Rituximab adverse effects

Severe adverse reactions have been fatal. It is important to infuse rituximab slowly. Hypotension, bronchospasm, and angioedema may occur. Chills and fever commonly accompany the first infusion, especially in patients with high circulating levels of neoplastic cells, because of rapid activation of complement, which results in the release of tumor necrosis factor α and interleukins. Pretreatment with diphenhydramine, acetaminophen, and bronchodilators can ameliorate these problems. Cardiac arrhythmias can also occur. Tumor lysis syndrome has been reported within 24 hours of the first dose of rituximab. This syndrome consists of acute renal failure that may require dialysis, hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatasemia (an abnormally high content of alkaline phosphatase in the blood). Leukopenia, thrombocytopenia, and neutropenia have been reported in less than 10 percent of patients.