Infliximab Pre-Medication — SCE Rheumatology MCQ

Correct answer: D — IV or oral Paracetamol antihistamine (Chlorphenamine) and sometimes low-dose IV Hydrocortisone before each infusion to reduce infusion-related reactions

Infliximab IV infusions are associated with infusion reactions (acute and delayed) occurring in approximately 5-10% of patients. Standard pre-medication protocols include: Paracetamol (1 g oral or IV) antihistamine (Chlorphenamine 10 mg IV or Cetirizine 10 mg oral) and in many units low-dose IV Hydrocortisone (100-200 mg). These reduce but do not eliminate infusion reaction risk. Infusion reactions range from mild (flushing pruritus headache) to severe (anaphylaxis bronchospasm hypotension). Slower infusion rates reduce reaction risk. Anti-drug antibodies increase infusion reaction risk hence the recommendation for concomitant Methotrexate to reduce immunogenicity. Biosimilar Infliximab carries the same infusion reaction profile as the originator.

Reference: BSR 2019 biologic safety guidelines; BNF Infliximab monograph