What is Rituximab?

Rituximab is a biological therapy known as a monoclonal antibody. Rituximab reduces the number of B cells which produce antibodies that may be associated with autoimmune diseases. 

Why does my child need Rituximab?

Rituximab may be used to treat autoimmune conditions such as:

• Nephrotic syndrome
• Vasculitis
• Lupus (systemic lupus erythematosus (SLE))
• Autoimmune haemolytic anaemia

What to tell your child’s Doctor before a Rituximab infusion:

• If your child has had a reaction to a rituximab infusion before
• If your child is unwell at the moment  
• If they have other allergies or asthma

Questions to ask your child’s doctor before the Rituximab infusion:

• What are some of the side effects? (see below)
• How long will it take for the infusion to work?

Possible side effects

Speak to your child’s doctor if you are worried about any of the following possible side effects.

Infusion reactions are common with the first dose (up to 10% of patients) and usually improve if the infusion is given slower:

• Fever
• Shivering
• Nausea
• Vomiting
• Headache
• Itch
• Dizziness
• Shortness of breath  

Rash: itchy skin rashes have been reported in patients around 1 to 2 days after the second or third dose of rituximab and can last for several day. An anti-histamine may be used to treat these symptoms, ask a pharmacist for advice on the most appropriate antihistamine for your child.

Increased risk of infection: rituximab works by reducing antibody production. Antibodies are important in fighting infections, lower levels of antibody in the blood may be associated with an increased risk of infection.

Rare side effects (less than 1% of patients)

• Serious allergic reactions such as anaphylaxis can occur
• Your child will be closely monitored during the infusion and for 60 minutes afterwards
• Low levels B cells for a long period of time (or permanent) that may need replacement

Alert nursing staff immediately if you/your child:

• Shows any signs of an allergic reaction (e.g. swelling of the lips, mouth or throat, or difficulty breathing [short of breath, puffing when speaking])

There may be other side effects that are not listed in this fact sheet. If you notice anything unusual or are worried about your child, speak to your doctor.

What happens on the day of the Rituximab infusion?

• Rituximab infusions are usually given in the Day Medical Unit at the Royal Children’s Hospital, sometimes patient will have the infusion on a different ward if they are in hospital for another reason.
• Before the infusion starts, a nurse will weigh your child and check their vital signs (pulse, blood pressure, temperature, breathing rate).
• Your child will need to have an intravenous (IV) line inserted if they don’t have one.  
• The nurse will start the infusion which may run over different periods of time depending on how your child tolerates the medication. Infusions usually run over 4 to 6 hours – ask your doctor or nurse how long the infusion will take.
• Your child’s vital signs and their IV line will be checked by a nurse during the infusion and for 60 minutes after it has finished. 

Key points to remember

• Tell your doctor if your child has had a reaction to a rituximab infusion before
• Alert nursing staff immediately if you/your child shows any signs of an allergic reaction during their infusion (e.g. swelling of the lips, mouth or throat, or difficulty breathing [short of breath, puffing when speaking])
• Alert nursing staff immediately if you/your child has any pain or swelling around their IV line

For more information

• This fact sheet has been made to provide advice about the use of this medicine in children and should be read in addition to the information at NPS MedicineWise.
• Kids Health Info fact sheet: Medicines for children and medicine reactions
• Talk to your doctor or pharmacist
• The Therapeutic Goods Administration: Consumers

Common questions our doctors are asked

1. How often is Rituximab given?

Rituximab is usually given once a week for four doses or a higher dose may be given two weeks apart for two doses only. 

1. How long will the infusion take to complete?

Infusions usually take between 4 and 6 hours. Sometimes the infusions will need to run over a longer period of time if your child has a reaction.  

1. Is there anything that can be done to reduce the risk of reacting to Rituximab?

We give patients medicines before the infusion to reduce the chances of having a reaction. If your child has had a reaction to a Rituximab infusion, it will be given slower next time.

1. What happens after the infusion?

Your doctors will let you know about any tests or appointments that are needed or any changes to your other medicines. Doctors will monitor your child’s response to the Rituximab and check their antibody levels with blood tests.

1. Are there any precautions I need to be aware of after I have the infusion?

Some patients will need to take antibiotics to reduce the risk of infection, your doctor will decide whether they are needed. If your child develops a fever, they will need to be assessed by a doctor.

Developed by The Royal Children's Hospital Quality and Improvement Department. We acknowledge the input of RCH consumers and carers. 

Developed December 2022. 

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au. 

Reviewed by: Medication Safety Committee, Joshua Kausman (Nephrology), Theresa Cole (Immunology), Jonathan Akikusa (Rheumatology).

Parent review: Kate Taylor, Medication Safety Committee Consumer Representative