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Key takeaways
Remicade (infliximab) is a tumor necrosis factor (TNF) blocker. It is administered through an intravenous (IV) tube to treat various inflammatory conditions such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and others.
The drug is infused over a period of at least two hours. A healthcare professional administers the medication.
Certain side effects of Remicade, like infusion reactions or immediate allergic reactions, may occur during or shortly after the infusion. Delayed allergic reactions can occur from 3 to 12 days after the infusion. Other serious side effects, such as heart problems, liver problems, and nervous system problems, can occur during treatment with Remicade, which will require urgent or emergency medical attention.
Consult your healthcare provider for more information and professional medical advice about your condition and treatment.
Remicade (infliximab) is a medication used to treat various inflammatory conditions, such as Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. It is classified in a group of drugs called tumor necrosis factor (TNF) blockers. Remicade works by blocking the action of TNF, which causes inflammation. Common side effects of Remicade include infusion reactions, headache, stomach pain, sore throat, and upper respiratory infections such as sinus infections. Remicade is made by the pharmaceutical company Janssen Biotech.
When starting treatment with Remicade, you may wonder what to expect. During the infusion, administered intravenously by a healthcare professional, immediate reactions may include fever or chills and changes in blood pressure, although more serious reactions may occur. Continue reading to learn more about Remicade infusions.
How to prepare for your first Remicade infusion
Your healthcare provider will advise you when to arrive at the infusion center, hospital, or other healthcare facility for your Remicade IV infusion. The medication is infused over a period of at least two hours. However, you may be asked to arrive early to prepare for your infusion and stay later to be monitored for side effects.
You may want to ask a family member, caregiver, or friend to drive you home from your appointment. In clinical trials, some people experienced dizziness and changes in blood pressure as a side effect of Remicade.
Your healthcare provider will test you for latent tuberculosis (TB) before your infusion. Latent TB means that you have TB bacteria in the body, but you are not sick. If the test is positive, you will need to be treated before starting Remicade.
Before you start Remicade, tell your healthcare provider if you:
- Think you have an infection, are being treated for an infection, get frequent infections, or have signs of infection like fever, cough, and fatigue
- Have any open cuts or sores on the body
- Have diabetes or any immune system problem
- Have TB or have been near someone with TB
- Live or have lived somewhere with a higher risk of certain types of fungal infections
- Have or have had hepatitis B
- Take the medications Kineret (anakinra), Orencia (abatacept), Actemra (tocilizumab), or other biologic medications, which should not be taken together with Remicade
Be sure to also tell your healthcare provider about all of your medical conditions and medical history, including if you are pregnant or breastfeeding and which medications you take.
What to expect during your Remicade treatment
At your appointment, a healthcare professional will administer your Remicade infusion through a vein in the arm. Before your infusion, they may give you medicine to prevent or lessen side effects. You will not be sedated during the procedure, but they will make sure you are comfortable throughout the infusion process. Because it will take at least two hours to receive the full dose of medication, you may want to bring something like a book or tablet with headphones so you can watch a movie to help pass the time. Alternatively, you can bring a pillow and blanket with you and just plan to take a nap.
If you have side effects during the infusion, your infusion may need to be adjusted or stopped—and you may also need treatment for your symptoms. A healthcare professional will monitor you during your infusion and for some time after the infusion. They may do some tests during your infusion to check for side effects and your response to the medication. Be sure to tell the provider administering the infusion immediately if you have symptoms of an allergic reaction or hypersensitivity reaction such as itching, hives, shortness of breath, difficulty swallowing, feeling faint, or swelling of the face, lips, tongue, or throat.
Your healthcare provider will tell you how often you should receive Remicade infusions. Make sure you keep all of your infusion appointments as well as follow-up appointments with your provider.
What to expect after Remicade treatments
Many people tolerate Remicade well and have no problems or only mild side effects. Some reactions you should be alert to include:
- Infusion reactions: These reactions can occur during infusion and up to two hours after your infusion is complete. Symptoms may include rash, itching, fever, chills, chest pain, shortness of breath, low blood pressure, or high blood pressure.
- Immediate allergic reactions: As mentioned earlier, you may experience an allergic reaction during the infusion, in which case the healthcare provider administering the medication will pause or stop your infusion. However, allergic reactions may happen shortly after treatment as well. Be alert for signs of an allergic reaction (e.g., hives, difficulty breathing, chest pain, fever, chills, low blood pressure, or high blood pressure), and get medical help right away if they occur.
- Delayed allergic reactions: A delayed allergic reaction can occur anywhere from three to 12 days after a Remicade infusion. Get medical help right away if you have a fever, rash, headache, sore throat, muscle pain, joint pain, difficulty swallowing, or swelling of the face and hands.
Serious Remicade side effects
Remicade has some potentially serious side effects, which require urgent or emergency medical care. Remicade has a boxed warning, also called a black box warning, the most serious warning required by the Food & Drug Administration (FDA).
The boxed warning mentions an increased risk of serious infections, including TB and other bacterial, viral, or fungal infections, which may lead to hospitalization or death. As such, your healthcare provider will monitor you for TB during the course of treatment. Be sure to let your healthcare provider know right away if you have any signs of infection, such as fever, cough, flu-like symptoms, or open cuts or sores on the body.
The boxed warning also states that Remicade poses a higher risk of lymphoma and other cancers (including skin cancer and cervical cancer), some of which may cause death.
Some cases of a type of cancer called hepatosplenic T-cell lymphoma have been reported in patients who took TNF blockers, and the cancer has caused death. Almost all of the patients also took a drug called azathioprine or 6-mercaptopurine. Most cases occurred in adolescent or young adult males with Crohn’s disease or ulcerative colitis.
Other side effects and warnings
If you are a hepatitis B virus carrier, the virus may become active during Remicade treatment, which is why your healthcare provider will test you for the virus not only before treatment but also occasionally during treatment. Let them know right away if you experience tiredness, appetite loss, fever, skin rash, or joint pain.
People with congestive heart failure may experience a worsening of the condition while taking Remicade. Immediately inform your healthcare provider of any new or worsening symptoms of shortness of breath, swelling of the ankles or feet, or sudden weight gain.
Some individuals have had a heart attack or other heart problems within 24 hours of beginning a Remicade infusion. Look out for the following symptoms and get emergency medical help if any of the symptoms occur:
- Chest pain or discomfort
- Arm pain
- Stomach pain
- Shortness of breath
- Anxiety
- Feeling lightheaded or dizzy
- Fainting
- Sweating
- Nausea and vomiting
- Feeling like the chest is fluttering or pounding
- Fast or slow heartbeat
Remicade can cause serious liver problems. Tell your healthcare provider right away if you have:
- Fever
- Fatigue
- Right-sided stomach pain
- Dark urine
- Yellowing of the skin and whites of the eyes
Remicade can also cause problems with blood cells. Let your healthcare provider know if you have a fever that does not subside, pale skin, or if you bruise or bleed easily.
Remicade can cause nervous system disorders. Get medical help if you have vision changes, numbness or tingling anywhere in the body, seizures, or weakness in the arms or legs.
Some individuals have had a stroke within 24 hours of the Remicade infusion. Get emergency medical help if you have:
- Numbness or weakness of the face, arm, or leg, especially on one side
- Confusion
- Trouble speaking or understanding
- Trouble with vision
- Difficulty walking
- Dizziness or loss of balance
- Sudden and severe headache
Some individuals have developed symptoms similar to those of lupus (this is called lupus-like syndrome), which may require stopping Remicade. Symptoms may include chest discomfort or pain, joint pain, shortness of breath, or a rash on the cheeks or arms that worsens in the sun.
Remicade may cause new psoriasis or worsen preexisting psoriasis, which would require discontinuation. Let your healthcare provider know if you develop pus-filled red, scaly patches or bumps on the skin.
Remicade vs. Inflectra
Biologic drugs like Remicade do not have a generic; instead, they have what is called a biosimilar. Remicade is called a reference product, and Inflectra is an FDA-approved biosimilar, which means it is highly similar to Remicade. The chart below outlines both drugs.
Remicade vs. Inflectra comparison |
||
|---|---|---|
| Remicade | Inflectra | |
| Drug class | Tumor necrosis factor (TNF) blocker | Tumor necrosis factor (TNF) blocker |
| Conditions treated |
|
|
| Brand/generic/biosimilar status | Brand/reference product | Biosimilar |
| What is the active ingredient | Infliximab | Infliximab-dyyb |
| What form(s) does the drug come in? | Single-dose vial for injection | Single-dose vial for injection |
| What is the standard dosage? | Varies by age, weight, and condition being treated | Varies by age, weight, and condition being treated |
| How long is the typical treatment? | Varies | Varies |
| Who typically uses the medication? |
|
|
Other Remicade biosimilars include Avsola (infliximab-axxq), Renflexis (infliximab-abda), and Zymfentra (infliximab-dyyb).
How long does it take for Remicade infusions to work?
While each condition is different and various factors may affect the results, people who respond to this medication start to notice an improvement in symptoms by the second week, according to the prescribing information. But may take up to several months to see the full benefit of this medication.
Remicade is given in three starter doses, followed by infusions every eight weeks for all conditions except ankylosing spondylitis, which is given every six weeks after the starter doses.
Timing of Remicade infusions by condition |
|
|---|---|
| Condition | Timing of infusions |
| Crohn’s disease, including pediatric Crohn’s disease | Intravenous induction regimen at 0, 2, and 6 weeks, then a maintenance dose every 8 weeks after that |
| Ulcerative colitis, including pediatric ulcerative colitis | Intravenous induction regimen at 0, 2, and 6 weeks, then a maintenance dose every 8 weeks after that |
| Rheumatoid arthritis | Given in combination with the drug methotrexate and administered as an intravenous induction regimen at 0, 2, and 6 weeks, followed by a maintenance dose every 8 weeks after that
Some people will need higher doses or more frequent infusions (every 4 weeks) |
| Ankylosing spondylitis | Intravenous induction regimen at 0, 2, and 6 weeks, then a maintenance dose every 6 weeks after that |
| Psoriatic arthritis | May be given with or without methotrexate via an intravenous induction regimen at 0, 2, and 6 weeks, followed by a maintenance dose every 8 weeks after that |
| Plaque psoriasis | Intravenous induction regimen at 0, 2, and 6 weeks, then a maintenance dose every 8 weeks after that |
Sources
- Infliximab injection, MedlinePlus (2021)
- Remicade, PDR
- FDA approves Inflectra, a biosimilar to Remicade, Food & Drug Administration (2016)
- Remicade, DailyMed (2022)