Infliximab Treatment: Uses, Dosage, Side Effects & Infusion Guide

Summary of Key Points

Infliximab is a prescription medication used to treat several autoimmune conditions, including rheumatoid arthritis, Crohn’s disease, and psoriasis. It works by reducing inflammation, which helps alleviate symptoms such as pain and swelling. Infliximab is typically administered through an intravenous (IV) infusion. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist in managing your treatment plan.

Names of Medication

US Brand Name: Remicade

Generic Name: Infliximab

The ‘generic name’ refers to the active ingredient, while the brand name is assigned by the manufacturer. In this case, infliximab is the generic name.

Pharmacologic Category

Tumor Necrosis Factor (TNF) Blocker

Infliximab belongs to a class of medications known as TNF blockers. These drugs reduce inflammation by targeting a specific protein in the immune system called tumor necrosis factor (TNF). This mechanism makes infliximab effective in treating autoimmune diseases.

Infliximab Dosing Guidelines

Infliximab is used to treat various autoimmune conditions in adults. The dosing schedule depends on the specific condition being treated. Always consult your healthcare provider before making any changes to your dose. Our telemedicine providers are available to guide you through your treatment plan.

Rheumatoid Arthritis

Initial dose: 3 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 3 mg/kg every 8 weeks. In some cases, the dose may be increased to 10 mg/kg, or the frequency may be adjusted based on your response to treatment.

Crohn’s Disease

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks. If symptoms persist, the dose may be increased to 10 mg/kg.

Ulcerative Colitis

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Ankylosing Spondylitis

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 6 weeks.

Psoriasis

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Psoriatic Arthritis

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Hidradenitis Suppurativa

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Juvenile Idiopathic Arthritis

Initial dose: 3 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 3 mg/kg every 8 weeks.

Sarcoidosis

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Behçet’s Disease

Initial dose: 5 mg/kg administered as an IV infusion at 0, 2, and 6 weeks. Maintenance dose: 5 mg/kg every 8 weeks.

Dosage Forms and Strengths

Intravenous (IV) infusion: 100 mg of infliximab per vial

Infliximab Administration Instructions

Infliximab is administered by a healthcare professional through an intravenous (IV) infusion. The infusion typically takes about 2 hours. You will be monitored during and after the infusion to ensure there are no immediate side effects. It is important to attend all scheduled infusions to maintain the effectiveness of your treatment. If you miss a dose, contact your healthcare provider to reschedule.

Adverse Reactions and Infliximab Side Effects

Like all medications, infliximab can cause side effects. Some are more common than others, and some may be serious. If you experience any side effects, contact your healthcare provider immediately. Our telemedicine providers are available to assist you.

Common Side Effects: These occur in more than 10% of patients.

1. Upper respiratory infections (cold-like symptoms)
2. Headache
3. Stomach pain
4. Nausea

Less Common Side Effects: These occur in 1-10% of patients.

1. Rash
2. Fever
3. Fatigue
4. Joint pain

Serious Side Effects: These are rare but may require immediate medical attention.

1. Severe allergic reactions (difficulty breathing, swelling of the face or throat)
2. Infections (fever, chills, persistent cough)
3. Liver problems (yellowing of the skin or eyes, dark urine)
4. Heart failure (shortness of breath, swelling of ankles or feet)

Contraindications for Infliximab Treatment

A contraindication is a specific condition where a medication should not be used because it may cause harm. It is important to know if you have any contraindications before starting infliximab.

Common Contraindications for Infliximab

Severe infections: Infliximab suppresses the immune system, making it harder to fight infections. If you have an active infection, such as tuberculosis (TB) or a serious bacterial, viral, or fungal infection, infliximab could worsen the condition.

Heart failure: Infliximab can worsen heart failure, especially in individuals with moderate to severe heart failure. If you have a history of heart failure, your doctor may recommend avoiding this medication.

Multiple sclerosis or other demyelinating diseases: Infliximab may increase the risk of developing or worsening demyelinating diseases, such as multiple sclerosis. If you have a history of these conditions, infliximab may not be safe for you.

Allergic reactions to infliximab or its components: If you have had a serious allergic reaction to infliximab or any of its ingredients, you should not take this medication. Allergic reactions can be life-threatening.

Recent live vaccines: Since infliximab weakens the immune system, live vaccines should be avoided while on this medication. Live vaccines can cause infections in individuals with weakened immune systems.

Drug to Drug Interactions

Infliximab can interact with other medications, potentially increasing the risk of side effects or reducing the effectiveness of either drug. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Medications That May Interact with Infliximab

Abatacept (Orencia): Using abatacept with infliximab can increase the risk of serious infections.

Anakinra (Kineret): Combining anakinra with infliximab may heighten the likelihood of infections and other side effects.

Adalimumab (Humira): Taking both adalimumab and infliximab can raise the risk of infections and immune system-related complications.

Etanercept (Enbrel): Using etanercept alongside infliximab may also increase the risk of infections.

Live vaccines: As mentioned earlier, live vaccines should be avoided while taking infliximab, as they can lead to infections in individuals with weakened immune systems.

Infliximab in Pregnancy

Is it safe to take infliximab during pregnancy?

Infliximab is classified as a pregnancy category B drug, meaning animal studies have not shown harm to the fetus, but human studies are limited. While infliximab may be necessary to control certain conditions during pregnancy, it’s essential to weigh the benefits and risks. Some studies suggest that infliximab crosses the placenta, particularly in the third trimester, which could potentially affect the baby’s immune system. If you are pregnant or planning to become pregnant, discuss your treatment options with your healthcare provider. Our telemedicine providers are available to help you make the best decision for both your health and your baby’s well-being.

Infliximab While Breastfeeding

Is it safe to take infliximab while breastfeeding?

Infliximab is a large protein, and only small amounts are expected to pass into breast milk. Studies suggest that infliximab is unlikely to be absorbed by the baby’s digestive system, making it less likely to cause harm. However, since infliximab affects the immune system, it’s important to discuss the potential risks and benefits with your healthcare provider. If you are breastfeeding or planning to breastfeed, consult with one of our telemedicine providers to determine the best course of action for you and your baby.

Estimated Cost of Infliximab

The cost of infliximab can vary depending on the dosage and where it’s purchased. Without insurance, the estimated cost of a 30-day supply using a GoodRX coupon ranges from $1,200 to $2,500. Prices may fluctuate, so it’s a good idea to check with your pharmacy or use a discount service like GoodRX to find the best price.

Possible Alternatives to Infliximab

If infliximab isn’t suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.

Rheumatoid Arthritis

Alternative medications: Methotrexate, Leflunomide (Arava), or biologics like Etanercept (Enbrel) or Adalimumab (Humira).

Lifestyle changes: Regular exercise, a balanced diet, and physical therapy can help manage symptoms.

Crohn’s Disease

Alternative medications: Ustekinumab (Stelara), Vedolizumab (Entyvio), or corticosteroids like Prednisone.

Lifestyle changes: A low-fiber diet, stress management, and avoiding trigger foods can help reduce flare-ups.

Ulcerative Colitis

Alternative medications: Mesalamine (Asacol), Vedolizumab (Entyvio), or corticosteroids.

Lifestyle changes: A low-residue diet and stress reduction techniques may help control symptoms.

Ankylosing Spondylitis

Alternative medications: NSAIDs like Ibuprofen or Naproxen, or biologics like Etanercept (Enbrel).

Lifestyle changes: Regular exercise, particularly stretching and strengthening exercises, can improve flexibility and reduce pain.

Psoriasis

Alternative medications: Topical treatments like corticosteroids, or biologics like Secukinumab (Cosentyx).

Lifestyle changes: Avoiding triggers such as stress, smoking, and certain foods may help reduce flare-ups.

Psoriatic Arthritis

Alternative medications: Methotrexate, Leflunomide (Arava), or biologics like Etanercept (Enbrel).

Lifestyle changes: Regular physical activity and maintaining a healthy weight can help manage symptoms.

Hidradenitis Suppurativa

Alternative medications: Antibiotics like Clindamycin, or biologics like Adalimumab (Humira).

Lifestyle changes: Weight management, avoiding tight clothing, and practicing good hygiene may help reduce flare-ups.

Juvenile Idiopathic Arthritis

Alternative medications: Methotrexate, Etanercept (Enbrel), or Adalimumab (Humira).

Lifestyle changes: Physical therapy and regular exercise can help improve joint function and reduce pain.

Sarcoidosis

Alternative medications: Corticosteroids like Prednisone, Methotrexate, or Azathioprine.

Lifestyle changes: Quitting smoking and maintaining a healthy diet may help manage symptoms.

Behçet’s Disease

Alternative medications: Colchicine, corticosteroids, or immunosuppressants like Azathioprine.

Lifestyle changes: Stress management and avoiding triggers may help reduce flare-ups.

Recent Updates on Infliximab Research

Recent studies on infliximab have focused on its long-term safety and effectiveness in treating autoimmune diseases. A 2022 study found that infliximab remains effective for up to 10 years in patients with Crohn’s disease and ulcerative colitis, with many experiencing sustained remission. Ongoing research is also exploring the use of biosimilars (cheaper, similar versions of infliximab) to reduce costs while maintaining the same level of effectiveness. Additionally, studies are investigating infliximab’s potential in treating other inflammatory conditions, such as COVID-19-related complications, though more research is needed.

As new research emerges, staying informed is crucial. If you have questions about how these updates may affect your treatment plan, our telemedicine providers are available to discuss the latest findings and help you make informed decisions.

James Kingsley

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