Page 67 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Live vaccines: Concomitant use has not be studied; currently recommended not to administer
live vaccines during rituximab treatment.

Side Effects:
 Cardiovascular: Hypotension, angina, arrhythmia, MI, peripheral edema, flushing, syncope,
cardiogenic shock
 Central nervous system: Fever, chills, headache, dizziness, anxiety, progressive
multifocal leukoencephalopathy (PML)
 Dermatologic: Angioedema, pruritus, rash, urticarial, Stevens-Johnson syndrome, toxic
epidermal necrolysis
 Endocrine & metabolic: Hyperglycemia, tumor lysis syndrome
 Gastrointestinal: Nausea, vomiting, abdominal pain, diarrhea, bowel obstruction and
perforation
 Hematologic: Lymphopenia, leukopenia, thrombocytopenia, neutropenia (up to 30 days
after last dose), aplastic anemia, hemolytic anemia
 Hepatic: Hepatitis
 Local: Pain at injection site
 Neuromuscular & skeletal: Myalgia, asthenia, arthralgia
 Renal: Acute renal failure
 Respiratory: Bronchospasm, dyspnea, rhinitis, throat irritation, cough, pneumonitis,
bronchiolitis obliterans, sinusitis
 Miscellaneous: Immunosuppression, infection, hepatitis B virus reactivation,
anaphylaxis, infusion related reaction (fever, chills, rigors occur in 80% of patients after
first infusion, decreasing to 40% in subsequent infusions), lupus-like syndrome, serum
sickness
 Infusion Related: Rituximab has caused severe infusion reactions. These severe reactions
typically occurred during the first infusion with time to onset of 30 to 120 minutes. Signs and
symptoms of severe infusion reactions may include hypotension, angioedema, hypoxia or
bronchospasm, and may require interruption of Rituximab administration. Patients experiencing
severe anaphylactic or other severe infusion related reactions should not receive completion of
the infusion or subsequent infusions.

Patients with following symptoms may have the rituximab infusion stopped temporarily:
 Fevers
 Chills
 Mild respiratory symptoms
 Mild to moderate hypotension
Once symptoms have resolved, resume infusion at a 50% reduction in rate

Monitoring Parameters:
 Vital Signs Q 15 min during infusion and for 30 min. post infusion
 B cell subsets: CD 20, CD 19, CD 16
 CBC with differential and platelets

Updated November 9, 2017 67