• Shruti GOCHHWAL

Reactions To Rituximab In An Outpatient Infusion Center

There are numerous deadly diseases and medical conditions that cause some fatal effects on the human body. For example, certain autoimmune conditions that the person is unable to take oral medications to treat their condition- the most obvious and common approach of non-invasive treatment. However, the advances and success in modern medicine gave rise to infusion therapy.

Some conditions that specifically require infusion therapy include:

  1. Multiple Sclerosis

  2. Rheumatoid Arthritis

  3. Crohn’s Disease

  4. Lupus

  5. Cancer

  6. Blood diseases

  7. Other conditions/diseases treated with injections.

What is an Outpatient Infusion Center?

Outpatient Infusion Center is a type of center that provides treatment for the conditions mentioned above through infusion therapy – where the medication enters into the patient’s body intravenously.

This means that the drugs or medication is administered straight into the vein using a sterile catheter. Sometimes, it may also be infused through other non-oral routes, such as epidurals in the spinal cord, intramuscular injections, etc

 In local hospitals such infusion treatment has traditionally been practiced. However, after an increase in specialization in this specific field and due to other factors like cost containment, outpatient infusion centers have become more common.

Image Credit: Wikimedia Commons


What is Rituximab?

Rituximab is an intravenous drug commonly sold under the Rituxan brand name. It is part of a class of drugs called monoclonal antibodies.

The Rituximab infusion reaction protocol: ⦁ It is commonly used to treat cancer by slowing or stopping the growth of cancerous and tumor cells. Eg- non-Hodgkin’s lymphoma, leukemia, etc ⦁ It is also used to treat rheumatoid arthritis by decreasing joint pain and swelling. ⦁ Treats certain types of blood vessel disease by decreasing the swelling of the blood vessels and also helps reduce skin lesions and thus, treats certain skin conditions.

Side Effects: Rituximab Infusion Reaction

Majority of patients undergoing this treatment develop a reaction during initial exposure of the drug.

Some serious side effects of rituximab include:

Infusion-related Reactions

  1. Hives

  2. Rashes

  3. Itching

  4. Swollen lips, tongue, throat, or face

  5. Sudden cough

  6. Difficulty breathing

  7. Wheezing

  8. Weakness and fatigue

  9. Dizziness

  10. Heart palpitations

  11. Chest ache

Such reactions are very common side effects of rituximab and usually occur within 24 hours after treatment.

Skin and Mouth Reactions

  1. Painful sores or ulcers on your skin, lips, or in your mouth

  2. Blisters

  3. Peeling skin

  4. Rash

  5. Pustules

Progressive Multifocal Leukoencephalopathy (PML)

People who receive rituximab, are at risk of developing a serious, rare, viral brain disease known as PML.

This condition is fatal as it weakens your immune system and results in severe disability or death.

Symptoms include:

  1. Confusion

  2. Dizziness

  3. Loss of balance

  4. Difficulty walking

  5. Speech problems

  6. Weakness

  7. Vision problems, such as blurred vision or loss of vision

Other serious systemic conditions including:

  1. Heart problems Chest pain, irregular heartbeats, and heart attack.

  2. Kidney problems Rituximab can cause severe kidney problems that could lead to death.

  3. Digestive problems Causes bowel problems like blockage or tears in the bowel, abdominal pain, or repeated vomiting during treatment. It could be fatal.

  4. Serious Infections The patient could develop certain viral, bacterial, and fungal infections that could seriously damage the immune system or lower its ability to fight infections.

Symptoms include:

  1. Fever

  2. Cold

  3. Runny nose

  4. Sore throat

  5. Flu symptoms, such as cough, tiredness, and body aches

  6. Earache

  7. Headache

  8. Urination pain

  9. Cold sores in the mouth or throat

  10. Cuts, or incisions that are inflamed- red, warm, swollen, or painful

  1.  Tumor Lysis Syndrome (TLS) It is a condition caused by the fast breakdown of cancer cells and often results in kidney failure and abnormal heart rhythm.

Early symptoms include:

  1. Nausea

  2. Vomiting

  3. Diarrhea

  4. Lack of energy

Rituximab and Hepatitis B Virus (HBV) Reactivation

Your health care providers will usually test your blood for HBV infection before treating you with rituximab.

This is because if the test is positive- meaning if you previously had hepatitis B or are a carrier of hepatitis B virus, then the drug would reactivate or activate the virus and the body would get infected, causing fatal liver problems.

Conclusion

As effective as the drug is, there are numerous possibilities of developing serious side effects. Thus, it is important for the patient to be closely monitored by their health care specialist during their treatment plan.

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