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What to Expect the Day After a Rituxan Infusion

Managing RA

May 29, 2023

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Photography by Bowery Image Group Inc./Stocksy United

Photography by Bowery Image Group Inc./Stocksy United

by Stefanie Remson


Medically Reviewed by:

Ami Patel PharmD, BCPS


by Stefanie Remson


Medically Reviewed by:

Ami Patel PharmD, BCPS


Rituxan (rituximab) is a biological medication used to treat various conditions, including rheumatoid arthritis. Common side effects include muscle aches, nausea, and fatigue. Learn from firsthand experiences what to expect.

Rheumatoid arthritis (RA) is an inflammatory autoimmune type of arthritis. It can be treated with medications, lifestyle changes, and alternative therapies.

If you have RA, and Rituxan (rituximab) has been recommended for you, you have likely had a long, turbulent journey with RA. Learn why Rituxan is prescribed for RA, and how you might expect to feel after an infusion.

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What is Rituxan and why is it important for RA?

Rituxan treats many conditions, including some cancers or those that affect your immune system, such as RA.

Rituxan is a biologic drug known as a B cell inhibitor. It binds to B cells, causing a B cell depletion in the body. This is thought to reduce the antibody production that causes the symptoms and joint damage commonly found in those living with RA.

Rituxan is not usually a first-line treatment option but is used when other treatments haven’t worked for RA. If your RA is improving on DMARDs and a TNF inhibitor, Rituxan may be prescribed. Usually, Rituxan is used with a DMARD medication, but it may be given to you on its own.

It’s used to treat moderate to severe RA that is active, meaning that you currently have symptoms.

An overview of medication options for RA

RA can be treated with two types of medications:

  1. Disease-modifying antirheumatic drugs, or DMARDs
  2. Biological response modifiers, known as biologicals or biologic drugs

DMARDs are the first port of call for RA treatment and include drugs such as methotrexate.

Biological medications are used as a second-line treatment option for RA, often in addition to DMARDs, or if DMARDs don’t work or cannot be taken. There are different types of biological therapies for RA. TNF inhibitors, also known as TNF blockers or anti-TNFs, are the most widely used biologics for inflammatory autoimmune arthritis.

Rituxan is a biologic drug. Specifically it is a B cell inhibitor.

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How will you feel after a Rituxan infusion?

Rituxan works by inhibiting B cells, causing a weakened immune system. This can cause certain side effects. Feeling tried, even exhausted and fatigued, for a week after your infusion was the most common experience reported when I spoke with fellow RA patients.

Typically, after that week, you may start to feel more like yourself. About 8-16 weeks after the infusion, you might start to see some symptom improvement.

Everyone’s experience is different. As well as feeling tired, fellow RA patients reported brain fog and food cravings.

“I feel sickly and flu-like for 5-7 days after my infusion, and I sleep for about 12 hours that evening, but I feel as though this is a small price to pay to be a productive human again.”

Kate M, living with RA for 13 years, started Rituxan in 2012.

“The day after my infusion, I am tired, but a week later I’m as good as new. The first infusion of a round is always worse, too.”

Dani B, living with RA for over 32 years, started Rituxan in 2015.

“I feel like I was hit by a truck the day after my infusions, but after about a week I’m back to normal.
I have 2 children who have grown up with their “Mama getting infusions that make her feel yucky.” They are used to “couch days” and they honestly enjoy the endless TV time they get [after my infusion].”

Laura M, living with RA for over 23 years, started Rituxan in 2018.

“The week after my infusion, I try to avoid people and crowds to avoid getting sick. I also had severe brain fog for a few days after, so I would avoid making any big decisions.”

Rozina S, living with RA for 15 years, started Rituxan in 2020.

“After my Rituxan infusion, I am very fatigued for 1-2 weeks and I seem to crave sweets more, too.”

Simmi L, living with RA for 4 years, on Rituxan since 2022.

Possible side effects

Like all medications, Rituxan can cause some side effects. Because it’s used for many conditions, side effects can vary.

Some of the most common side effects include:

  • infusion-related reactions, which refers to a type of hypersensitivity that can develop during or shortly after
  • fatigue and tiredness
  • fever and chills
  • muscle aches
  • headaches
  • nausea and vomiting
  • bruising and bleeding more easily
  • alopecia (hair loss)

Less common, although more serious, side effects can include:

  • generalized weakness
  • swelling
  • shortness of breath or trouble breathing
  • abnormal heart rate
  • serious or rare infections or both

If you experience side effects, they can last a few hours to weeks. You might be able to prevent some side effects by taking pre-medications the day before your infusion, or you may need to stop treatment immediately if you experience more serious side effects.

After an infusion, make sure to listen to your body and rest. This is not the time to push through.

How is a Rituxan infusion administered?

When used to treat RA, Rituxan is an intravenous infusion usually given in 2 separate infusions, about 2 weeks apart, every 24 weeks (although sometimes it’s given 16 weeks from the previous dose).

The infusion can take 3-6 hours and must be done in a designated medical facility with trained nursing staff who have experience administering this medication. Some cases can take longer.

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Some FAQs

What should I avoid after Rituxan?

Rituxan works by affecting your immune system. This means that you might be more likely to contract an infection. You may want to take measures to protect yourself from common illnesses. It can affect other treatment plans, too, so always mention that you are on Rituxan when treated by any healthcare professional.

How long does Rituxan stay in your system?

Rituxan can stay in your body for 6-12 months after your last dose. This means it can be used as a long-term maintenance treatment.

Can Rituxan cause any long-term side effects?

Long-term side effects can include heart or kidney problems. Because Rituxan weakens your immune system, you can be at higher risk of infections for longer after the infusion. If you become sick, promptly call your rheumatologist because you may need to be evaluated urgently and treated more aggressively than someone not on this medication.

Can I get vaccinations while using Rituxan?

Vaccinations can be tricky when on Rituxan. This medication makes it nearly impossible for your body to produce antibodies. Discuss with your rheumatologist about any vaccinations needed, especially if you are planning to travel.

Let’s recap

Rituxan is a biologic medication used to treat RA via infusions when other first-line treatments have not been effective.

Common side effects include muscle aches, nausea, and feeling exhausted for weeks. More serious side effects are uncommon, but if you experience any tell a healthcare professional promptly.

Starting and continuing any infusion for RA can be very hard and scary. Rituxan can be an effective medication for RA. For many, it has given back functionality, hope, and pain-free days.

“Rituxan has changed my life. Although the anticipation of my infusion days and actually sitting in the chair on that day is still hard for me, it’s the best thing that ever happened to me and my RA.”

Dani B, living with RA for over 32 years, started Rituxan in 2015.

*All quotes were shared with permission.

Medically reviewed on May 29, 2023

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About the author

Stefanie Remson

Ms. Stefanie Remson MSN, APRN, FNP-BC is the CEO and founder of She is a family nurse practitioner and is a rheumatoid arthritis (RA) patient herself. She has spent her entire life serving the community as a healthcare professional and has refused to let RA slow her down. She has worked with The Arthritis Foundation, The Lupus Foundation of America, Healthline, Grace and Able, Arthritis Life, Musculo, Aila, and HopeX. You can learn more at her website and on Instagram, Facebook, and Pinterest.

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