Rituximab is a monoclonal antibody therapy used to treat conditions like certain cancers and autoimmune diseases (e.g., rheumatoid arthritis and vasculitis). The drug works by targeting and depleting B-cells, a type of white blood cell involved in the immune response. While this depletion reduces disease activity, it also compromises the body’s ability to fight off infections. Understanding the necessary temporary and long-term precautions post-infusion is paramount for patient safety and maximizing therapeutic benefit.
Immediate Post-Infusion Safety Precautions
The initial 24 to 48 hours following a rituximab infusion require adherence to safety measures due to the immediate effects of the treatment. Pre-medications given to prevent infusion reactions, such as antihistamines, frequently cause drowsiness and dizziness. Patients must strictly avoid operating heavy machinery, including driving, until these sedating effects have fully worn off.
Immediate post-infusion alcohol consumption should also be avoided. Combining alcohol with sedating pre-medications amplifies impairment and increases the risk of accidents. Focus on rest and proper hydration with non-alcoholic fluids to help the body recover from the lengthy infusion process.
Close self-monitoring for delayed infusion reactions is necessary within the first day. Although most reactions occur during the infusion, symptoms like fever, chills, rash, or severe fatigue can manifest up to 24 hours afterward. Any signs of chest pain, difficulty breathing, or severe swelling of the face or throat require immediate medical attention, as these indicate a severe reaction.
Minimizing Infection Risk and Exposure
Rituximab depletes B-cells, leading to a prolonged period of increased susceptibility to infection. Avoiding exposure to contagious individuals is a necessary, long-term precaution, including limiting time spent in heavily crowded, enclosed public spaces.
Diligent hygiene practices form a strong line of defense. Frequent and thorough handwashing is essential, especially before eating and after touching shared surfaces. Patients should also exercise caution regarding environmental exposures, such as avoiding contact with bird droppings or soil when gardening, and wearing gloves if necessary.
Food Safety and Environmental Avoidances
Special attention must be paid to food safety to prevent foodborne illness, which can be serious when immunocompromised. Handling animal waste, particularly cleaning a cat’s litter box, should be delegated to another household member due to the risk of toxoplasmosis. Patients should strictly avoid unpasteurized dairy products, undercooked meats, and raw fish or shellfish, which carry higher bacterial and viral loads.
Vaccinations and Future Medical Avoidances
Certain medical treatments and procedures must be avoided or carefully timed while B-cell counts remain low following rituximab therapy. Patients must absolutely avoid all live viral or bacterial vaccines, such as the nasal spray flu vaccine, measles-mumps-rubella (MMR), or yellow fever vaccine. Live vaccines contain small amounts of the weakened pathogen, which can potentially cause a full-blown infection when the immune system is suppressed.
In contrast, inactivated vaccines, like the standard flu shot or COVID-19 vaccines, are safe but require careful scheduling to ensure effectiveness. Since rituximab blunts the immune response, non-live vaccines should ideally be administered toward the end of a treatment cycle to maximize the antibody response. If this is not possible, the subsequent rituximab dose may be delayed by at least two weeks after vaccination to allow time for immunity to build.
Any non-emergency medical or dental procedure, including elective surgeries, should be discussed with the healthcare provider and may need to be postponed until B-cell levels show signs of recovery. Before any treatment, patients must inform all providers, including dentists and surgeons, that they are on rituximab therapy. Patients should also review all current medications, including over-the-counter drugs and herbal supplements, with their doctor to prevent potential drug interactions.