Anti-CD20 Monoclonal Antibody Pregnancy: D

Rituximab (Haematology)

Brand names: MabThera, Rixathon, Truxima

Adult dose

Dose: 375 mg/m² IV weekly × 4 weeks (lymphoma); 1000 mg IV × 2 doses 2 weeks apart (RA)

Route: intravenous infusion

Frequency: weekly (lymphoma) or two doses 2 weeks apart (RA/ITP)

Max: Protocol dependent

Pre-medicate with paracetamol, antihistamine, methylprednisolone (or dexamethasone) to reduce infusion reactions; first infusion slow (50 mg/h initially)

Paediatric dose

Route: IV infusion

Frequency: weekly × 4

Max: Protocol dependent

Concentration: 10 mg/mL (dilute to 1–4 mg/mL in NaCl 0.9%) mg/m²/ml

Specialist use only for paediatric B-cell lymphoma, PTLD, or autoimmune conditions

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution

Clinical pearls

Screen for hepatitis B (HBsAg and anti-HBc) before every course — reactivation can be fatal
PML risk: check JC virus antibody status; counsel about neurological symptoms
Immunoglobulin levels should be checked before each cycle and during therapy — consider IVIG replacement if IgG <4 g/L with infections

Contraindications

Active severe infection
Severe cardiac failure (NYHA IV)
Active hepatitis B (screen all patients — risk of reactivation)

Side effects

Infusion reactions (fever, rigors, hypotension, bronchospasm)
Hepatitis B reactivation
PML (progressive multifocal leukoencephalopathy — JC virus)
Delayed neutropenia
Hypogammaglobulinaemia

Interactions

Live vaccines (contraindicated during and 12 months after)
Other immunosuppressants (infection risk)

Monitoring

FBC (neutropenia)
Hepatitis B serology (all patients)
Immunoglobulins
JC virus antibodies
Infusion reaction monitoring

Reference: BNFc; BNF 86; NICE TA137; SPC rituximab. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways