Home Drug Guide Infliximab

Drug Guide

Generic Name

Infliximab

Brand Names Remicade

Classification

Therapeutic: Immunosuppressant/Anti-inflammatory

Pharmacological: TNF-alpha inhibitor

FDA Approved Indications

  • Crohn's disease
  • Ulcerative colitis
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Plaque psoriasis

Mechanism of Action

Infliximab is a chimeric monoclonal antibody that binds to tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory cytokine, thereby inhibiting its activity and reducing inflammation.

Dosage and Administration

Adult: Varies by condition; typically 3-10 mg/kg IV at weeks 0, 2, and 6, then every 8 weeks.

Pediatric: Dosing based on weight; administered IV, frequency similar to adults; specific schedules depend on condition.

Geriatric: Adjustments based on renal and hepatic function, with careful monitoring due to increased infection risk.

Renal Impairment: No specific dose adjustment, but caution advised.

Hepatic Impairment: No specific guidelines; caution recommended.

Pharmacokinetics

Absorption: Not absorbed orally; administered IV.

Distribution: Widely distributed; penetrates inflamed tissues.

Metabolism: Metabolized into peptides and amino acids via proteolytic catabolism.

Excretion: Renal and non-renal routes.

Half Life: Approx. 7-10 days.

Contraindications

  • Hypersensitivity to infliximab or its components.
  • Active infections, including tuberculosis.

Precautions

  • Screen for latent TB prior to initiation.
  • Monitor for signs of infection during therapy.
  • Use with caution in patients with heart failure, demyelinating diseases, or hepatitis B virus infection.

Adverse Reactions - Common

  • Infusion reactions (fever, chills, pruritus) (Common)
  • Infections (upper respiratory, sinusitis) (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Serious infections (pneumonia, sepsis) (Serious, less common)
  • Demyelinating disorders (Rare)
  • Lupus-like syndrome (Rare)
  • Liver injury (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines, antibiotics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, infusion reactions, and immunogenicity.

Diagnoses:

  • Risk for infection
  • Allergic reaction

Implementation: Administer IV per protocol, monitor infusion site and vitals during infusion.

Evaluation: Assess for efficacy and adverse effects, including infection and infusion reactions.

Patient/Family Teaching

  • Report signs of infection immediately.
  • Understand infusion schedule and importance of adherence.
  • Notify healthcare provider of any allergic reactions or side effects.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis and invasive fungal infections.
  • Malignant lymphoma and other malignancies.

Genetic Factors: Genetic predisposition may influence response and risk.

Lab Test Interference: Can suppress signs of inflammation, potentially affecting lab tests.

Overdose Management

Signs/Symptoms: Unknown, but may include exaggerated immunosuppressive effects.

Treatment: Supportive care, monitor vital signs, and manage symptoms.

Storage and Handling

Storage: Store vials refrigerated at 2-8°C, do not freeze.

Stability: Stability varies by manufacturer; use within specified shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.