Za Pharmacy
Drugs, Supplies and Delivery
Infliximab (Remicade)
Infliximab, marketed under the brand name Remicade, is a chimeric monoclonal antibody biologic medication that targets tumor necrosis factor-alpha (TNF-α). It is widely used to treat autoimmune and inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, and ankylosing spondylitis. This article synthesizes information from the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to provide a detailed overview of infliximab, including its mechanism, uses, dosing, side effects, precautions, and drug interactions.
Infliximab binds to soluble and membrane-bound TNF-α, a pro-inflammatory cytokine, and prevents it from interacting with its receptors. This action:
- Reduces inflammation: Inhibits the release of other inflammatory cytokines (e.g., IL-1, IL-6) and decreases immune cell migration to inflamed tissues (Lippincott, Lange).
- Modulates immune response: Suppresses the overactive immune system in autoimmune diseases, reducing tissue damage and symptoms (BNF).
Infliximab is administered intravenously and has a half-life of approximately 8–10 days, allowing for dosing intervals of 4–8 weeks (Lippincott).
- Rheumatoid Arthritis (RA):
- Used in combination with methotrexate to reduce joint inflammation and slow disease progression (BNF).
- Crohn’s Disease and Ulcerative Colitis:
- Induces and maintains remission in moderate to severe inflammatory bowel disease (IBD) (Lippincott).
- Psoriasis and Psoriatic Arthritis:
- Improves skin lesions and joint symptoms (Lange).
- Ankylosing Spondylitis:
- Reduces spinal inflammation and improves mobility (BNF).
- Pediatric Crohn’s Disease:
- Approved for children aged 6 years and older (Lippincott).
- Adults:
- Rheumatoid Arthritis: 3 mg/kg intravenously at weeks 0, 2, and 6, then every 8 weeks (BNF).
- Crohn’s Disease and Ulcerative Colitis: 5 mg/kg intravenously at weeks 0, 2, and 6, then every 8 weeks (Lippincott).
- Psoriasis and Psoriatic Arthritis: 5 mg/kg intravenously at weeks 0, 2, and 6, then every 8 weeks (Lange).
- Ankylosing Spondylitis: 5 mg/kg intravenously at weeks 0, 2, and 6, then every 6–8 weeks (BNF).
- Children (≥6 years):
- Pediatric Crohn’s Disease: 5 mg/kg intravenously at weeks 0, 2, and 6, then every 8 weeks (Lippincott).
Administration:
- Administered as an intravenous infusion over 2 hours.
- Pre-treatment with antihistamines, corticosteroids, or acetaminophen may reduce infusion reactions (Lange).
- Common: Infusion reactions (e.g., fever, chills, rash), headache, and upper respiratory infections (Lippincott).
- Serious:
- Infections: Increased risk of bacterial, viral (e.g., TB, hepatitis B), and fungal infections (Lange).
- Malignancies: Rare cases of lymphoma and other cancers (BNF).
- Heart Failure: Worsening of pre-existing heart failure (Lippincott).
- Hypersensitivity Reactions: Anaphylaxis or serum sickness-like reactions (Lange).
- Common: Infusion reactions (e.g., fever, chills, rash), headache, and upper respiratory infections (Lippincott).
- Serious:
- Infections: Increased risk of bacterial, viral (e.g., TB, hepatitis B), and fungal infections (Lange).
- Malignancies: Rare cases of lymphoma and other cancers (BNF).
- Heart Failure: Worsening of pre-existing heart failure (Lippincott).
- Hypersensitivity Reactions: Anaphylaxis or serum sickness-like reactions (Lange).
- Live Vaccines: Avoid concurrent use due to risk of vaccine-induced infections (Lippincott).
- Other Immunosuppressants: Increased risk of infections when combined with drugs like methotrexate or corticosteroids (Lange).
- Anakinra or Abatacept: Increased risk of serious infections; avoid concurrent use (BNF).
Infliximab is the generic name for this medication. It is marketed under the brand name Remicade®. Biosimilar versions, such as Inflectra®, Remsima®, and Renflexis®, are also available, providing cost-effective alternatives.
