The Basics
What is Rituximab?
Used alone or with other medications to treat various types of non-Hodgkin’s lymphoma (NHL).
Brand names for Rituximab
Rituxan
How Rituximab is classified
Antibodies – Monoclonal, Antirheumatic Agents, Antineoplastic Agents
Rituximab During Pregnancy
Rituximab pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Rituximab while pregnant
N/A
Taking Rituximab While Breastfeeding
What are recommendations for lactation if you're taking Rituximab?
Rituximab is a genetically engineered chimeric murine/human monoclonal antibody that targets CD20, a B-cell-specific surface antigen. Limited data indicate that the amount in milk is very low and absorption is unlikely because it is a protein with a molecular weight of 143,860, it is probably destroyed in the infant’s gastrointestinal tract.[1][2] Although 2 breastfed infants apparently experienced no adverse effects during maternal use of rituximab, no long-term data are available. If rituximab is required by the mother, it is not a reason to discontinue breastfeeding.[3][4] Until more data become available, rituximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.[5][6][7] The manufacturer recommends that breastfeeding be discontinued during rituximab therapy and for 6 months after the last dose.
Maternal / infant drug levels
Rituximab is a genetically engineered chimeric murine/human monoclonal antibody that targets CD20, a B-cell-specific surface antigen. Limited data indicate that the amount in milk is very low and absorption is unlikely because it is a protein with a molecular weight of 143,860, it is probably destroyed in the infant’s gastrointestinal tract.[1][2] Although 2 breastfed infants apparently experienced no adverse effects during maternal use of rituximab, no long-term data are available. If rituximab is required by the mother, it is not a reason to discontinue breastfeeding.[3][4] Until more data become available, rituximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.[5][6][7] The manufacturer recommends that breastfeeding be discontinued during rituximab therapy and for 6 months after the last dose.
Possible effects of Rituximab on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Rituximab
(Multiple Sclerosis) Glatiramer, Immune Globulin, Interferon Beta (Rheumatoid Arthritis) Auranofin, Gold Sodium Thiomalate, Hydroxychloroquine, Infliximab, Methotrexate, Penicillamine, Sulfasalazine.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Pistilli B, Bellettini G, Giovannetti E et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39:207-11. PMID: 23199900
2. Bragnes Y, Boshuizen R, de Vries A et al. Low level of rituximab in human breast milk in a patient treated during lactation. Rheumatology (Oxford). 2017;56:1047-8. PMID: 28339781
3. Gotestam Skorpen C, Hoeltzenbein M, Tincani A et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75:795-810. PMID: 26888948
4. Whittam DH, Tallantyre EC, Jolles S et al. Rituximab in neurological disease: principles, evidence and practice. Pract Neurol. 2019;19:5-20. PMID: 30498056
5. Ostensen M. Management of early aggressive rheumatoid arthritis during pregnancy and lactation. Expert Opin Pharmacother. 2009;10:1469-79. PMID: 19505214
6. Keeling SO, Oswald AE. Pregnancy and rheumatic disease: by the book or by the doc . Clin Rheumatol. 2009;28:1-9. PMID: 18987777
7. Almas S, Vance J, Baker T et al. Management of multiple sclerosis in the breastfeeding mother. Mult Scler Int. 2016;2016:6527458. PMID: 26966579
8. Jin J, Mills J, Conboy E et al. In utero rituximab: Detection of rituximab in an infant at 4 months of age. Ann Allergy Asthma Immunol. 2014;113:A14. Abstract 36. http://www.sciencedirect.com/science/journal/10811206/113/5/supp/S
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
