Introduction
Remicade is used for the treatment of various inflammatory conditions of the joints (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), skin (psoriasis), and bowel (ulcerative colitis, Crohn’s disease). It reduces inflammation in these conditions by blocking TNF alpha.
Remicade is given as an infusion (slow drip) into a vein under the supervision of a doctor. You will be monitored while you are given this medicine. The dose and how often you need it will be decided by your doctor so that you get the right amount to control your symptoms. Make sure that you turn up for all your injections as per the schedule advised by your doctor. Taking this medicine regularly will greatly help to relieve your symptoms.
The most common side effects seen with this medicine include headache, sinus inflammation, upper respiratory tract infection, abdominal pain, and pharyngitis (pain or irritation in the throat). Some people may experience fever, chills, sweating, etc. due to an infusion reaction while this medicine is administered. Consult your doctor if any of the side effects persist or bother you. You may get infections more easily when you are being treated with this medicine. Tell your doctor right away if you develop any symptoms of an infection like fever, cough, rash, loose stools, or flu-like symptoms.
Before the start of treatment, let your doctor know if you have heart failure or tuberculosis or another serious infection like pneumonia or if you the hepatitis B virus. Pregnant and breastfeeding women should also consult their doctor before using this medicine. Some other medicines may react with this medicine so talk to your doctor about other medications you are taking as well. During treatment, your doctor will advise some tests to monitor your blood cell counts and track your progress.
Uses of Remicade
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriasis
- Psoriatic arthritis
- Ulcerative Colitis
- Crohn’s disease
Side effects of Remicade
Common
- Headache
- Sinus inflammation
- Upper respiratory tract infection
- Infusion reaction
- Abdominal pain
- Sore throat
How to use Remicade
Your doctor or nurse will give you this medicine. Kindly do not self administer.
How Remicade works
Remicade is a monoclonal antibody that blocks a protein in immune system called TNF (tumor necrosis factor) that causes inflammation (pain and swelling) in joints.
What if you forget to take Remicade?
If you miss a dose of Remicade, please consult your doctor.
Indication
Crohn's disease, Rheumatoid arthritis, Ulcerative colitis, Ankylosing spondylitis, Psoriatic arthritis, Plaque psoriasis
Adult Dose
Intravenous
Crohn's disease
Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk after 1st infusion. No further doses should be given if there is no response after 2 doses. Responders: Maintenance: 5 mg/kg at 6 wk after initial dose then 8 wkly thereafter. May be re-administered w/in 16 wk after last infusion if signs/symptoms recur.
Rheumatoid arthritis
Adult: In combination w/ methotrexate: Initially, 3 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter. May increase dose in increments of 1.5 mg/kg to a max of 7.5 mg/kg 8 wkly if patient has inadequate response or loses response over a period of 12 wk. Alternatively, 3 mg/kg 4 wkly. May be re-administered w/in 16 wk after last infusion if signs/symptoms recur.
Fistulising Crohn's disease
Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion. No further doses should be given if there is no response after 3 doses. Responders: Maintenance: 5 mg/kg 8 wkly. Re-admin: 5 mg/kg if signs/symptoms recur, followed by 5 mg/kg 8 wkly.
Ankylosing spondylitis
Adult: Initially, 5 mg/kg, repeated at 2 wk and 6 wk, then 6-8 wkly thereafter. Stop treatment if there is no response after 2 doses.
Ulcerative colitis
Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter. No further doses should be given if there is no response after 3 doses.
Psoriatic arthritis; Plaque psoriasis
Adult: Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk, then 8 wkly thereafter. Stop treatment if there is no response after 12 wk for psoriatic arthritis and after 14 wk for plaque psoriaris.
Child Dose
Intravenous
Crohn's disease
Child: 6-17 yr Initially, 5 mg/kg by infusion over at least 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter.
Ulcerative colitis
Child: 6-17 yr Initially, 5 mg/kg by infusion over 2 hr, repeated at 2 wk and 6 wk after 1st infusion then 8 wkly thereafter.
Contraindication
Patient w/ TB or other severe infections (e.g. sepsis, abscesses, opportunistic infections), moderate or severe heart failure (NYHA class III or IV).
Mode of Action
Infliximab is a chimeric monoclonal antibody which binds w/ high affinity to the soluble and transmembrane forms of tumour necrosis factor-α (TNF-α) thereby inhibiting binding of TNF-α to its receptors.
Precaution
Patient w/ mild heart failure (NYHA class I or II), history of blood dyscrasias, chronic or recurrent infection. Childn. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor for signs and/or symptoms of infection, hypersensitivity reaction, lupus-like syndrome, heart failure, malignancy. Monitor vital signs every 2-10 min if reaction is noted during infusion. Perform hepatitis B virus screening prior to and hepatitis B virus carriers during and several mth after therapy; CBC w/ differential, LFTs.
Interaction
Increased risk of serious infection and neutropenia w/ anakinra or abatacept. Risk of clinical infections, including disseminated infections w/ concurrent admin of live vaccines.