INFLIXIMAB
(Remicade)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)
infliximab__mg (__mg/kg/dose) IV at__, __ and __weeks, then__mg IV Q__week(s)
Dosages
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
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
Mechanism of Action
IgG 1 monoclonal antibody; Tumor Necrosis Factor-alpha (TNF) blocking agent; Immunosuppressant agent; Disease-modifying anti-rheumatic drug (DMARD)
Forms Supplied
injection: 100 mg/vial
Comments
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
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
References
32, 44,138, 152, 321, 385
Last Edited
2019-04-03 18:40:55