| DRUG | SUPPLIED | DOSE | COMMENTS |
|---|---|---|---|
| INFLIXIMAB (Paeds) (Remicade) Mechanism of action: IgG 1 monoclonal antibody; Tumor Necrosis Factor-alpha (TNF) blocking agent; Immunosuppressant agent; Disease-modifying anti-rheumatic drug (DMARD) Ref: 32, 44,138, 152, 321, 385 Last update: 2019-04-03 |
injection: 100 mg/vial |
Rheumatic diseases: e.g. juvenile idiopathic arthritis, uveitis, vasculitis (in combination with methotrexate): Initial: 6 mg/kg/dose IV; repeat at 2 and 6 weeks after initial infusion, then 6 mg/kg/dose every 6-8 weeks thereafter. (Doses up to 10 mg/kg have been used in incomplete responders with uveitis) GI Disease (Crohn's, Ulcerative colitis): Initial: 5 mg/kg/dose IV at 0, 2 & 6 weeks followed by 5 mg/kg/dose IV every 8 weeks (frequency may be reduced to Q4 weeks and dose increased to 10 mg/kg for incomplete responders (trough infliximab levels may guide dosing). Refer to BCCH parenteral monograph for additional administration and monitoring information |
CXR and TB skin test or Quantiferon assay before therapy is essential. The manufacturer recommends vaccinations be brought up to date prior to initiating therapy. Acute or subacute adverse effects: Infusion reactions (fever, chills, chest pain, hypotension, hypertension, dyspnea, pruritis, urticaria, headache) occur in 19% of patients. within 1-2 hours after infusion. Premedication with acetaminophen, diphenhydramine and /or a corticosteroid may prevent or reduce severity. Delayed allergic reactions (muscle/joint pain with fever or rash) can occur 3-12 days after treatment. Anaphylaxis is infrequent. Resuscitation equipment, epinephrine, diphenhydramine and corticosteroids must be available on the unit when infliximab is given. Chronic adverse effects include: Severe infections: typical (strep or staph) or atypical (e.g. mycobacterium) bacterial infections and invasive fungal infections, resulting in 12 reported deaths. Herpes Zoster may be reactivated. Malignancy: rare but serious; most commonly lymphomas and most commonly in age < 25 yrs. Contraindicated in active infection, congestive heart failure, and with concurrent live vaccines. Caution in patients with chronic or recurrent infection, tuberculosis, HIV and hepatitis B Standard Prescription: infliximab__mg IV Q__week(s) ( mg/kg/dose) infliximab__mg (__mg/kg/dose) IV at__, __ and __weeks, then__mg IV Q__week(s) |