Live Vaccines
Contraindicated
Database
B-cell depletion/immunosuppression → disseminated vaccine infection + poor response
Complete live vaccines ≥4 weeks before; avoid during therapy
Source: Kimi deep-research + Cla
Drug reference
Rituximab
Anti-CD20 chimeric monoclonal antibody · Antineoplastic
Also known as Mabthera, Reditux, Ristova, Riximyo, Truxima, Ruxience
START
Screen HBV first; oncology 375 mg/m² IV per regimen; RA 1000 mg days 1 & 15; premedicate
TYPICAL MAX
Regimen-defined (375 mg/m² or 1000 mg ×2)
STOP IF
Severe infusion reaction/CRS, HBV reactivation, suspected PML, severe mucocutaneous reaction
WATCH
HBV serology (baseline + monitoring), infusion reactions, neuro symptoms (PML), CBC, infections
CDSCO approvedSchedule H (Prescription Drug, to be sold by retail on the prescription of a Registered Medical Practitioner only). In India, it is often administered under supervision in a hospital setting due to potential infusion reactions and need for close monitoring. The exact class of schedule H may vary in some states to also include 'Rx' designation (prescription only). This drug is not OTC (Over-The-Counter). The drug should not be supplied to the general public for direct consumption without professional medical advice. It requires specialized handling and administration. As an injectable cytotoxic/immunomodulatory agent, it strictly falls under prescription-only medicine category and typically administered in controlled clinical environments. Thus, it is not OTC and requires prescription. Schedule H drugs are substances which are required to be sold by retail on the prescription of a Registered Medical Practitioner. Rituximab falls under this category. Given its nature and administration, it is also subjected to more stringent control measures beyond simple Schedule H, often requiring hospital-level administration and monitoring. While it fits the general criteria for Schedule H, its complex usage context often leads to it being managed under stricter hospital protocols akin to Schedule H1 or even X in practice for safety, although technically, the molecule itself is often listed as Schedule H. Therefore, Schedule H is the most appropriate classification based on general Indian drug regulations for prescription drugs. It is not an OTC medicine. Thus, it requires a prescription from a Registered Medical Practitioner and is to be sold by retail only on their prescription. Given its nature and administration requirements, it is generally supplied to hospitals and administered in a clinical setting by trained professionals. The legal classification is Schedule H. Many such advanced injectable medications, while technically Schedule H, are managed with heightened vigilance similar to the intent of Schedule H1 or X in practice due to their risk profile and administration complexity. However, strictly speaking, Schedule H is the correct official classification for prescription drugs. Therefore,ATC L01FA01
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption onset
- PEAK
- 4h · end of infusion
- t½
- 3.1w · terminal t½ (~22 days)
- DURATION
- 26.1w · B-cell depletion ~6 months
EXCRETION
Reticuloendothelial catabolism; not renal
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid unless benefit outweighs risk — transient neonatal B-cell depletion; effective contraception during and 12 months after
FDA category + note
Top interactionssee all 12 →
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- BaricitinibSevereDatabaseDDInter
- CertolizumabSevereDatabaseDDInter
Available in India
37 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Binds CD20 on B-lymphocytes causing depletion via complement-dependent and antibody-dependent cellular cytotoxicity and apoptosis; depletes normal and malignant CD20+ B cells (pre-B to mature, sparing plasma cells/stem cells).
Indications
CD20+ non-Hodgkin lymphoma and chronic lymphocytic leukaemiaRheumatoid arthritis (with methotrexate)ANCA-associated vasculitis (GPA/MPA)Pemphigus vulgaris; off-label many autoimmune diseases
Dosing
- Adult
- Oncology: 375 mg/m² IV per cycle (schedule by regimen). RA: 1000 mg IV days 1 and 15, repeat ~q6 months. Premedicate (antihistamine, paracetamol ± corticosteroid).
- Pediatric
- Per protocol (specialist).
- Renal adjustment
- No adjustment (antibody — not renally cleared).
- Hepatic adjustment
- No specific adjustment; screen/monitor HBV.
- Geriatric
- Higher cardiac/infection risk; monitor.
- Max dose
- Regimen-defined (e.g. 375 mg/m²/dose oncology; 1000 mg ×2 RA)
Pharmacokinetics
Onset
B-cell depletion within days; clinical effect weeks
Peak effect
End of infusion
Duration
B-cell depletion months (often 6–12)
Half-life
~3 weeks (variable; ~18–32 days)
Bioavailability
100% IV (SC formulations exist)
Protein binding
Not applicable (immunoglobulin)
Metabolism
Catabolised to peptides/amino acids (reticuloendothelial)
Excretion
Not renally excreted
Contraindications
- Active severe infection
- Active hepatitis B (reactivation risk — screen first)
- Severe hypersensitivity to rituximab or murine proteins
Side effects
Common
Infusion-related reactions (fever, chills, rigors, hypotension)Infections (esp. respiratory)CytopeniasFatigue, headache
Serious
- Severe/fatal infusion reactions; cytokine release syndrome
- Hepatitis B reactivation (fulminant hepatitis)
- Progressive multifocal leukoencephalopathy (JC virus)
- Severe mucocutaneous reactions (SJS/TEN)
- Tumour lysis syndrome; severe prolonged neutropenia; bowel perforation
Pregnancy & lactation
Pregnancy
Avoid unless benefit outweighs risk — transient neonatal B-cell depletion; effective contraception during and 12 months after
Lactation
Limited data; minimal oral infant absorption of IgG — caution
Drug interactions
Adalimumab
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: others
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Deferiprone
Severe
Database
Clinical effect not specified
Source: DDInter
Etanercept
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Fingolimod
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Golimumab
Severe
Database
Clinical effect not specified
Source: DDInter
Infliximab
Severe
Database
.
Source: DDInter
Leflunomide
Severe
Database
.
Source: DDInter
Related guidelines
Ask House about Rituximab
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19