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INTRODUCTION

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rituximab (ri-tux-i-mab)

Rituxan

Classification

Therapeutic: antineoplastics

Pharmacologic: monoclonal antibodies

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Indications
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Treatment of low-grade or follicular, CD20-positive, B-cell non-Hodgkin's lymphoma alone, with, or following treatment with cyclophosphamide, vincristine, and prednisolone (CVP). Moderately to severely active rheumatoid arthritis with methotrexate in patients who have had an inadequate response to one of more TNF antagonist therapies.

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Action
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Binds to the CD20 antigen on the surface of lymphoma cells, preventing the activation process for cell-cycle initiation and differentiation. Therapeutic Effects: Death of lymphoma cells. Reduced signs and symptoms of rheumatoid arthritis.

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Adverse Reactions/Side Effects
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CNS: PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, headache. Resp: bronchospasm, cough, dyspnea. CV: ARRHYTHMIAS, hypotension, peripheral edema. GI: abdominal pain, altered taste, dyspepsia. Derm: MUCOCUTANEOUS SKIN REACTIONS, flushing, urticaria. Endo: hyperglycemia. F and E: hypocalcemia. Hemat: ANEMIA, NEUTROPENIA, THROMBOCYTOPENIA. MS: arthralgia, back pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND ANGIOEDEMA, infections, INFUSION REACTIONS, TUMOR LYSIS SYNDROME, fever/chills/rigors (infusion related).

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions including anaphylaxis and angioedema. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria, burning skin, swelling in the face). Be especially alert for these signs after drug infusion (infusion reactions). Notify physician or nursing staff immediately if these reactions occur.

  • Monitor and report signs of progressive multifocal leukoencephalopathy, including headache, confusion, seizures, and loss of vision. Early recognition and adjustment of drug dosage is important in resolving this syndrome.

  • Assess heart rate (HR), ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor neuromuscular signs of electrolyte imbalances that might indicate tumor lysis syndrome. Signs include severe muscle weakness or paralysis due to increased plasma potassium (hyperkalemia), or muscle hyperexcitability and tetany due to phosphate and calcium imbalances (hyperphosphatemia and hypocalcemia). Notify physician or nursing staff immediately if these signs occur.

  • Monitor and report skin or mucocutaneous reactions, including inflammation, swelling, and burning pain of the skin and mucous membranes.

  • Monitor signs of bone marrow suppression, including neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Notify physician of these signs immediately.

  • If treating rheumatoid arthritis, periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help determine if antirheumatic drug therapy is successful.

  • Assess any increased joint or back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Assess blood pressure (BP) periodically. Report a problematic decrease in BP (hypotension; See Appendix F), especially if dizziness and syncope ...

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