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What are the possible risks and side-effects of rituximab?

A few people experience a fever, wheeziness, a rash or fall in blood pressure during or shortly after the infusion, or you may feel unwell during infusions. If this happens, tell the person giving you the infusion so they can slow it down. If your symptoms are severe you may need to stop treatment, but this is rare.

Rituximab affects your immune system, so you may be more likely to pick up infections. Tell your doctor or rheumatology nurse straight away if you develop a sore throat, fever or other signs of infection, or any other new symptoms that concern you.

You should also see your doctor if you develop chickenpox or shingles or come into contact with someone who has chickenpox or shingles. These illnesses can be more severe if you're on rituximab, and you may need antiviral treatment.

After three or four courses of rituximab, the levels if useful antibodies in your blood (the ones that protect against infection) may go down. This may not be a problem, but rarely it might mean that repeated courses increase your risk of infection. Your clinical team will discuss this with you before considering further treatment.

Very rarely severe skin reactions have been reported with rituximab up to four months after the infusion. You should tell your doctor or rheumatology nurse straight away if you develop a rash after starting rituximab.

In very rare cases rituximab can cause a serious condition called progressive multifocal leukoencephalopathy (PML), which can damage the brain and spinal cord. You must see your doctor immediately if you notice any of the following:

  • pins and needles, weakness, shaky movements or unsteadiness
  • loss of vision
  • speech problems
  • changes in behaviour or mood
  • difficulty moving your face, arms or legs.

Reducing the risk of infection

  • Try to avoid close contact with people with severe active infections.
  • For advice on avoiding infection from food, visit the NHS Choices Food Poisoning website. 

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