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Rituxan (rituximab)

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What is Rituxan?

Rituxan is a medicine that doctors prescribe to treat various illnesses. It helps adults with types of cancer like Non-Hodgkin’s Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL).

It also helps with Rheumatoid Arthritis (RA) when other treatments haven’t worked, and it treats serious conditions like Granulomatosis with Polyangiitis (GPA) and Pemphigus Vulgaris (PV).

For children, Rituxan is used to treat types of cancer such as mature B-cell NHL and acute leukemia (B-AL), as well as GPA and another condition called Microscopic Polyangiitis (MPA).

Rituxan is given through an injection into a vein. Common side effects include reactions during the infusion, infections, feeling achy, tiredness, and nausea. Some people may also experience low blood cell counts, swelling, or diarrhea.

How Does Rituxan Work?

Rituxan works by finding and attaching to a protein called CD20 that is found on the surface of certain blood cells, including cancer cells.

When Rituxan sticks to this protein, it helps your immune system attack and destroy the cancer cells.

Rituxan can also kill the cancer cells directly. By targeting the CD20 protein, Rituxan breaks down these harmful cells without damaging other important cells that don’t have this protein.

This process involves special ways the body kills cells, called complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity, which help to get rid of the cancer cells.

Storage Information

Store Rituxan vials in a refrigerator at 36°F to 46°F (2°C to 8°C). Keep them out of direct sunlight. Do not freeze or shake the vials.

Rituxan is available as clear, colorless solutions in single-dose vials, with packaging options including single vials and multi-vial packs.

Side Effects of Rituxan

Common Side Effects of Rituxan

  • Infusion-related reactions (fever, chills, etc.)
  • Infections
  • Body aches
  • Tiredness
  • Nausea

In adults with GPA or MPA:

  • Low white and red blood cells
  • Swelling
  • Diarrhea
  • Muscle spasms

In children with B-cell NHL or B-AL:

  • Decreased white blood cells with fever
  • Mouth sores
  • Inflammation of the upper intestine
  • Serious infection throughout the body and organs (sepsis)
  • Changes in liver function blood tests
  • Low level of potassium in the blood
  • Aching joints during or within hours of receiving an infusion
  • More frequent upper respiratory tract infections

Serious Side Effects of Rituxan

  • Infusion-related reactions:
    • Hives (red itchy welts) or rash
    • Itching
    • Swelling of lips, tongue, throat, or face
    • Sudden cough
    • Shortness of breath, difficulty breathing, or wheezing
    • Weakness
    • Dizziness or feeling faint
    • Palpitations (feeling like your heart is racing or fluttering)
    • Chest pain
  • Severe skin and mouth reactions:
    • Painful sores or ulcers on skin, lips, or in the mouth
    • Blisters
    • Peeling skin
    • Rash
    • Pustules
  • Hepatitis B virus (HBV) reactivation:
  • Worsening tiredness
  • Yellowing of the skin or white part of the eyes
  • Progressive Multifocal Leukoencephalopathy (PML):
    • Confusion
    • Dizziness or loss of balance
    • Difficulty walking or talking
    • Decreased strength or weakness on one side of the body
    • Vision problems

Dosage Information and Usage

Dosage form and strengths of Rituxan

Rituxan is available as a clear, colorless solution for intravenous infusion.

It comes in single-dose vials:

  • 100 mg/10 mL (10 mg/mL)
  • 500 mg/50 mL (10 mg/mL)

Recommended Dosages for Specific Conditions:

  • For Non-Hodgkin’s Lymphoma (NHL): The recommended dose is 375 milligrams per square meter (m²) of body surface area given as an intravenous infusion. The treatment schedule varies depending on the type and stage of NHL, which are different forms and severity levels of this type of cancer.
  • For Chronic Lymphocytic Leukemia (CLL): Patients receive 375 milligrams per square meter (m²) the day before starting chemotherapy, then 500 milligrams per square meter (m²) on the first day of cycles 2 through 6 of chemotherapy. CLL is a type of cancer affecting white blood cells, and this treatment is part of the chemotherapy regimen.
  • For Rheumatoid Arthritis (RA): Patients are given two infusions, each containing 1,000 milligrams of the medication, with a two-week gap between them. After this initial treatment, additional infusions are repeated every 24 weeks or as necessary, but not before 16 weeks. Rheumatoid arthritis is an autoimmune disease affecting the joints.
  • For Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA): The initial treatment involves receiving 375 milligrams per square meter (m²) weekly for four weeks. After this induction phase, patients receive maintenance doses of 500 milligrams every six months. GPA and MPA are autoimmune diseases causing inflammation of blood vessels.
  • For Pemphigus Vulgaris (PV): Patients receive two infusions, each containing 1,000 milligrams of the medication, with a two-week interval between them. After these initial infusions, patients are given a 500-milligram infusion at Month 12 and every six months after that. Pemphigus Vulgaris is a rare autoimmune disorder affecting the skin and mucous membranes.


Rituxan should be given only as an intravenous infusion, not as a quick injection or bolus. It must be administered by a healthcare professional equipped to manage severe infusion reactions if they occur.

Patients should be premedicated before each infusion to lower the risk of severe reactions. Before the first infusion, they must be screened for hepatitis B and get a complete blood count (CBC).

During therapy, CBC with differential and platelet counts should be regularly monitored. If infusion-related reactions occur, the infusion should be slowed or stopped and then resumed at a slower rate once symptoms improve.


Use an aseptic technique and ensure the solution is clear before use.

Dilute Rituxan to a final concentration of 1 mg/mL to 4 mg/mL in an infusion bag with either 0.9% Sodium Chloride or 5% Dextrose Injection.

Mix the solution gently and do not combine it with other medications.

Warnings & Precautions

Rituxan may cause severe reactions during infusion, sometimes leading to serious outcomes like difficulty breathing, low blood pressure, or even heart problems. If severe reactions happen, doctors may stop the infusion or slow it down until the symptoms get better.

  • Severe Mucocutaneous Reactions: Rarely, Rituxan can cause severe skin and mucous membrane reactions, which can be life-threatening. If patients experience these reactions, Rituxan should be stopped, but it’s not clear if it can be restarted safely.
  • Hepatitis B Virus (HBV) Reactivation: Patients with a history of hepatitis B infection should be monitored closely while on Rituxan, as it can reactivate the virus, leading to liver problems. Doctors may need to treat the hepatitis B infection before starting Rituxan or stop Rituxan if the virus becomes active again.
  • Progressive Multifocal Leukoencephalopathy (PML): Rituxan may increase the risk of a rare brain infection called PML, especially in patients with weakened immune systems.
  • Tumor Lysis Syndrome (TLS): Some patients with certain types of cancer may develop TLS after starting Rituxan, which can cause kidney failure and other serious problems. Doctors will take steps to prevent and treat TLS in at-risk patients.
  • Infections: Serious infections, including viral infections like herpes or hepatitis, can happen while on Rituxan and even after treatment ends. Rituxan might not be suitable for patients with severe infections.
  • Cardiovascular Adverse Reactions: Rituxan can sometimes cause heart problems like irregular heartbeats or heart attacks.
  • Renal Toxicity: In some patients, Rituxan can cause kidney problems, especially when combined with certain other medications.
  • Bowel Obstruction and Perforation: Rarely, Rituxan can lead to blockages or holes in the intestines, which can be fatal. Patients should report any new abdominal pain or vomiting to their doctor.
  • Immunization: Rituxan might affect how well vaccines work, especially live vaccines. Patients should be up-to-date with their vaccinations before starting Rituxan, but live vaccines are not recommended while on treatment.
  • Embryo-Fetal Toxicity: Rituxan can harm unborn babies, so pregnant women should avoid it. Women of childbearing age should use effective birth control while on Rituxan and for some time after treatment ends.
  • Simultaneous Use with Other Biologic Agents and Disease Modifying Anti-Rheumatic Drugs (DMARDS): The safety of using Rituxan with other drugs in certain conditions is not well understood.
  • Use in RA Patients Who Have Not Had Prior Inadequate Response to Tumor Necrosis Factor (TNF) Antagonists: Rituxan may not be suitable for patients with rheumatoid arthritis who haven’t responded well to other treatments. Doctors will consider other options for these patients.

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Rituxan is commonly used to treat different conditions, like certain types of cancers, autoimmune diseases, and immune system disorders. It’s often used for non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis, microscopic polyangiitis, and pemphigus vulgaris.

The cost of Rituxan can vary. For example, a single 10-milliliter vial costs around $99.88, while a 50-milliliter vial costs around $99.12. If you need a package of 100 vials (each 10 milliliters), it could cost around $99.03 per vial. However, the actual price you pay might be different based on factors like your treatment plan and whether you have insurance.

Rituxan works by targeting and attaching to a protein called CD20 found on the surface of certain blood cells, including cancerous ones. It helps your immune system fight cancer by either destroying cancer cells directly or by activating your immune system to attack them. This way, Rituxan helps to reduce the number of cancer cells in your body.

Rituxan works for autoimmune diseases by targeting and reducing B-cells in the body. In autoimmune disorders like rheumatoid arthritis, these B-cells can cause swelling and damage to joints. By depleting these B-cells, Rituxan helps to lessen inflammation and protect the joints.

It also works similarly for other autoimmune conditions like granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), where B-cells play a role in causing inflammation and damage.

Rituxan can have lasting effects that may continue for up to 12 months after the final infusion. This means that even after completing the treatment course, the benefits of Rituxan may persist for a considerable period. However, the duration of Rituxan’s effects can vary from person to person depending on factors such as the specific condition being treated, individual response to the medication, and other treatments being used in conjunction with Rituxan.

Rituxan may start showing some initial effects within about 8 weeks after treatment. However, this early response is usually temporary and often happens because of the medication given before Rituxan, called glucocorticoid pre-medication. It’s important to remember that the full benefits of Rituxan may take longer to become noticeable, and individual responses to the treatment can vary.

Yes, Rituxan can potentially cause liver damage, especially in people who have had hepatitis B or are carriers of the hepatitis B virus (HBV). If you fall into this category, receiving Rituxan might reactivate the virus, leading to serious liver problems like liver failure or even death. It’s important for your healthcare provider to screen you for hepatitis B before starting Rituxan treatment and to monitor your liver function during and after treatment closely.

Yes, Rituxan can potentially cause anxiety as a side effect. Some people may experience feelings of anxiety or nervousness while receiving Rituxan treatment. If you notice any changes in your mood or mental state during Rituxan therapy, it’s essential to discuss them with your healthcare provider.

While taking Rituxan, avoid alcoholic beverages and marijuana (cannabis). Rituxan can increase your risk of infections or worsen existing ones, so stay away from people with contagious infections like chickenpox, COVID-19, measles, and the flu.

Rituxan can cause side effects that might last a few days to weeks. If these side effects last longer, bother you, or become severe, talk to your doctor or pharmacist. Common side effects include infusion reactions, infections, and tiredness. The effects of Rituxan itself can last up to 12 months after your last infusion.

No, Rituxan is not a form of chemotherapy. It is a type of antibody therapy that can be used alone or with chemotherapy.