INFLIXIMAB (Remicade®) INFORMATION SHEET

Developed by Andy Thompson MD FRCPC

What is Infliximab?

Infliximab is a biologic. It is used for the treatment of Rheumatoid arthritis, Psoriatic arthritis, Ankylosing spondylitis, and other types of arthritis.

How does Infliximab work?

In some people with arthritis, a protein called Tumour Necrosis Factor (TNF) is present in the blood and joints in excessive amounts where it increases inflammation (pain & swelling). Infliximab is another type of protein (antibody) called a TNF blocker which blocks the action of TNF. By blocking TNF, Infliximab works by suppressing the body’s immune system. Although this suppression can make it slightly harder for you to fight off infections, it also helps to stabilize an overactive immune system.

Why am I taking Infliximab?

Your doctor has prescribed this medicine to help with the following:

1. Reduce the pain and swelling (inflammation) in your joints.
2. Improve your day to day function.
3. Prevent long-term damage from the joint inflammation.

What is the usual dose of Infliximab?

• Infliximab is given by an intravenous (IV) infusion.
• The normal starting dose is typically 3 mg/kg which is based on your body weight. Your doctor may increase your dose as you are taking the medication.
• Methotrexate is commonly used in combination with Infliximab which improves your response to the medication.

How often do I take Infliximab?

• You will receive your first dose of Infliximab on week 0. The second dose is given on week 2 and the third dose on week 6.
• The maintenance dose begins 6 to 8 weeks after the third dose and infusions are then given every 6 to 8 weeks thereafter.
• The infusions usually take about 2 hours.

Who should NOT take Infliximab?

• Patients who have had a previous serious allergic reaction to Infliximab.
• Women who are pregnant, planning on becoming pregnant, or currently breast feeding.
• Possibly patients who have cancer or have had a past history of certain cancers.
• Patients who have congestive heart failure.
• Patients who have Lupus or multiple sclerosis.
• Patients with active infections (such as tuberculosis).

When will I start to feel the effects of Infliximab?

Infliximab may take about 2 weeks before you start to feel the effects. Some patients notice benefit with the first dose and with others it may take several weeks. It may take 4 to 12 weeks before you feel a lot of benefit.

What should I AVOID while taking Infliximab?

• You should discuss all vaccinations with your doctor as some vaccines are not advisable while you are taking Infliximab.
• If you are scheduled for surgery, please tell your doctor.

When should I NOT TAKE my Infliximab?

You contact your doctor before missing any infusion of Infliximab. In the following situations, it would be advisable to stop the Infliximab:

• If you have a fever.
• If you have or think you have an infection.
• If you think you are pregnant.

Which Medications are safe to take with Infliximab?

Your rheumatologist may decide to add other medications to treat your arthritis.

Nearly all medications are safe to take with Infliximab. As an example, some of the other medications which may be safely added to Infliximab include: Acetaminophen (Tylenol), Prednisone, and Other DMARDs.

What are the side-effects of Infliximab?

MORE COMMON side-effects include:

• Abdominal pain, nausea, vomiting, and diarrhea.
• Back pain, aching joints.
• Rash, fllushing.
• Headaches.
• Upper respiratory tract infections (such as sinusitis).

RARE side-effects include:

• Infusion Reaction – Some patients may react to the medication during or shortly after and infusion.
• Infection – There is an increased risk of serious infections associated with the use of Infliximab. Any infections or fevers should be taken very seriously and reviewed by your doctor.
• Nervous System – There have been rare reports of some patients developing disorders that affect the nervous system (multiple sclerosis, seizures, or inflammation of the nerves of the eye) while taking Infliximab. Fortunately, these reports are exceedingly rare.
• Heart – Inform your doctor if you have congestive heart failure as Infliximab may make it worse.
• Malignancy – Infliximab has been associated with a small increased risk of developing cancer (<1%).

How can I help to minimize the side-effects of Infliximab?

• Take your Infliximab as prescribed by your doctor.

Do I need to have regular blood tests while taking Infliximab?

Blood tests are not routinely required while you are taking Infliximab. However, your doctor will likely order periodic blood tests to check your blood counts and follow the activity of your arthritis, especially if you are on other DMARDs.

How do I stop the Infliximab?

You do not need to wean yourself off the Infliximab. It can simply be stopped. However, your arthritis will likely “flare” after you stop the medicine.

What should I do if I miss a dose of Infliximab?

• If you miss your Infliximab infusion contact your doctor to find out when to reschedule for your next infusion.

Is Infliximab safe in pregnancy?

• Infliximab is a new medication and it is unknown if it is safe to use in pregnancy. Therefore, you should AVOID PREGNANCY while on Infliximab.
• All women of child bearing potential taking Infliximab must use reliable contraception.
• If you become pregnant while taking Infliximab NOTIFY YOUR DOCTOR IMMEDIATELY.
• You should not breast feed while taking Infliximab.