Home Drug Guide Infliximab-abda

Drug Guide

Generic Name

Infliximab-abda

Brand Names Renflexis

Classification

Therapeutic: Anti-inflammatory, Immunosuppressant

Pharmacological: Tumor Necrosis Factor (TNF) alpha inhibitor

FDA Approved Indications

Crohn's Disease (including ulcerative colitis)
Rheumatoid Arthritis
Plaque Psoriasis
ankylosing spondylitis
Psoriatic Arthritis
Juvenile Idiopathic Arthritis

Mechanism of Action

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

Dosage and Administration

Adult: The recommended dose is 5 mg/kg at 0, 2, and 6 weeks, then every 8 weeks. Dose adjustments may be necessary based on clinical response.

Pediatric: Dosing varies based on condition and weight. Usually 5 mg/kg at similar intervals as adults, with adjustments based on response.

Geriatric: No specific adjustment; consider comorbidities and concomitant medications.

Renal Impairment: No specific adjustment; monitor closely.

Hepatic Impairment: No specific adjustment; use cautiously, especially in severe hepatic impairment.

Pharmacokinetics

Absorption: Administered intravenously, so absorption is complete and immediate.

Distribution: Distributed systemically in plasma; volume of distribution approximately 4.4 L.

Metabolism: Metabolized via catabolic pathways into small peptides and amino acids.

Excretion: Cleared via reticuloendothelial system; not excreted renally.

Half Life: Approximately 7-10 days.

Contraindications

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

Precautions

Screen for latent TB before initiating therapy.
Monitor for infections during and after treatment.
Use with caution in patients with a history of demyelinating disease, heart failure, or hepatic impairment.
Pregnancy risk: Use only if clearly needed; discuss potential risks.

Adverse Reactions - Common

Infusion reactions (fever, chills, pruritus, rash) (Occur in approximately 10-20% of patients)
Infections (upper respiratory, urinary tract, sinusitis) (Common)
Headache (Common)

Adverse Reactions - Serious

Serious infections (sepsis, tuberculosis reactivation) (Less common but significant)
Lymphoma and other malignancies (Rare)
Churg-Strauss syndrome (vasculitis) (Rare)
Progressive multifocal leukoencephalopathy (PML) (Very rare)

Drug-Drug Interactions

Live vaccines (avoid during therapy)
Other immunosuppressants (risk of increased immunosuppression)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

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

Diagnoses:

Risk for infection
Impaired skin integrity
Risk for hypersensitivity reactions

Implementation: Administer IV infusion slowly as per protocol, monitor vitals during and after.

Evaluation: Assess symptom improvement, monitor for adverse effects, and check for signs of infection.

Patient/Family Teaching

Report signs of infection promptly.
Avoid live vaccines during therapy.
Inform about possible infusion reactions and how to respond.
Follow-up appointments for monitoring.

Special Considerations

Black Box Warnings:

Increased risk of serious infections and lymphoma

Genetic Factors: Limited data; consider genetic susceptibility in adverse reactions.

Lab Test Interference: May cause false-positive readings in certain assays or interfere with immune responses.

Overdose Management

Signs/Symptoms: N/A for specific overdose; monitor for adverse reactions and signs of infection.

Treatment: Supportive care, discontinue infliximab, provide symptomatic treatment.

Storage and Handling

Storage: Refrigerate at 2-8°C (36-46°F). Protect from light.

Stability: Stable until the expiration date on the label when stored properly.