For nurses supporting patients on rituximab, consistent preparation and monitoring are everything. This quick guide covers who receives rituximab, how it’s given at Nufactor, and the essential safety steps we follow at every infusion.
By Leanne Edwards, BSN, RN, IgCN, Clinical Nurse Educator - May 18, 2026
What Rituximab Is
Rituximab is a monoclonal antibody that targets the CD20 antigen on B cells, leading to B-cell depletion. By reducing B-cells, rituximab helps control immune-driven inflammation and plays a key role in treating certain blood cancers and autoimmune diseases. Rituximab is available as the reference product Rituxan® and as FDA-approved biosimilars including Truxima®, Ruxience®, and Riabni®.
What Is a Biosimilar?
A biosimilar is a biologic medication that is highly similar to an FDA-approved reference product (for rituximab, this is Rituxan®) with no clinically meaningful differences in safety, purity, or potency. Biosimilars are made from living cells and are not considered “generic drugs,” but they undergo rigorous testing to ensure they work the same way as the reference product and are given at the same dose and route.
Who Can Receive Rituximab?
FDA-approved indications include:
- Non-Hodgkin lymphoma (NHL) in adults; selected pediatric B-cell diseases
- Chronic lymphocytic leukemia (CLL) with chemotherapy
- Rheumatoid arthritis (with methotrexate, after TNF-inhibitor failure)
- Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)
- Pemphigus vulgaris (PV) in adults
Off-label uses commonly seen at Nufactor:
Refractory lupus nephritis, myasthenia gravis, neuromyelitis optica, antibody-mediated rejection in transplantation, and Waldenström macroglobulinemia.
How Rituximab Is Given
- Route: Intravenous (IV) infusion. Care pathway: The first rituximab infusion is administered in a controlled setting (e.g., hospital or infusion center). After the first dose is completed and tolerated, Nufactor provides subsequent home infusions per prescriber orders. If 12 months (365 days) have passed in between rituximab doses, handle as if a firstlifetime dose.
- Pre-medications: Typically, acetaminophen and an antihistamine, with or without a corticosteroid, depending on prescriber orders.
Nufactor Nurse Steps
To ensure safety and consistency of care, Nufactor nurses follow these steps before and during each home rituximab infusion:
- Screen before every dose for prior infusion reactions, active infection (including post-op wounds with drainage), new neurological symptoms (possible PML), hepatitis B symptoms, severe skin or mouth lesions, arrhythmias or chest pain, bowel obstruction symptoms, cytopenia indicators, renal concerns, and tumor lysis risk (for lymphoma patients).
- If infection is present at screening: do not infuse; notify Nufactor pharmacy and reschedule the patient.
- Hepatitis B: Screen for hepatitis B symptoms such as abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea/vomiting, weakness, fatigue, or jaundice. If symptoms are present, do not infuse; notify Nufactor pharmacy and reschedule the patient.
- Verify premedications were taken or administered 30–60 minutes before infusion unless otherwise directed.
- Prepare for safety:
- An anaphylaxis kit is required for all doses.
- The first infusion cannot be done at home.
- IV access and infusion setup:
- Establish IV access.
- Inspect the drug solution prior to infusion.
- Dilution: Rituximab comes as a ready-to-use liquid and does not require reconstitution. The ordered dose is withdrawn and diluted in a bag of 9% Sodium Chloride (normal saline) per pharmacy or prescriber instructions.
- Begin infusion at the ordered rate and titrate slowly based on patient tolerance and established Nufactor protocols.
- Monitoring:
- Obtain baseline vital signs.
- Monitor at least every 30 minutes, or every 15 minutes if the patient previously experienced a reaction.
- Adjust monitoring and rate changes based on the patient’s condition.
- Escalation:
- For mild–moderate reactions, pause or slow the infusion, treat per orders, and resume at a slower rate once symptoms resolve.
- For severe reactions (angioedema, bronchospasm, hypotension), stop the infusion immediately, follow anaphylaxis protocols, call EMS if needed, and notify Nufactor pharmacy.
- Communication:
- Report and communicate any significant findings to Nufactor pharmacy. Document appropriately.
Safety Highlights
- Serious infusion reactions (most often during the first dose)
- Severe skin and mucosal reactions (SJS/TEN)
- Hepatitis B reactivation
- PML (progressive multifocal leukoencephalopathy)
- Serious infections, tumor lysis syndrome, renal toxicity, blood dyscrasias
- Arrhythmias, angina, and bowel obstruction/perforation
Vaccines: Avoid live vaccines.
Pregnancy and lactation: Use effective contraception during treatment and for 12 months after the final dose. Coordinate breastfeeding and infant vaccination timing with the prescriber if exposed in utero.
Common Side Effects
Patients may experience infusion-related symptoms such as chills, rash, headache, fatigue, joint pain, nausea, or infections affecting the skin, urinary tract, or respiratory system. Report any concerning symptoms promptly—especially fever, cough, shortness of breath, severe headaches/confusion, jaundice, or new rashes.
Tips for Patients
- Your first infusion takes place in a controlled clinical setting. Home infusions with Nufactor begin after that first dose is completed and tolerated.
- Nurses will check vitals frequently during home infusions to keep you safe and comfortable.
- Report symptoms of infection or allergic reaction immediately.
- Avoid live vaccines during treatment.
- Tell your care team if you’re pregnant, planning pregnancy, or breastfeeding.
Wrap-Up
Rituximab is a trusted, targeted therapy across B-cell–driven conditions. At Nufactor, our standardized screening, premedication, and monitoring practices help ensure every home infusion is delivered safely and comfortably—dose after dose.
References (Sources)
