Yesterday was my second Rituxan infusion. Because of potential serious infusion side effects, receiving a Rituxan infusion is unlike any other RA biological treatment I’ve had to date (this is my 7th biological treatment).
The infusion clinic likes to schedule Rituxan infusions early in the day since the entire process can take up to 6 hours. My appointment was at 8:30 a.m. After checking in, a nurse took me to a semi-private room that contains a lounge chair, TV, guest chair, infusion pump machine, and a drawer full of equipment and supplies. The first thing the nurse does is to take blood pressure and heart rate baseline measurements. She then sets up an IV line in the vein of your choice. I usually choose a vein in the back of my hand as it allows me to move my arm if needed. But I’ve had IVs in various places on my arm since having infusions with other biologicals.
Rituxan requires a set of pre-medications that are designed to squelch possible infusion reactions. The pre-meds include tylenol, solu-medrol, and benadryl. The solu-medrol, a corticosteroid, is injected directly into the IV but the nurse does it slowly in order to avoid a “head rush” as she called it. The 100mg dose seems massive compared to the 4mg pills that I take periodically. This amount tends to keep me awake far into the next morning and makes me constantly hungry. The benadryl is an anti-histamine and is infused from a bag. The dose was 50mg. One side effect of the benadryl is that is can cause burning or pain in the arm as it goes in. This happened to me and the nurse put a hot pack on my arm to help relieve the pain. It subsided soon after the medicine was all in. Another side effect is that it makes me rather loopy and groggy and I slept for about an hour. The nurse said that we may be able to ask the doctor to only use half the benadryl and solu-medrol dose next time since it looked like I tolerated the Rituxan well. During my first Rituxan infusion, I also had 500mg of saline solution infused to make sure I was hydrated. They did not do this on the second infusion.
The entire set up and pre-medication routine took about 1 hour. During that time the pharmacist is preparing the Rituxan solution. I received a 1,000mg dose diluted in 500ml of saline solution. The infusion pump is carefully programmed to start the infusion slowly and pick up speed over time. The Rituxan was started at about 9:30 and wasn’t over until 12:30. This was actually an hour shorter than the first infusion when they go even more slowly to avoid infusion reactions. This is a long time to sit in a chair and I usually bring music, videos, books, and food to keep myself occupied. I get up periodically to stretch and go to the restroom. The entire IV and pump set up is mobile and can be wheeled around if needed. The pump is battery operated but must be plugged in when not moving so the battery can remain fully charged. The nurse periodically comes by to check on how I’m feeling. When the Rituxan bag is empty, a beeper on the infusion pump sounds and the nurse comes in to shut everything down and to remove the IV. Towards the end I found myself constantly checking the bag to see how close it was to being empty.
Other than the arm pain and sleepiness from the Benadryl, and the solu-medrol keeping me awake that evening, the process was pretty uneventful. But the grogginess and lack of sleep knocks me off for a day or two. A friend drove me home after the first infusion but after grabbing a cup of coffee, I felt fine driving myself home after the second one.
The dosing schedule is two infusions two weeks apart with another two infusions at either 4 or 6 months. This is a much different schedule than other RA biologicals which are typically given regularly every week or month. Now I wait for between 2-3 months in order to see if the Rituxan will have a positive impact on RA.
Below are some photos of the infusion.