Understanding Rituximab and Immune Suppression
Rituximab is a powerful monoclonal antibody medication used to treat certain types of cancers and autoimmune diseases, such as rheumatoid arthritis [1.3.1]. It works by targeting and depleting B-cells, a type of white blood cell that plays a role in the immune response [1.3.1]. While this is effective for managing the underlying disease, it also intentionally weakens the immune system. This immunosuppression is why having an active infection, even a seemingly minor one like the common cold, is a significant concern [1.4.4]. Your body's ability to fight off pathogens is reduced, and what might be a simple illness for a healthy person could become more serious [1.2.5].
Official Guidance: Why Delaying is the Standard Advice
Medical guidelines and drug manufacturers are clear: patients with active, severe infections should not receive rituximab [1.3.3, 1.4.4]. Healthcare providers are advised to withhold the infusion until an infection is controlled or resolved [1.3.4]. If you have symptoms of an infection—such as a fever, a sore throat, a cough, or a runny nose that doesn't go away—you must inform your healthcare provider immediately [1.2.5, 1.6.3]. A fever, in particular, is a key sign that your body is fighting an infection, and proceeding with an infusion that further suppresses the immune system is risky [1.7.3]. The standard procedure is to defer the infusion at the doctor's discretion due to infection [1.4.2].
Risks of Proceeding with an Infusion While Sick
Ignoring symptoms and receiving the infusion can lead to several negative outcomes:
- Worsening Infection: Your immune system is already compromised by rituximab. Adding an active infection to the mix means a simple cold could escalate into a more severe condition like bronchitis or pneumonia [1.6.7].
- Increased Severity of Side Effects: The body is under stress fighting an infection. Undergoing an infusion can exacerbate both the illness symptoms and the potential infusion-related reactions [1.6.2].
- Blunted Immune Response: Rituximab can lead to prolonged periods of low antibody levels (hypogammaglobulinemia), making you susceptible to future infections [1.5.5]. Infusing during an active illness puts further strain on this already weakened state.
- Delayed Recovery: Your body will have a harder time clearing the virus, potentially leading to a much longer and more severe illness than you would typically experience.
Mild Sniffles vs. Significant Infection: How to Tell the Difference
While the final decision always rests with your doctor, it's helpful to know which symptoms are bigger red flags. Always report all symptoms, but a minor, isolated symptom might be treated differently than a full-blown illness.
| Symptom | Mild Concern (Might Proceed with Caution) | Significant Concern (Likely to Delay Infusion) |
|---|---|---|
| Fever | No fever | Any temperature above normal [1.6.3] |
| Cough | Dry, infrequent tickle | Persistent, productive, or deep cough [1.6.7] |
| Sore Throat | Mild scratchiness | Painful, swollen, difficult to swallow [1.2.5] |
| Body Aches | None | Present, especially with flu-like symptoms [1.6.3] |
| Nasal Symptoms | Clear, runny nose without other issues | Congested, colored mucus, sinus pressure [1.2.2] |
| Overall Feeling | Feeling generally well | Fatigue, feeling unwell, tired [1.7.3] |
Action Plan: What to Do if You're Sick Before Your Infusion
If you wake up with a cold, sore throat, or fever on the day of your scheduled rituximab treatment, do not simply show up to your appointment hoping for the best. Follow these steps:
- Contact Your Doctor Early: Call your rheumatologist, oncologist, or the infusion center as soon as you notice symptoms. Do not wait until the last minute.
- Describe Your Symptoms Accurately: Be specific. Tell them if you have a fever (and what your temperature is), a cough, body aches, or other signs of illness [1.2.5].
- Follow Medical Advice: Your healthcare team will assess the situation and tell you whether to come in, postpone, or see your primary care physician first. A short delay in your treatment schedule is almost always safer than risking a severe infection [1.4.2].
- Plan for Rescheduling: A delay of a week or two is common and generally does not negatively impact the long-term effectiveness of the treatment for many conditions [1.4.1]. Your provider will find the next safe and appropriate time for your infusion.
Authoritative Resource
For more detailed safety information directly from the manufacturer, you can review the Rituxan Medication Guide.
Conclusion
While it can be frustrating to delay a much-needed treatment, the answer to 'Can I have a rituximab infusion if I have a cold?' is almost always no. Rituximab's powerful effect on the immune system means that safety must be the top priority [1.4.4]. Introducing the medication during an active infection can turn a minor cold into a serious health threat. Always communicate openly and immediately with your healthcare provider about any signs of illness before an infusion. They will make the safest decision for your health, which typically involves postponing the treatment until you have fully recovered.
