Rituximab Rituximab is a medicine that is usually used to treat certain types of cancer. It belongs to a class of medications called monoclonal antibodies. Rituximab also offers an alternative to current immunosuppressive therapies for difficult-to-treat Nephrotic Syndrome. Why is rituximab needed for Nephrotic Syndrome patients? Rituximab has shown best treatment outcomes in patients with steroid-resistant Nephrotic Syndrome, particularly those with Focal Segmental Glomerulosclerosis (FSGS) and young patients who suffer with recurrent FSGS. Successful rituximab treatment can help you go into prolonged remission and allow you to stop taking other medications without substantially increasing the risk of infections and other serious side effects. How should I take rituximab? How is rituximab administered? Rituximab is a clear liquid given intravenously (IV) in a hospital or a clinic. Patients are often pre-medicated with Benadryl to ward off allergic reactions. Rituximab is given slowly over a period of several hours. While receiving rituximab, a patient is closely monitored for adverse side effects and can expect to have blood pressure and other vitals monitored very closely. How does rituximab work? Rituximab reduces the number of harmful antibodies called autoantibodies (ANCA) that a body produces by targeting and destroying B-cells. ANCAs attack healthy tissue and cells and are produced by B-cells. The autoantibodies target specific white blood cells called neutrophils, and the ANCAs cause neutrophils to stick and clump to the walls of small blood vessels in different tissues and organs of the body. This clumping leads to inflammation. Rituxan decreases the number of B-cells by targeting those that have a specific marker on their cell surface called CD20. It is thought that interfering with B-cell function can disrupt ANCA production as well. What are the possible side effects of rituximab? Rituximab can cause some reactions during the time the drug is being given or shortly after. These are called infusion reactions. They will usually occur with the first dose and are less common with later doses. To help prevent this type of reaction, acetaminophen (Tylenol) and diphenhydramine (Benadryl) are given before rituximab. However, tell your doctor immediately if you experience a reaction during the infusion or within 24 hours afterwards, such as: Chills or fever Nausea (upset stomach) or vomiting (throwing up) Swelling of the tongue or throat Hives (raised red spots on the skin) or itching Headache Trouble breathing Dizziness or lightheadedness Flushing (feeling warm and turning red) Blurred vision Some side effects are experienced while taking Rituximab. Check with your doctor if you continue to have any of these side effects and they do not go away: Tiredness Pain in joints or muscle stiffness Dizziness or lightheadedness Diarrhea (loose, watery bowel movements) Night sweats Most of the following side effects are not common, but they may be a sign of a serious problem. Call your doctor right away or go to the emergency room if you experience the following side effects: Fever or chills Cough or sore throat Abdominal pain or stomach pain Lower back or side pain Chest pain Swelling of the tongue or throat, face, hands, or feet Trouble breathing or swallowing Shortness of breath Fast or uneven heartbeat Severe skin reactions such sores or peeling skin Blood in urine or stools Unusual bruising or bleeding What are precautionary measures I should take while taking rituximab? Check with your doctor before taking any other medicines (prescription, non-prescription, herbal, or natural products). Before having any operation or procedure, inform your doctor or dentist that you are taking rituximab. Rituximab may make you dizzy, drowsy, and less alert than normal. Watch carefully when you are doing something that you need to be alert for, such as climbing stairs. Rituximab can lower the number of white blood cells in the blood temporarily, which increases chances of getting an infection. Your doctor should do regular blood tests to monitor your blood counts and test for other side effects such as neutropenia. You should not receive any immunizations (vaccines) without your doctor’s approval while being treated with rituximab. Unrecognized Hepatitis B infection may become worse during rituximab treatment, so you should get the Hepatitis B test. Blood pressure medications may affect response to rituximab. Check with your doctor if you are taking any medicines to control blood pressure. *Note: The decision to prescribe a medication is the responsibility of your physician/primary care provider based on his/her evaluation of your condition. The above is meant for informational purposes only. Discuss this information and all information about drugs/medications with your physician before starting or stopping any medication.