infliximab (Rx)

Brand and Other Names:Remicade, Inflectra, more...infliximab-dyyb, Renflexis, infliximab-abda, Ixifi, infliximab-qbtx, Avsola, infliximab-axxq
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, lyophilized powder for reconstitution

  • 100mg/vial (Remicade, Inflectra, Renflexis, Ixifi, Avsola)

Biosimilars to Remicade

  • Inflectra (infliximab-dyyb)
  • Renflexis (infliximab-abda)
  • Ixifi (infliximab-qbtx)
  • Avsola (infliximab-axxq)

Rheumatoid Arthritis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in patients with moderately-to-severely active rheumatoid arthritis in combination with methotrexate

3 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

If incomplete response is noted, dose may be increased to 10 mg/kg OR increasing the dosing frequency to q4Weeks

Psoriatic Arthritis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for reducing signs and symptoms of active arthritis, inhibiting the progression of structural damage, and improving physical function in patients with psoriatic arthritis

5 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

May be used with methotrexate

Plaque Psoriasis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for the treatment of adult patients with chronic severe (ie, extensive and/or disabling) plaque psoriasis who are candidates for systemic therapy and when other systemic therapies are medically less appropriate

Should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician

5 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

Can be used with or without methotrexate

Crohn Disease

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for moderately-to-severely active Crohn disease in patients who have had inadequate response to conventional therapy

Also, indicated for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in adult patients with fistulizing Crohn disease

5 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

For adult patients who respond and then lose their response, consideration may be given to treatment with 10 mg/kg

Patients who do not respond by Week 14 are unlikely to respond with continued dosing and consideration should be given to discontinue

Ulcerative Colitis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adults with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy

5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks  

Ankylosing Spondylitis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Indicated for reducing signs and symptoms in patients with active ankylosing spondylitis

5 mg/kg IV at 0, 2, and 6 weeks, THEN q6Weeks thereafter  

Idiopathic Pulmonary Fibrosis (Orphan)

Treatment of idiopathic pulmonary fibrosis

Orphan indication sponsor

  • Foundation for Fatal Rare Diseases; Herrengasse 21; Furstentum Liechtenstein; Germany

Dosage Modifications

Moderate-to-severe (NYHA class III or IV) heart failure: Not to exceed 5 mg/kg/dose (see Contraindications)

Dosing Considerations

Prior to initiating treatment and periodically during therapy, patients should be evaluated for active tuberculosis and tested for latent infection

Higher incidence of serious infections in infliximab-treated patients ≥65 years; use with caution

Dosage Forms & Strengths

injection, lyophilized powder for reconstitution

  • 100mg/vial (Remicade, Inflectra, Renflexis, Ixifi, Avsola)

Biosimilars to Remicade

  • Inflectra (infliximab-dyyb)
  • Renflexis (infliximab-abda)
  • Ixifi (infliximab-qbtx)
  • Avsola (infliximab-axxq)

Crohn Disease

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Reduction of signs and symptoms and induction and maintenance of clinical remission in pediatric patients aged ≥6 year with moderately to severely active Crohn disease who have had inadequate response to conventional therapy

<6 years: Not studied

≥6 to 17 years: 5 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

Ulcerative Colitis

Remicade, Inflectra, Renflexis, Ixifi, Avsola

Treatment of moderately to severely active ulcerative colitis in children aged ≥6 yr who have had inadequate response to conventional therapy

<6 years: Not studied

≥6 years: 5 mg/kg IV at 0, 2, and 6 weeks, THEN q8Weeks thereafter  

Dosing considerations

  • Due to risk of hepatosplenic T-cell lymphoma, a careful risk-benefit assessment should be made when drug is used in combination with other immunosuppressants in pediatric UC patients

Juvenile Rheumatoid Arthritis (Orphan)

Orphan indication sponsor

  • Centocor, Inc; 200 Great Valley Parkway; Malvern, PA 19355-1307

Dosing Considerations

Children should be current with immunizations before starting infliximab

Do not administer live vaccines while patient is taking infliximab

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Interactions

Interaction Checker

and infliximab

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      Serious - Use Alternative

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              Serious - Use Alternative (70)

              • abatacept

                abatacept, infliximab. Mechanism: pharmacodynamic synergism. Contraindicated. Increased risk of serious infection.

              • adalimumab

                adalimumab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • alefacept

                alefacept and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • anakinra

                anakinra and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • anthrax vaccine

                infliximab decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • antithymocyte globulin equine

                antithymocyte globulin equine and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • antithymocyte globulin rabbit

                antithymocyte globulin rabbit and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • azathioprine

                azathioprine and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • baricitinib

                baricitinib, infliximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.

              • basiliximab

                basiliximab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • BCG vaccine live

                infliximab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • canakinumab

                canakinumab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • certolizumab pegol

                infliximab and certolizumab pegol both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid combination because of an increased risk of serious infection.

              • cyclosporine

                cyclosporine and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • diphtheria & tetanus toxoids

                infliximab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • diphtheria & tetanus toxoids/ acellular pertussis vaccine

                infliximab decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

                infliximab decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • etanercept

                etanercept and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • everolimus

                everolimus and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • glatiramer

                glatiramer and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • golimumab

                golimumab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • hepatitis A vaccine inactivated

                infliximab decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • hepatitis a/b vaccine

                infliximab decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • hepatitis a/typhoid vaccine

                infliximab decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • hepatitis b vaccine

                infliximab decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • human papillomavirus vaccine, nonavalent

                infliximab decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

              • human papillomavirus vaccine, quadrivalent

                infliximab decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

              • hydroxychloroquine sulfate

                hydroxychloroquine sulfate and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • influenza virus vaccine quadrivalent

                infliximab decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • influenza virus vaccine quadrivalent, adjuvanted

                infliximab decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine quadrivalent, cell-cultured

                infliximab decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • influenza virus vaccine quadrivalent, intranasal

                infliximab decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • influenza virus vaccine trivalent

                infliximab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • influenza virus vaccine trivalent, adjuvanted

                infliximab decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • Japanese encephalitis virus vaccine

                infliximab decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • leflunomide

                infliximab and leflunomide both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • measles (rubeola) vaccine

                infliximab decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • measles mumps and rubella vaccine, live

                infliximab decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • measles, mumps, rubella and varicella vaccine, live

                infliximab decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • meningococcal A C Y and W-135 polysaccharide vaccine combined

                infliximab decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • muromonab CD3

                infliximab and muromonab CD3 both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • mycophenolate

                infliximab and mycophenolate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • pexidartinib

                infliximab and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pneumococcal vaccine 13-valent

                infliximab decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • pneumococcal vaccine heptavalent

                infliximab decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • pneumococcal vaccine polyvalent

                infliximab decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • pretomanid

                infliximab, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • rabies vaccine

                infliximab decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.

              • rabies vaccine chick embryo cell derived

                infliximab decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • rilonacept

                infliximab and rilonacept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • rotavirus oral vaccine, live

                infliximab decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • rubella vaccine

                infliximab decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • selinexor

                selinexor, infliximab. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sirolimus

                infliximab and sirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • smallpox (vaccinia) vaccine, live

                infliximab decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • tacrolimus

                infliximab and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • temsirolimus

                infliximab and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tetanus toxoid adsorbed or fluid

                infliximab decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • tick-borne encephalitis vaccine

                infliximab decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • tocilizumab

                tocilizumab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tofacitinib

                infliximab, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tongkat ali

                infliximab and tongkat ali both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • travelers diarrhea and cholera vaccine inactivated

                infliximab decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • typhoid polysaccharide vaccine

                infliximab decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • typhoid vaccine live

                infliximab decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • ustekinumab

                infliximab and ustekinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • varicella virus vaccine live

                infliximab decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • vedolizumab

                vedolizumab and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid coadministration of vedolizumab with TNF blockers because of the potential for increased risk of infections

              • yellow fever vaccine

                infliximab decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • zoster vaccine live

                infliximab decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              Monitor Closely (28)

              • astragalus

                infliximab increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • belatacept

                belatacept and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • cholera vaccine

                infliximab decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • dengue vaccine

                infliximab decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                infliximab, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • echinacea

                infliximab increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fingolimod

                infliximab increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • haemophilus influenzae type b vaccine

                infliximab decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

              • hydroxyurea

                hydroxyurea, infliximab. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of immunosuppression.

              • ifosfamide

                ifosfamide, infliximab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • influenza virus vaccine quadrivalent, recombinant

                infliximab decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

              • influenza virus vaccine trivalent, recombinant

                infliximab decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

              • lomustine

                lomustine and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • maitake

                infliximab increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mechlorethamine

                mechlorethamine, infliximab. immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections. .

              • meningococcal group B vaccine

                infliximab decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • mercaptopurine

                infliximab and mercaptopurine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • ocrelizumab

                infliximab and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunomodulators is expected to increase the risk of immunosuppression.

              • ofatumumab SC

                ofatumumab SC, infliximab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                infliximab and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • ozanimod

                ozanimod, infliximab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

              • poliovirus vaccine inactivated

                infliximab decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

              • ponesimod

                ponesimod and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • siponimod

                siponimod and infliximab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                infliximab decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • trastuzumab

                trastuzumab, infliximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, infliximab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • zoster vaccine recombinant

                infliximab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

              Minor (1)

              • cat's claw

                cat's claw, infliximab. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible additive immunosuppr'n.

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              Adverse Effects

              >10%

              Development of antinuclear antibodies (50%)

              Infection (36%)

              Upper respiratory tract infection (32%)

              Abdominal pain (12%; 26% with Crohn disease)

              Nausea (21%)

              Infusion-related reaction (20%)

              Headache (18%)

              Development of antibodies to double-stranded DNA (17%)

              Other respiratory infection (eg, sinusitis, cough) (12-14%)

              Diarrhea (12%)

              Elevated alanine transaminase (ALT), >1 to <3 ULN (12-34%)

              1-10% (Adults)

              Bronchitis (10%)

              Dyspepsia (10%)

              Rash (1-10%)

              Elevated ALT, ≥3 ULN (2-10%)

              Fatigue (9%)

              Back pain (8%)

              Rhinitis (8%)

              Urinary tract infection (8%)

              Arthralgia (1-8%)

              Fever (7%)

              Hypertension (7%)

              Pruritus (7%)

              Dyspnea (6%)

              Candidiasis (5%)

              Lupuslike symptoms (<5%)

              Elevated ALT, ≥5 ULN (<1-4%)

              1-10% (Children)

              Leukopenia (9%)

              Flushing (9%)

              Viral infection (8%)

              Neutropenia (7%)

              Bone fracture (7%)

              Bacterial infection (6%)

              Respiratory tract allergic reaction (6%)

              Postmarketing Reports

              Adults

              • Anaphylacticlike reactions, including anaphylactic shock, laryngeal/pharyngeal edema, severe bronchospasm, and seizure
              • Myocardial ischemia or infarction and transient visual loss have also been rarely reported during or within 2 hours of infusion
              • Serious infections and malignancies, including melanoma, leukemia, and Merkel cell carcinoma
              • Neutropenia, agranulocytosis (including infants exposed in utero to infliximab), interstitial lung disease (including pulmonary fibrosis/interstitial pneumonitis and rapidly progressive disease), idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, pericardial effusion, systemic and cutaneous vasculitis, erythema multiforme, Stevens-Johnson Syndrome, toxic epidermal necrolysis
              • Peripheral demyelinating disorders (such as Guillain- Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy), new onset and worsening psoriasis (all subtypes including pustular, primarily palmoplantar), transverse myelitis, and neuropathies (additional neurologic reactions have also been observed), acute liver failure, jaundice, hepatitis, and cholestasis, serious infections, malignancies, including melanoma, Merkel cell carcinoma, and cervical cancer

              Children

              • Malignancies, including hepatosplenic T-cell lymphomas
              • Transient hepatic enzyme abnormalities, lupus-like syndromes, and the development of autoantibodies
              • Infections (some fatal) including opportunistic infections and tuberculosis
              • Infusion reactions
              • Hypersensitivity reactions
              • Idiopathic thrombocytopenic purpura
              • Thrombotic thrombocytopenic purpura
              • Stevens-Johnson Syndrome, toxic epidermal necrolysis, linear IgA bullous dermatosis (LABD)
              • Acute generalized exanthematous pustulosis (AGEP), new onset and worsening psoriasis (all subtypes including pustular, primarily palmoplantar)
              • Lichenoid reactions
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              Warnings

              Black Box Warnings

              Serious infection risk

              • Increased risk for developing serious infections resulting in hospitalization or death; most patients were taking concomitant immunosuppressants (eg, methotrexate, corticosteroids)
              • Patients older than 65 years may be at greater risk
              • Discontinue if patient develops serious infection or sepsis; reported infections include the following:
              • (1) Active tuberculosis, including reactivation of latent disease (frequently present with disseminated or extrapulmonary disease); test for latent tuberculosis before use and during therapy; treat latent infection before use
              • (2) Invasive fungal infections (eg, histoplasmosis, coccidioidomycosis, cryptococcosis, candidiasis, aspergillosis, salmonellosis, blastomycosis, pneumocystosis); may present with disseminated, rather than localized, disease; antigen/antibody testing for histoplasmosis may yield negative results in some patients with active infection; initiate empiric antifungal therapy if severe systemic illness develops
              • (3) Infections caused by other opportunistic pathogens, including bacteria (eg, Legionella, Listeria), mycobacteria (eg, Mycobacterium tuberculosis), and viruses (eg, hepatitis B virus)

              Malignancy

              • Lymphoma and other malignancies, some fatal, have been reported in children and adolescents treated with tumor necrosis factor (TNF) blockers
              • Manufacturer is required to report all malignancies to FDA for complete and consistent analysis

              Hepatosplenic T-cell lymphoma

              • Hepatosplenic T-cell lymphoma (HSTCL) is an aggressive, rare type of T-cell lymphoma (usually fatal)
              • Rare postmarketing cases of HSTCL are reported primarily in adolescent and young adult patients with Crohn disease and ulcerative colitis treated with infliximab
              • Reports have also included 1 patient being treated for psoriasis and 2 patients being treated for rheumatoid arthritis
              • Most reported cases with infliximab have occurred with concomitant treatment with azathioprine or 6-mercaptopurine (6-MP), though cases have been reported in patients receiving azathioprine or 6-MP alone
              • In the FDA Adverse Event Reporting System (AERS) database, the literature, and the HSTCL Cancer Survivors' Network, HSTCL cases have been identified in association with the following agents: infliximab (20), etanercept (1), adalimumab (2), infliximab/adalimumab (5), certolizumab (0), golimumab (0), azathioprine (12), and 6-MP (3)

              Contraindications

              Active serious infections

              Documented hypersensitivity

              Doses >5 mg/kg in patients with moderate-to-severe heart failure (NYHA Class III/IV)

              Cautions

              Patients should be closely monitored for development of signs and symptoms of infection during and after treatment

              Hypersensitivity reactions reported; most hypersensitivity reactions, which include anaphylaxis, urticaria, dyspnea, and/or hypotension, have occurred during or within 2 hr of infusion

              Caution in neurologic disorder

              Moderate-to-severe chronic obstructive pulmonary disease

              Monitor closely for signs and symptoms of demyelinating disease (eg, confusion, numbness, vision changes); consider termination of therapy if significant CNS reactions develop

              Risk of tuberculosis, histoplasmosis, and other opportunistic infections, as well as hepatitis B reactivation; test for HBV infection before starting infliximab; monitor HBV carriers during and several months after therapy

              Consider discontinuance if hematologic disorder occurs (eg, leukopenia, thrombocytopenia, neutropenia, pancytopenia)

              Consider discontinuance if lupuslike symptoms occur

              Readministration after period of no treatment resulted in higher incidence of infusion reactions than was seen with regular maintenance treatment (4% vs <1%)

              Consider empiric antifungal therapy for patients who develop a systemic illness on infliximab and reside or travel to regions where mycoses are endemic

              Serious cerebrovascular accidents, myocardial ischemia/infarction (some fatal), hypotension, hypertension, and arrhythmias have been reported during and within 24 hr of initiation of infliximab infusion; cases of transient visual loss have been reported during or within 2 hr of infliximab infusion; monitor patients during infusion and if serious reaction occurs, discontinue infusion

              Use caution in patients with history of seizures; discontinue therapy if significant adverse reactions develop

              Use caution in patients with mild heart failure (NYHA Class I, II) or decreased left ventricular function; worsening and new-onset heart failure reported

              Before initiating therapy in pediatric and adult patients, update vaccinations in accordance with current vaccination guidelines

              Neurologic reactions

              • Associated with CNS manifestation of systemic vasculitis, seizure and new onset or exacerbation of clinical symptoms and/or radiographic evidence of central nervous system demyelinating disorders, including multiple sclerosis and optic neuritis, and peripheral demyelinating disorders, including Guillain-Barré syndrome
              • Prescribers should exercise caution in considering use of therapy in patients with these neurologic disorders and should consider discontinuation of drug if these disorders develop

              Hepatoxicity

              • Severe hepatic reactions (eg, acute liver failure, jaundice, hepatitis and cholestasis), have been reported in postmarketing data
              • Severe hepatic reactions occurred between 2 weeks to more than 1 year after initiation of infliximab; elevations in hepatic aminotransferase levels were not noted prior to discovery of the liver injury in many of these cases
              • Some fatal or necessitating liver transplantation; stop therapy in cases of jaundice and/or marked liver enzyme elevations (≥5 ULN)

              Malignancies

              • Increased risk of lymphoma (including hepatosplenic T-cell lymphoma, especially if given with azathioprine or 6-MP), pneumonia, hepatotoxicity (including acute liver failure, jaundice, hepatitis, cholestasis)
              • Increased risk of lymphoma and other cancers is reported in children and adolescents
              • Skin cancer (eg, melanoma, Merkel cell carcinoma) is reported with TNF blockers
              • Increased incidence of invasive cervical cancer in women reported; a causal relationship between infliximab and cervical cancer cannot be excluded; periodic screening should continue in women receiving therapy
              • Occurrence of leukemia and new-onset psoriasis also with TNF blockers

              Tuberculosis

              • Cases of reactivation of tuberculosis or new tuberculosis infections reported, including patients who have previously received treatment for latent or active tuberculosis; cases of active tuberculosis have also occurred during treatment for latent tuberculosis
              • Evaluate for tuberculosis risk factors and test for latent infection prior to initiating treatment and periodically during therapy; treatment of latent tuberculosis infection prior to therapy with TNF blockers has been shown to reduce the risk of tuberculosis reactivation during therapy; consider tuberculin skin test with an induration ≥5 mm is a positive test result when assessing if treatment for latent tuberculosis is needed before initiating treatment, even for patients previously vaccinated with Bacille Calmette-Guérin (BCG)
              • Consider antitubercular therapy before initiating treatment in patients with a history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection
              • Consult with a physician with expertise in the treatment of tuberculosis is recommended to aid in the decision whether initiating antitubercular therapy is appropriate for an individual patient
              • Consider tuberculosis if a new infection develops during treatment, especially in patients who have previously or recently traveled to countries with a high prevalence of tuberculosis, or who have had close contact with a person with active tuberculosis

              Heart failure

              • Worsening or new-onset congestive HF reported with TNF blockers; exercise caution when using in patients who have heart failure; consider TNF therapy in patients with HF if there are no other reasonable treatment options, and then consider only in patients with compensated HF
              • Doses >5 mg/kg are contraindicated in patients with moderate or severe HF; 10 mg/kg-dose has been associated with an increased incidence of death and hospitalization due to worsening HF; new-onset and worsening HF, with and without identifiable precipitating factors (eg, pre-existing cardiovascular disease), reported in postmarketing data
              • If administering doses ≤5 mg/kg to patients with moderate or severe HF or to administer it (any approved dose) to patients with mild HF, closely monitor these patients during therapy, and discontinue if new or worsening symptoms of HF appear

              Drug interactions overview

              • Anakinra
                • Coadministration not recommended
                • Serious infections and neutropenia reported with concurrent use of anakinra and etanercept (another TNF blocker)
                • Similar toxicities may result with concomitant use of anakinra with other TNF blockers
              • Abatacept
                • Coadministration not recommended
                • Coadministration of abatacept with TNF blockers may increase the risk of infections
              • Other biologic products
                • Coadministration not recommended
                • Insufficient data are available regarding coadministration of infliximab products with other biological products
                • Concurrent use with these biological products may increase the risk of infection
              • Vaccinations
                • Coadministration with live vaccines is not recommended
                • Before initiating in pediatric and adult patients, update vaccinations in accordance with current vaccination guidelines
                • In patients receiving TNF blockers, limited data are available on response to vaccination with live vaccines or on the secondary transmission of infection by live vaccines
                • Infliximab products cross the placenta and can detected up to 6 months following birth; recommend waiting at least 6 months following birth before administering of any live vaccine to infants exposed in utero to infliximab products
              • Therapeutic infectious agents
                • Coadministration not recommended
                • Other uses of therapeutic infectious agents such as live attenuated bacteria (eg, BCG bladder instillation for the treatment of cancer) could result in clinical infections, including disseminated infections
              • CYP450 substrates
                • Monitor of effect (eg, warfarin) or drug concentration (eg, cyclosporine, theophylline) and the individual dose of the drug product may be adjusted as needed
                • Upon initiation or discontinuation of infliximab in patients being treated with CYP450 substrates with a narrow therapeutic index, monitor effect (eg, warfarin) or drug concentration (eg, cyclosporine or theophylline) and adjust the individual dose of the CYP450 substrate may be adjusted as needed
                • Formation of CYP450 enzymes may be suppressed by increased levels of cytokines (eg, TNFα, IL-1, IL-6, IL-10, IFN) during chronic inflammation
                • Therefore, it is expected that for a molecule that antagonizes cytokine activity, such as infliximab, the formation of CYP450 enzymes could be normalized
              • Methotrexate (MTX) and other concomitant medications
                • Use with caution
                • Specific drug interaction studies, including interactions with MTX, have not been conducted
                • Concomitant MTX use may decrease the incidence of anti-drug antibody production and increase infliximab product concentrations
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              Pregnancy & Lactation

              Pregnancy

              Available observational studies in pregnant women exposed to infliximab products showed no increased risk of major malformations among live births as compared to those exposed to non- biologics; however, findings on other birth and maternal outcomes were not consistent across studies of different study design and conduct

              Monoclonal antibodies such as infliximab products are transferred across placenta during third trimester of pregnancy and may affect immune response in the in utero exposed infant

              Because infliximab products do not cross-react with TNF in species other than humans and chimpanzees, animal reproduction studies have not been conducted with infliximab products

              In a developmental study conducted in mice using an analogous antibody, no evidence of maternal toxicity or fetal harm was observed

              Published data suggest that there is increased risk of adverse pregnancy outcomes in women with inflammatory bowel disease or rheumatoid arthritis associated with increased disease activity

              Adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2.5 kg) and small for gestational age at birth

              As with other IgG antibodies, infliximab products cross the placenta; infliximab products have been detected in the serum of infants up to 6 months following birth

              Animal data

              • No evidence of maternal toxicity, embryotoxicity or teratogenicity observed in a developmental toxicity study conducted in mice using an analogous antibody that selectively inhibits the functional activity of mouse TNF alpha

              Lactation

              Published literature show that infliximab is present at low levels in human milk

              Systemic exposure in a breastfed infant is expected to be low because infliximab products are largely degraded in the gastrointestinal tract

              A U.S. multi-center study of 168 women treated with infliximab for inflammatory bowel disease (breast milk samples obtained, n=29) showed that infants exposed to infliximab through breast milk had no increase in rates of infections and developed normally

              There are no data on effects of infliximab products on milk production; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Recombinant humanized monoclonal anti-TNF-α antibody; prevents synovial and intestinal inflammation

              Absorption

              Onset: 2 wk (Crohn disease)

              Duration: 12 wk

              Distribution

              Vd: 3-6 L

              Metabolism

              Unknown

              Elimination

              Half-life: 7.7-9.5 days

              Development of antibodies to infliximab increased infliximab clearance

              Excretion: Unknown

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              Administration

              IV Compatibility

              0.9% NaCl

              IV Incompatibilities

              Do not infuse with other agents

              IV Preparation

              Reconstitute vials aseptically with 10 mL SWI; swirl vial gently to dissolve powder, and do not shake

              Allow solution to stand for 5 minutes

              Remove volume from 250-mL sterile 0.9% NaCl infusion bag equal to drug volume of reconstituted infliximab being added

              Slowly add reconstituted infliximab solution to 250-mL infusion bag; gently mix; final diluted concentration: 0.4 - 4 mg/mL

              Discard if particulate matter is present or discoloration observed

              Begin infusion within 3 hr of preparation (product contains no preservatives)

              IV Administration

              Infuse over ≥2 hr

              Use an infusion set with an in-line, sterile, non-pyrogenic, low-protein-binding filter (pore size of 1.2 µm or less)

              Do not infuse in same line as other drugs

              Discontinue if infusion reaction occurs

              Vials do not contain antibacterial preservatives; discard any unused portion

              Storage

              Unopen vials

              • Refrigerate at 2-8ºC (36-46ºF) or at temperatures up to 30°C (86°F) for a single period of up to 6 months but not exceeding the original expiration date
              • New expiration date must be written on the carton
              • Upon removal from refrigerator, vials cannot be returned to refrigerated storage

              Diluted solutions

              • 0.4 mg/mL solutions: Refrigerate at 4°C for up to 14 days (Ikeda 2012)
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Remicade intravenous
              -
              100 mg vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              infliximab intravenous

              INFLIXIMAB - INJECTION

              (in-FLIX-i-mab)

              COMMON BRAND NAME(S): Avsola, Inflectra, Remicade, Renflexis

              WARNING: This medication can decrease your body's ability to fight an infection. This effect can lead to very serious (possibly fatal) infections (such as fungal infections, bacterial infections including tuberculosis). You should have a tuberculosis (TB) skin test before and during treatment with this medication. Also tell your doctor your medical history, especially of past/recent/current infections. You should also tell your doctor if you have lived or traveled in areas where certain fungal infections (such as coccidioidomycosis, histoplasmosis) are common or if you have been near someone with tuberculosis. Areas where these types of fungal infections are commonly found include the Ohio and Mississippi River valleys and the southwestern United States. See Side Effects section for symptoms of infections to watch out for, and get medical help right away if you have any of these symptoms.The immune system also helps prevent and control cancer. There is a very small risk (especially in children/teens/young adults) of developing cancer (such as lymphoma, skin cancer) due to this medication or due to your medical condition. A rare, mostly fatal cancer (hepatosplenic T-cell lymphoma) has occurred in people receiving this medication along with certain other drugs (azathioprine or 6-mercaptopurine) to treat Crohn's disease or ulcerative colitis. Talk to your doctor about the risks and benefits of treatment. Tell your doctor right away if you have symptoms such as unusual lumps/growths, swollen glands, swollen or painful abdomen, unexplained weight loss, unusual tiredness, loss of appetite, fever that doesn't go away, or night sweats.

              USES: This medication is used to treat certain types of arthritis (rheumatoid arthritis, arthritis of the spine, psoriatic arthritis), certain bowel diseases (Crohn's disease, ulcerative colitis), and a certain severe skin disease (chronic plaque psoriasis). In these conditions, the body's defense system (immune system) attacks healthy tissues. Infliximab works by blocking the actions of a certain natural substance (tumor necrosis factor alpha) in the body. This helps to decrease swelling (inflammation) and weaken your immune system, which slows or stops the damage from the disease.This monograph is about the following infliximab products: infliximab, infliximab-abda, infliximab-axxq, and infliximab-dyyb.

              HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using infliximab and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is given by injection into a vein over at least 2 hours as directed by your doctor. The dosage is based on your medical condition, weight, and response to treatment. After the first dose, this medication is usually given again after 2 weeks and 6 weeks, then every 8 weeks (or every 6 weeks for arthritis of the spine), as directed by your doctor.Symptoms of an infusion reaction that may occur during infliximab treatment include pain/swelling at the injection site, shortness of breath, flushing, chills, fever, headache, and rash. If you have any of these symptoms, your healthcare professional may need to adjust/stop your infusion and treat your symptoms.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Do not shake this medication. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Your doctor may direct you to use other medications (to help prevent side effects) before using infliximab. Use those medications exactly as directed.Use this medication regularly to get the most benefit from it. To help you remember, mark the days on the calendar when you need to receive the medication.Tell your doctor if your condition lasts or gets worse.

              SIDE EFFECTS: See also Warning and How to Use section.Headache, stomach pain, or nausea may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: joint/muscle pain, easy bruising/bleeding, seizures, confusion, muscle weakness, numbness/tingling of arms/legs, butterfly-shaped facial rash, pain/redness/swelling of arms or legs, new or worsening symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Tell your doctor right away if you develop signs of infection while using this drug, such as: cough/sore throat that doesn't go away, fever, chills, night sweats, trouble breathing, painful/frequent urination, unusual vaginal discharge, white patches in the mouth (oral thrush).This drug may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, such as: extreme tiredness, nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.This medication may cause serious heart problems (such as heart attack) during the infusion and up to 24 hours after the start of the infusion. Get medical help right away if you have any symptoms of heart problems such as chest/jaw/left arm pain, shortness of breath, unusual sweating, lightheadedness, dizziness, fainting, vision changes, or fast/irregular/slow heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, difficulty swallowing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using infliximab, tell your doctor or pharmacist if you are allergic to it; or to other infliximab products; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: tuberculosis (previous infection or positive skin test), past/recent/current infections (such as cold sores, valley fever), heart disease (such as heart failure), blood/bone marrow disorder (such as leukopenia, thrombocytopenia), nervous system disorder (such as numbness/tingling, seizures, multiple sclerosis), cancer (such as breast cancer, skin cancer, lymphoma), a certain lung disorder (chronic obstructive pulmonary disease-COPD), liver disease (such as hepatitis B), light treatment for psoriasis (phototherapy).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Infliximab can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Call your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Older adults may be more sensitive to the side effects of this drug, especially risk for infections.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Mothers who have used this medication during pregnancy should ask a doctor about immunizations/vaccinations for their newborn babies.This drug may pass into breast milk, but it is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: other drugs that weaken the immune system/increase the risk of infection (such as abatacept, anakinra), treatment with weakened bacteria/viruses (such as live vaccines, BCG for bladder cancer).

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, liver function test, skin exams, Pap smear) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.