Rituximab/Hyaluronidase Human (Rituxan Hycela™)

About This Drug

Rituximab and hyaluronidase human is used to treat cancer. It is given under the skin (subcutaneously).

Possible Side Effects

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Infection
  • Nausea and vomiting (throwing up)
  • Constipation (not able to move bowels)
  • Cough
  • Tiredness
  • Hair loss. Hair loss is often temporary, although with certain medicine, hair loss can sometimes be permanent. Hair loss may happen suddenly or gradually. If you lose hair, you may lose it from your head, face, armpits, pubic area, chest, and/or legs. You may also notice your hair getting thin.
  • Fever
  • Skin and tissue irritation such as redness, pain, warmth, or swelling at the injection site.

Note: Each of the side effects above was reported in 20% or greater of patients treated with Rituximab and hyaluronidase human. Not all possible side effects are included above.

Warnings and Precautions

  • Skin and tissue irritation such as redness, pain, warmth, or swelling at the injection site-may occur more than 24 hours after injection.
  • Tumor lysis syndrome: This drug may act on the cancer cells very quickly. This may affect how your kidneys work. Your doctor will monitor your kidney function.
  • Risk of severe infections
  • Abnormal heart beat
  • Heart attack
  • This drug may affect how your kidneys work. Your kidney function will be checked as needed.
  • Bowel obstruction -a partial or complete blockage of your small and/or large intestine.
  • Bowel perforation -a hole in your small and/or large intestine.
  • Severe allergic skin reaction. You may develop blisters on your skin that are filled with fluid or a severe red rash all over your body that may be painful and very rarely be fatal.
  • Reactivation of the hepatitis B virus if you have ever been exposed to the virus which can affect your liver function and cause liver failure, and very rarely be fatal.
  • Changes in your central nervous system can happen. The central nervous system is made up of your brain and spinal cord. You could feel extreme tiredness, agitation, or confusion, or have hallucinations (see or hear things that are not there), trouble understanding or speaking, loss of control of your bowels or bladder, eyesight changes, numbness or lack of strength to your arms, legs, face, or body, and coma. If you start to have any of these symptoms let your doctor know right away.
  • Allergic reactions, including anaphylaxis are rare but may happen in some patients. Signs of allergic reaction to this drug may be swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way. If this happens, do not take another dose of this drug. You should get urgent medical treatment.

Important Information

  • Talk to your doctor before receiving any vaccinations during your treatment. Vaccinations are not recommended while receiving rituximab and hyaluronidase human.

Treating Side Effects

  • Manage tiredness by pacing your activities for the day.
  • Be sure to include periods of rest between energy-draining activities.
  • To decrease your risk of infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • To decrease your risk of bleeding, use a soft toothbrush. Check with your nurse before using dental floss.
  • Be very careful when using knives or tools.
  • Use an electric shaver instead of a razor.
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation.
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help or stop lessen these symptoms.
  • To help with hair loss, wash with a mild shampoo and avoid washing your hair every day.
  • Avoid rubbing your scalp, pat your hair or scalp dry.
  • Avoid coloring your hair.
  • Limit your use of hair spray, electric curlers, blow dryers, and curling irons.
  • If you are interested in getting a wig, talk to your nurse. You can also call the American Cancer Society at 800-ACS-2345 to find out information about the “Look Good, Feel Better” program close to where you live. It is a free program where women getting chemotherapy can learn about wigs, turbans and scarves as well as makeup techniques and skin and nail care.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.

Food and Drug Interactions

  • There are no known interactions of all-trans retinoic acid with food.
  • This drug may interact with other medicines. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills.
  • Feeling dizzy or lightheaded.
  • Easy bleeding or bruising
  • Confusion and/or agitation
  • Hallucinations
  • Trouble understanding or speaking
  • Blurry vision or changes in your eyesight
  • Numbness or lack of strength to your arms, legs, face, or body
  • You cough up yellow, green, or bloody mucus
  • Wheezing or trouble breathing
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • No bowel movement in 3 days or when you feel uncomfortable
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Severe Abdominal pain that does not go away
  • Loose bowel movements (diarrhea) 4 times a day or loose bowel movements with lack of strength or a feeling of being dizzy
  • Fatigue that interferes with your daily activities
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Decreased urine
  • A new rash or a rash that is not relieved by prescribed medicines
  • Signs of allergic reaction: swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way
  • While you are getting this drug, please tell your nurse right away if you have any pain, redness, or swelling at the site of the injection
  • Signs of possible liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
  • If you think you may be pregnant

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 12 months after treatment. Let your doctor know right away if you think you may be pregnant.
  • Breastfeeding warning: Women should not breast feed during treatment and for 6 months after treatment because this drug could enter the breast milk and cause harm to a breast feeding baby.
  • Fertility warning: This drug is not expected to affect your ability to have children in the future. Human fertility studies have not been done with this drug.

New September 2017