infliximab: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
infliximab: clinical details
Prescribing considerations
- Initiate and supervise treatment through an experienced specialist service.
- Screen for active and latent tuberculosis and hepatitis B before treatment; assess current, chronic and recurrent infection risks.
- Review vaccination status before initiation and avoid live vaccines during treatment.
- Record the brand and batch number for traceability.
- Assess heart failure, malignancy history, demyelinating disease, liver disease and planned surgery.
- Consider increased serious-infection risk in older adults and when other immunosuppressants are used.
Contraindications and cautions
- Hypersensitivity to infliximab, murine proteins or product excipients.
- Tuberculosis or another severe infection, including sepsis, abscess or opportunistic infection.
- Moderate or severe heart failure.
Monitoring
- Monitor for infection before, during and after treatment, including delayed presentation because elimination may take several months.
- Monitor hepatitis B carriers for reactivation during treatment and for several months afterwards.
- Assess infusion, systemic injection and delayed hypersensitivity reactions.
- Review new or worsening heart failure, liver injury, cytopenia, neurological symptoms, severe skin reactions and malignancy warning signs.
- For subcutaneous treatment, assess injection technique, adherence, local reactions and continuing suitability for home administration.
Clinical pharmacology
Infliximab is a chimeric human–murine IgG1 monoclonal antibody that binds soluble and transmembrane TNF-alpha. Subcutaneous bioavailability is incomplete, and the terminal half-life is measured in days rather than hours.
Formulation and product differences
- Flixabi is a powder requiring reconstitution and dilution for intravenous infusion by healthcare professionals.
- Remsima is a ready-to-use, single-use subcutaneous pre-filled pen for adults; patients may self-inject after training and assessment.
- The selected intravenous formulation includes licensed paediatric inflammatory bowel disease indications; the selected subcutaneous formulation does not.
infliximab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 100 mg
Injection
Route: Parenteral
Strengths: 120 mg
infliximab interactions
Provide a complete list of prescribed, non-prescribed and complementary treatments. Important combinations include:
Anakinra
Concurrent use is not recommended because serious infection and neutropenia may be more likely without added benefit.
Abatacept
Concurrent use is not recommended because infection risk increases without demonstrated additional benefit.
Other biological treatments for the same disease
Overlapping immune effects may increase infection and other adverse-reaction risks.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.