Rituximab adverse reaction to pre-meds

[BlueTheCat]

Hi

I have Vasculitis GPA

I have my fourth dose of rituximab coming up in a few weeks.

I seem to have a reaction to the pre-meds they give prior to the rituximab infusion. One of the pre-med drugs I believe to be a steroid of some description.

The history so far...

Dose 1 - I was in hospital and already taking steroids (predisnolone) so believe I was not given the same pre-meds if any. I was still a bit delerious at that point so not really 100% sure what was happening.

Dose 2 - About 2 mins after receiving the pre-meds I started retching badly and thinking I was about to vomit. It sort of surprised the infusion nurse who went scurring off for a barf bowl

Dose 3 - I did warn the nurse of the pevious issue so she had a barf bowl to hand Again after 2 mins I started retching badly for about 3-4 minutes but again I did not physically vomit. After that I felt fine.

Dose 4 coming up

After dose 3, the infusion nurse said what they could try, was to mix the steroid up with/give it at a reduced rate alongside the rituximab infusion.

So I guess my question is....

1 Has anyone else had a similar reaction to the pre-meds?

2 Have they tried the suggested mixing the pre-med with the infusion as was suggested to me and was it effective?

My fear is that with having the pre-meds prior to the infusion, the reaction whilst unpleasant for me, and those around me, only lasted a few minutes after which I am absolutely fine. However, will mixing it up make me feel ill for the whole three/four hours of the infusion

[Churg]

My gut reaction was the same as yours- that you would feel awful for longer if combining the steroid and rituximab (presumably you can do that without incurring other problems?) . But it may well be the speed of delivery of the steroids that is causing the problem in which case you would not get the same symptoms. I have no personal experience of this situation. It would be good, as you say, if you could get personal testimony from others who have the steroids over slow infusion along with the rituximab. Otherwise you just have to go for it and hope. Not a pleasant scenario. but because the initial reaction is so transient I am inclined to think you would be OK . Not very helpful - sorry

[SusanEleven]

I’m also GPA, ANCA vasculitis diagnosed recently. Did the infusion nurse consider your reaction an allergic reaction? Were any of your premeds by mouth?

For my first rituximab infusion my premeds were the standard for my infusion center: 125 mg IV steroids (solumedrol), 50 mg IV Benadryl, and two Tylenol by mouth. After 30 minutes wait they start the infusion.

For my second infusion they added an 180 mg Allegra tablet (fexofenadine) as well since I had an allergic reaction to the first infusion.

I’ll ask regarding the mixing in another group I’m in and let you know if I hear anything back.

[Paprika60]

Whenever I had been given biologics infusions, I had always had bad reaction to premeds, both liquid steroids and antihistamine. It turned out the nurses (in my experiences) rushed the liquid steroids and my body just couldn't take it. Once I begged nicely to do it very very slowly and what a difference it really made for me. Also I asked about skipping premeds, my doctors wouldn't allow skipping steroids but did allow skipping liquid antihistamine and it improved. So experiment paid off. Hope you find a good solution. Best wishes!

[SusanEleven in reply to Paprika60]

The infusion nurse said given how many heart palpitations I get they’ll probably lower my dose of solumedrol going forward.

But yes, they push the premeds very quickly.

[SusanEleven]

I noticed that someone in another country said that her Rituximab premeds include an IV anti-nausea drug.

[BlueTheCat]

Thanks Churg Paprika60 SusanEleven for your comments and thoughts. Much appreciated

I never really though to question what the pre-meds actually were. I just watched them plug me up and put them in All the pre-meds were all given intravenously.

Some good things for me to think about and discuss/suggest with the staff at the infusion centre.

Cheers all. I'll update next month with how I got on

[eh66]

I was on steroids when I had my first infusions but not the later ones. I think pre-meds were Paracetamol and an intravenous antihistamine (maybe something else) . I had no reaction. Only once have I had a low blood pressure issue with Rituximab.

[BlueTheCat]

As a follow up to my initial post about my reaction issues to the pre-meds, I had another rituximab infusion recently.

After a discussion with the infusion staff we agreed that the pre-med steroids and anti-histamine would be given at a reduced flow rate (rather than mixing it into the infusion)

Previously the nurse had pretty well squeezed the syringe straight into the iv line as fast as possible. This this time, they took at least 5 minutes on each syringe slowly introducing it to my body.

What a difference 😃 I had no adverse effects or reactions 🙂

Paprika60