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Infliximab (Remicade)

What is a Remicade?
Infliximab is a TNF-alpha blocking drug. TNF-alpha is a chemical mediator in the body. It is present in high concentration in patients with Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis & some other autoimmune conditions. It is a mediator of inflammation in these arthritic conditions. By blocking the TNF-alpha, Infliximab can reduce the inflammation.
When is Infliximab used in Rheumatoid arthritis?
Infliximab is used in rheumatoid arthritis patients when the disease is not controlled with the basic disease modifying agents (Methotrexate/ leflunomide/ sulphasalazine/ hydroxychloroquine) or if the patient does not tolerate these medicines.
How is Infliximab given?
Infliximab is given by an IV infusion over 2- 4 hours. It is administered in a hospital. The second dose is given 2 weeks after the first dose & the third one 6 weeks after the first one. Subsequent doses are given at 6- 8 week interval depending on the RA disease activity. It is usually combined with Methotrexate in rheumatoid arthritis treatment.
What are the possible side effects of Infliximab?
One can have chills, rash, nausea, light headedness (infusion reaction) during the infusion.
Infliximab is an immunosuppressant & hence affects the body's ability to fight infections. As a result, one is more prone to catch infections. Your Rheumatologist will screen you for Tuberculosis with a X ray chest & a mantoux test prior to starting you on Infliximab.
Rare cases of liver injury, Hepatosplenic T-cell Lymphoma after Remicade, lupus like syndrome have been reported.
Infliximab is not given in patients with heart failure, demyelinating disease like multiple sclerosis, Guillain barre syndrome as they may worsen with Infliximab.
Before starting Infliximab, tell your Rheumatologist if you have any of these-
Tuberculosis in the recent past
Close contact with someone with tuberculosis
Any active infection
Demyelinating diseases like multiple sclerosis, Guillain barre syndrome
Hepatitis in the past
Diabetes or any other immune system problem
Planning to conceive, nursing a child.
Cardiac ailment, especially heart failure
Have had any type of cancer
Do I need any blood checks while on Infliximab?
Yes. Apart from basic blood tests, one has to undergo X ray of the chest & a tuberculin skin test before starting Infliximab. This is done as Infliximab can reactivate tuberculosis in those who have been previously infected with tuberculosis.
Can I consume alcohol while on Infliximab?
You may consume alcohol while on Infliximab. However, if you are also on Methotrexate, alcohol is better avoided.
Can I have vaccines while on Infliximab?
It is recommended to avoid live vaccines while on Infliximab.
Does Infliximab affect pregnancy?
The effects of infliximab on pregnancy are not exactly known. It is recommended that you do not plan pregnancy for 1 year after the last dose of Infliximab.
Can I breast feed while on Infliximab?
No, you should not breast feed while on Infliximab.
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Created on: April 2007
Last updated on: Feb 2015
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