon (0.1% to 1%): Dysgeusia
• Postmarketing reports: Posterior reversible encephalopathy syndrome (PRES)/reversible posterior leukoencephalopathy syndrome (RPLS)^[Ref]

Ocular

• Common (1% to 10%): Lacrimation disorder, conjunctivitis
• Very rare (less than 0.01%): Severe vision loss
• Postmarketing reports: Uveitis, optic neuritis^[Ref]

Oncologic

• Postmarketing reports: Disease progression of Kaposi's sarcoma^[Ref]

Other

• Very common (10% or more): Fever (53%), chills (33%), asthenia (26%), fatigue (13%), pain (12%)
• Common (1% to 10%): Migraine, asthenia, tinnitus, ear pain, tumor pain, flushing, malaise, cold syndrome, shivering, multi-organ failure
• Very rare (less than 0.01%): Hearing loss^[Ref]

Psychiatric

• Common (1% to 10%): Anxiety, depression, nervousness, agitation, insomnia^[Ref]

Renal

• Very rare (less than 0.01%): Renal failure^[Ref]

Respiratory

• Very common (10% or more): Cough (13%), rhinitis (12%), epistaxis (11%), dyspnea (10%), bronchitis
• Common (1% to 10%): Bronchospasm, sinusitis, pneumonia, chest pain
• Uncommon (0.1% to 1%): Upper respiratory tract infection, asthma, bronchiolitis obliterans (fatal), lung disorder, hypoxia
• Rare (0.01% to 0.1%): Interstitial lung disease
• Very rare (less than 0.01%): Respiratory failure
• Frequency not reported: Lung infiltration
• Postmarketing reports: Pleuritis^[Ref]

See also:

Frequently asked questions

• What are the new drugs for rheumatoid arthritis (RA)?
• How will I feel after a Rituxan infusion?
• What are monoclonal antibodies?
• How long does it take for Rituxan to work?
• What are biosimilar drugs and how do they compare to biologics?
• Does Rituxan cause hair loss?
• How does the drug Rituxan work?
• What is the difference between Truxima and Rituxan?
• What is the success rate of Rituxan (rituximab) in patients with blood cancers?

Further information

Rituxan side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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