Benidipine and Rituximab Infusion
Continue benidipine 8 mg on the day of rituximab infusion—there is no indication to withhold this calcium channel blocker before rituximab administration.
Rationale for Continuation
Benidipine is a dihydropyridine calcium channel blocker used for hypertension management, and there are no guideline recommendations or drug interaction concerns requiring its discontinuation before rituximab infusion 1, 2.
The primary concern with rituximab infusions is infusion-related reactions, which occur in up to 77% of patients during the first infusion, with symptoms including fever, chills, rash, dyspnea, and hypotension 1.
Hypotension during rituximab infusion is managed acutely by stopping or slowing the infusion and providing symptomatic treatment with antihistamines and corticosteroids—not by preemptively withholding antihypertensive medications 1, 2.
Management of Rituximab Infusion-Related Hypotension
For Grade 1-2 reactions with mild hypotension, the American College of Oncology recommends stopping or slowing the infusion rate, providing symptomatic treatment, and restarting at 50% of the previous rate after symptom resolution 1.
For Grade 3 reactions with severe hypotension, immediately stop the infusion, administer aggressive symptomatic treatment including H1/H2 antihistamines and corticosteroids, and consider 24-hour observation 1, 2.
Severe hypotension can occur as early as 5 minutes after rituximab infusion initiation, even in treatment-naïve patients, requiring vigilant monitoring throughout the infusion 3.
Standard Rituximab Infusion Protocol
The American College of Oncology recommends premedication with antipyretic and antihistamine for all patients receiving rituximab, along with a slow initial infusion rate 1, 2.
Following any infusion reaction, patients should be observed for a minimum of 1-2 hours after infusion completion, with consideration for more intensive premedication and slower infusion rates for subsequent doses 1.
Key Clinical Pitfall to Avoid
Do not withhold chronic antihypertensive medications like benidipine before rituximab infusion—this could lead to uncontrolled hypertension without preventing infusion-related hypotension, which is managed acutely with infusion rate adjustment and symptomatic treatment 1, 2.
Benidipine provides effective 24-hour blood pressure control with once-daily morning dosing and does not cause excessive nighttime hypotension or reflex tachycardia, making it safe to continue during rituximab therapy 4.