Medical Oncologist
MabThera / Rituximab
Rituximab Infusion Day: — Premedication, Duration and What to Expect
Your rituximab infusion starts with premedications given before the drip begins. The rate is increased gradually, and your first session is the longest. Knowing what each stage involves makes the day easier to prepare for.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- Pre-medications first — You receive paracetamol, an antihistamine and usually a steroid before the drip starts — to reduce the chance of a reaction.
- First infusion is slowest — The rate starts low and is increased gradually. Later infusions are often faster if your first went well.
- Monitored throughout — A nurse checks your temperature, blood pressure and pulse at regular intervals and after each rate increase.
- Day care — no overnight stay — Rituximab is given as a day-care procedure. You go home the same day once your team is satisfied you are well.
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Rituximab infusion starts with premedications — usually paracetamol, an antihistamine and a steroid — given before the drip begins. The infusion itself runs slowly at first and speeds up if you tolerate it well. Your first session is longer than later ones. You are monitored throughout and can go home the same day.
Why does the infusion rate start so slowly?
Rituximab is a monoclonal antibody — a different kind of treatment from chemotherapy. Infusion-related reactions are most common in the first session, particularly in its earliest phase.
Starting at a low rate gives your body time to adjust. It also gives your nursing team time to spot any reaction early, when it is easiest to manage.
If you feel well at each check, the nurse increases the rate. Most people reach the full running speed without any problems.
How does your first infusion differ from later ones?
| Feature | Your first infusion | Later infusions |
|---|---|---|
| Duration | Longer — the rate builds slowly across the session | Often shorter if your first infusion was well tolerated |
| Starting rate | Very slow, increased in stages as you are checked | Can be started higher if previous sessions were uneventful |
| Reaction risk | Highest in the earliest phase of the first session | Lower with each session for most patients |
| Premedication | Always given beforehand | Always given beforehand |
| Nursing checks | Frequent, especially around each rate increase | Regular throughout every session |
| Going home | After an observation period once the drip ends | After an observation period once the drip ends |
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What happens on the day, in order?
You arrive and are settled in
A nurse takes your weight, temperature, blood pressure and pulse before anything begins. Bring your appointment letter and a list of every medicine you currently take.
Premedications are given
You receive paracetamol, an antihistamine and usually a corticosteroid — as tablets, an infusion, or both. These are given a short time before the rituximab drip begins so they can take effect.
A cannula is placed
A small plastic tube is inserted into a vein in your arm or hand. This is what the infusion runs through. Tell the nurse if you have had difficult cannula insertions before.
The infusion begins at a low rate
The drip starts slowly. You may notice nothing at all, or you may feel mildly flushed or warm — common in the early phase. Tell the nurse straight away if anything feels unusual.
The rate is increased gradually
After each nursing check, if you feel well, the rate goes up. This staged approach is standard at every session, not just the first. Most people move through the increases without difficulty.
The infusion finishes and the cannula is removed
Once the full dose has run through, the drip is stopped and the cannula taken out. You remain in the chair for an observation period while the team confirms you are well.
You are discharged
Once your team is satisfied there are no delayed reactions, you can go home. After your first session in particular, you will usually need someone to accompany you rather than travelling alone.
Did you know?
Most infusion-related reactions to rituximab happen during the first session — and specifically in its earliest phase, while the rate is still at its lowest.
The slow-start approach exists precisely to catch those reactions early, when they are easiest to manage. This is why each subsequent session typically runs more smoothly than the first.
Source: NCCN Guidelines for B-Cell Lymphomas
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Common questions
Frequently asked questions
Can I eat and drink before my rituximab infusion?
Yes — there is no need to fast before rituximab, and eating beforehand is sensible. You will be in the chair for several hours, and arriving on an empty stomach can make mild nausea or light-headedness feel worse. Bring water and a light snack for during the session. If your team has given you specific instructions that differ, follow those.
What should I bring for such a long day?
Bring something to read or watch — a phone, tablet, book or headphones are all practical for a long infusion. Wear loose, comfortable clothing that gives the nurse easy access to your arm. Bring any medicines you take during the day and the contact number your team has given you. A family member or friend is welcome to sit with you, and can be reassuring during your first session.
What should I tell the nurse during the infusion?
Tell the nurse straight away if you notice flushing, itching, chest tightness, shortness of breath, back or stomach pain, chills, or simply a feeling that something is wrong. These are the symptoms the team is watching for. You do not need to decide whether it is serious — that is their role. The earlier you speak up, the easier it is to manage. Never wait to see if something settles on its own during an infusion.
Will every rituximab infusion take this long?
Not necessarily. The first infusion is always the longest because the rate is built up slowly and the team is observing you closely for the first time. If your first session goes well, your oncologist may recommend a faster approach for later sessions, which can meaningfully shorten the time you spend in the chair. Your team will tell you what to expect at your next appointment.
Is it normal to feel tired after rituximab?
Fatigue after an infusion is common. It may be partly from the premedications — antihistamines in particular can cause drowsiness — and partly from the length of the day. Most people feel more themselves within a day or two. If you feel unusually unwell in the days after an infusion, particularly with fever, chills, or any difficulty breathing, call your oncology team rather than waiting for your next scheduled visit.