BMA Concise Guide to Medicine & Drugs

Infliximab

Brand name Remicade

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for inflammatory bowel disease and disease-modifying antirheumatic drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Infliximab is a monoclonal antibody that can modify the activity of the immune system and cut down inflammation. It reduces the activity of a substance produced by the body called tumour necrosis factor alpha (TNF-alpha), which drives many inflammatory conditions, such as psoriasis, rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. Infliximab can therefore be used to treat these conditions by reducing TNF-alpha activity.

Infliximab is given by intravenous infusion, generally into the arm.

Infections, most often those affecting the upper respiratory and urinary tracts, occur more commonly with infliximab treatment.

INFORMATION FOR USERS

The drug is given only under medical supervision and is not for self-administration.

How taken/used Intravenous infusion.

Frequency and timing of doses Every 6 to 8 weeks. Infusion time is generally over a 2-hour period.

Adult dosage range Dosing is based on body weight; 3mg/kg to 5mg/kg per dose.

Onset of effect 1 hour; full beneficial effect may take several weeks.

Duration of action 2–8 weeks.

Diet advice None.

Storage Not applicable. The drug is not normally kept in the home.

Missed dose As infliximab is dosed every 6–8 weeks, it is important to adhere to the dosing schedule arranged by your doctor. Missed doses should be rectified as soon as possible.

Stopping the drug No adverse effects are reported when stopping infliximab abruptly.

Exceeding the dose Infliximab is given in hospital under close supervision so it is unlikely that the dose will be exceeded.

POSSIBLE ADVERSE EFFECTS

Infusion reactions may occur during treatment or within 1–2 hours, particularly with the first or second treatment. Delayed reactions, including muscle and joint pain, fever, and rash, may occur 3–12 days after infusion. Nausea, vomiting, diarrhoea, headache, back pain, dizziness, and infusion reactions are common. Susceptibility to infection is a rarer adverse effect. Discuss this and any infusion reaction with your doctor. If you experience swelling of the tongue, wheezing, or a rash, the drug should be stopped and you should seek immediate medical attention.

INTERACTIONS

Anakinra should not be combined with infliximab because there is an increased risk of reactions.

Vaccines Infliximab may affect the efficacy of these.

SPECIAL PRECAUTIONS

Infliximab is prescribed only under close medical supervision. However, be sure to tell your doctor if:

· You have active tuberculosis or any other current infection.

· You have any signs of infection (e.g. fever, malaise, wounds, dental problems).

· You are having any surgery or dental treatment.

· You have liver or kidney problems.

· You have a central nervous system disorder such as multiple sclerosis.

· You have recently received, or are scheduled to receive, a vaccine.

· You have had heart failure.

· You are taking other medicines.

Pregnancy Not recommended.

Breast-feeding Not recommended during breast-feeding or for 6 months after last dose of the drug.

Infants and children Not recommended.

Over 60 No special problems.

Driving and hazardous work Do not undertake such activities until you have learned how infliximab affects you because the drug can cause fatigue and dizziness.

Alcohol No special problems.

PROLONGED USE

There is an increased risk of infections (including tuberculosis). Concerns that infliximab may increase the risk of some cancers have not been confirmed.

Monitoring Periodic blood and liver-function tests may be carried out. Body temperature, heart rate, and blood pressure may be monitored during the first infusion.