Rituxan Info > What
to expect . . .
. . . and how
to prepare, for your first treatment with Rituxan
Andy writes: "It seems that most
people have a pretty easy time of it. Despite being pretty positive,
I had a pretty tough time (fevers, chills, rigors (convulsions) the
first time and then progressively easier times (mostly just chest
The best help is that they will pre-medicate to alleviate the side
effects. It is standard to get oral Tylenol, oral or IV Benadryl,
and with R-CHOP see if they will give the IV prednisone (or
Dexamethasone) before the Rituxan. The last one helps a lot and I
think has become much more standard since I had Rituxan 4 years ago.
The best thing the two of you can do is to tell the nurses
anything you notice right away. This is NOT the time to gut through
a reaction. Ask them what to watch for, tell them immediately if it
starts, and they can slow down or stop the infusion and/or give
extra medication until the reactions subside.
Most people have no problems, some of us are problem cases but with
teamwork between us and our nurses get through just fine, and only a
very few have serious problems. It is good to be aware of the
possibilities but try not to stress too much as you will probably
may want to review and print
out the Dosage
and Administration Guide for details
This will help you to become familiar with the procedure so that
you might ask informed questions and know what to expect.
Ask questions of
your doctor about specific risk factors you may have.
"Patients requiring close monitoring
during first and all subsequent infusions include those with:
pre-existing cardiac and pulmonary conditions,
those with prior
clinically significant cardiopulmonary adverse events,
with high numbers of circulating malignant cells (<25,000/mm3)
with or without evidence of high tumor burden."
Plan to stay
of the day - especially for the first infusion
should be given very slowly to minimize infusion-related risks. If you
tolerate the first infusion well, you may be done in as little as
three hours after that.
NOTE: It does not appear to make a difference how long it
takes to get the full dose of Rituxan. You can stop one day,
and begin the next, for example.
For details, see Multimodality Therapies and
Optimal Schedule of Antibodies: Rituximab in Lymphoma as an
bad idea to prepare a thank-you-in-advance
gift, such as
baked goods, for the nursing staff. They work very hard and
appreciate being appreciated.
Arrange to have a friend or relative accompany
you, because the therapy can make you drowsy and impact
your ability to drive or observe unusual sensations that should be
reported to the attending nurse.
If you cannot arrange this, post a request to one of the many
online support lists for a patient or caregiver volunteer to
accompany you. See Support
material, or a portable audiotape/CD
player with headphones to help pass the time.
Bring snacks, bottled water, and a pillow as well.
Many centers will have snacks and drink available.
Most patients have little problem at all. It's common
to experience fatigue for the remainder of the day, and the next day
Monitoring your reactions:
Talk to the nurse and your doctor about treatment risks
they will do to monitor you.
Indicate that you are in no hurry
to complete the infusion and that you will appreciate being monitored
closely, especially the first time.
Ask the nurse or doctor about sensations
that are to be expected and
what to report immediately. Also refer to the Dosage and Administration
Guide for details. When in doubt: ASK
and Administration Guide Rituxan.com
Just before treatment, you
in pill form.
You will receive
Benadryl to help you tolerate the infusion better. This will make you drowsy. The same IV used to administer the Benadryl will
be used to administer the Rituxan. The Benadryl may cause a temporary
The rate of administering the Rituxan is very slow at the
may be increased when it's determined you are tolerating it well.
helps to decrease reactions, but it also works against being observant. Watching for
and notifying the nurse of changes, such as hives, skin
sensations, and difficulty in breathing - especially when the dose increases
- can help to head off strong adverse reactions.
Your vitals (temperature and blood
pressure) will be taken and monitored throughout the treatment
session, as often as every 30 minutes. Use this time to
report unusual sensations.
Notify the nurse
when you have any unusual
receiving a treatment is not the time to be stoical and brave.
the sensations you feel. It's much better to pick up on
reactions sooner. The rituxan can be continued later, and more
slowly to overcome problems, and this will not influence the efficacy
of the treatment.
Also, it doesn't hurt to buy some over-the-counter
Benadryl and have
that on hand at home for any delayed reactions. AndyM,