Remicade (Infliximab) – Intravenous

Warning:

Taking Remicade can increase the risk of developing severe infections, like tuberculosis and other bacterial and fungal infections. There also has been an increased risk of developing certain types of cancers, such as lymphoma, associated with Remicade.



What Is Remicade?

Remicade (infliximab) is an intravenous (IV) infusion belonging to a drug class called tumor necrosis factor (TNF) blockers. It is commonly used to treat different types of autoimmune diseases. 

TNF blockers, like Remicade, are biologic medications that work by interfering with the TNF protein. Overproduction of this protein in the body leads to inflammation experienced in many autoimmune diseases. Remicade blocks this protein, reducing the amount of inflammation in the body.

Remicade is given intravenously (in the vein) in your arm. A trained healthcare provider will administer it to you in a medical office or infusion center.

Drug Facts

Generic Name: Infliximab

Brand Name(s): Remicade

Drug Availability: Prescription

Administration Route: Intravenous

Therapeutic Classification: TNF blocker

Available Generically: Biosimilar is available

Controlled Substance: N/A

Active Ingredient: Infliximab

Dosage Form(s): Powder for solution

What Is Remicade Used For?

Remicade has been approved for multiple autoimmune disorders, including:

How to Take Remicade

As it is an IV infusion, Remicade is typically given at an outpatient infusion center. Before the infusion, a healthcare provider will start an IV in your arm and take your vital signs (e.g., heart rate, blood pressure, temperature). 

There is a possibility of an infusion reaction when starting Remicade. This means that during the infusion, certain symptoms may develop. It’s unclear exactly why this happens, but the healthcare providers at the infusion center will be prepared to treat them. The symptoms of an infusion reaction include:

  • Flu-like symptoms
  • Headache
  • Shortness of breath
  • Low blood pressure
  • Fever
  • Chills
  • Nausea
  • Skin rash

If any symptoms develop, notify a healthcare provider. They will stop the infusion immediately and treat the symptoms with medications such as steroids, antihistamines, and acetaminophen. Once the symptoms subside, the Remicade infusion will be resumed, but at a slower rate.

Rarely, people can have an anaphylactic reaction to Remicade. If this severe and potentially life-threatening reaction occurs, you will not receive Remicade again. 

Due to the possible increased risk of getting an infection, people typically undergo a test for tuberculosis and hepatitis B before starting Remicade.


Off-Label Uses 

Remicade is approved to treat several autoimmune disorders. However, it is often used off-label to treat other health conditions. Off-label use is when a drug is prescribed for purposes not listed on the product label.

Off-label uses of Remicade include:

  • Pulmonary sarcoidosis (a rare disease caused by inflammation)
  • Uveitis (eye inflammation) 
  • Behcet’s disease (a rare autoimmune disease)
  • Kawasaki disease (a rare systemic inflammatory condition affecting children) when not responding to intravenous immunoglobulin (IVIG) treatment 

How Long Does Remicade Take to Work?

How long Remicade takes to work will vary for each person and condition being treated. Some individuals have symptom improvement within a few days after receiving their dose, while others may not see improvement until a few infusions.

What Are the Side Effects of Remicade?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects from Remicade infusions are:


Severe Side Effects 

Call your healthcare provider immediately if you experience serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and symptoms can include the following:

  • Serious infection, including tuberculosis and severe fungal, viral, and bacterial infections
  • Heart failure, with swelling to the extremities, shortness of breath, and sudden weight gain
  • Liver injury, including right-sided abdominal pain and yellowing of the eyes or skin (jaundice)
  • Low white blood cell and platelet counts
  • Lupus-like syndrome, which may include joint pain, a rash on the cheeks and arms, and shortness of breath
  • Nervous system changes such as vision changes, weakness, numbness, or seizures


Long-Term Side Effects

Serious long-term side effects from Remicade have been reported, including the increased risk of cancers such as: 

  • Lymphoma in children, adolescents, and adults
  • Hepatosplenic T-cell lymphoma in adolescents and young adults if they have the inflammatory bowel diseases (IBDs) Crohn's disease or ulcerative colitis and also took azathioprine

However, a recent review of studies evaluating this risk suggests that the research lacks evidence for a definite association between Remicade and the above-listed cancers. Moreover, the review indicates that participants in many of these studies also had previous exposure to thiopurine therapy.

Report Side Effects

Remicade may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Remicade Should I Take?

Your Remicade dosage will depend on the reason it has been prescribed and your weight.

The first doses (induction doses) are initially given once, then at two and six weeks. After the induction doses, the maintenance dose is given every six to eight weeks.

There are no specific dose modifications needed for Remicade. 

Overdose: What Happens If I Take Too Much Remicade?

As this medication is prepared by a specialized pharmacist and checked by specially trained nurses, an overdose is unlikely. If too much Remicade is given, you may need to be monitored for any side effects.

What Happens If I Overdose on Remicade?

If you think you or someone else may have overdosed on Remicade, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Remicade, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your or your child's progress closely and at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Infliximab may cause an infusion reaction, including a heart attack, stroke, changes in blood pressure, or heart rhythm problems (eg, arrhythmia), while you or your child are receiving it or right after the infusion ends. Check with your doctor or nurse right away if you have chest pain, fever, chills, itching, hives, rash, dizziness, fainting, lightheadedness, headache, joint pain, difficulty with swallowing, trouble breathing, or swelling of the face, tongue, and throat.

Your body's ability to fight an infection may be reduced while you or your child are using infliximab. It is very important that you call your doctor at the first sign of any infection. Check with your doctor right away if you or your child have a fever, chills, cough, flu-like symptoms, or unusual tiredness or weakness.

Serious skin reactions can occur while you or your child are receiving this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, fever, itching, joint or muscle pain, red skin lesions, sore throat, sores, ulcers, or white spots in your mouth, or unusual tiredness or weakness.

This medicine may increase your or your child's risk of having a lupus-like syndrome or a liver disease called autoimmune hepatitis. Check with your doctor right away if you or your child have dark brown-colored urine, fever or chills, a general feeling of discomfort, illness, or weakness, joint pain, light-colored stools, nausea, vomiting, a rash on the cheeks or arms that gets worse under the sun, severe tiredness, upper right-sided stomach pain, or yellow eyes and skin.

A small number of people (including children and teenagers) who have used this medicine have developed certain types of cancer. This is more common in patients who have lung diseases (eg, emphysema, COPD) or are heavy smokers, and in psoriasis patients who have had phototherapy treatment for a long time. Phototherapy treatment is ultraviolet light or sunlight combined with oral medicine to make your skin sensitive to light. Some teenagers and young adults with Crohn disease or ulcerative colitis also developed a rare type of cancer called hepatosplenic T-cell lymphoma. Talk with your doctor if you have unusual bleeding, bruising, or weakness, swollen lymph nodes in the neck, underarms, or groin, unexplained weight loss, or red, scaly patches, or raised bumps with pus on the skin.

Receiving this medicine may increase your risk of getting skin cancer (eg, melanoma, Merkel cell carcinoma) or cervical cancer. If you have any changes or growths on your skin, abnormal vaginal bleeding or pelvic pain, tell your doctor right away.

While you are being treated with infliximab, do not have any immunizations (vaccines) without your doctor's approval. Live virus vaccines should not be given with infliximab. Your child's vaccinations must be current before receiving infliximab. Talk to your child's doctor if you have any questions about this.

Women: If you have a baby while receiving infliximab, make sure the baby's doctor knows that you are receiving this medicine. You will need to wait a few months before giving certain vaccines to your baby. Talk to the baby's doctor if you have questions.

You will need to have a skin test for tuberculosis before you start receiving this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.

It is important to have your heart checked closely if you receive infliximab. Call your doctor right away if you have trouble breathing, swelling in the ankles and feet, or a sudden weight gain.

Do not take other medicines unless they have been discussed with your doctor. This includes abatacept (Orencia®), anakinra (Kineret®), tocilizumab (Actemra®), or other medicines called biologics that are used to treat the same conditions as infliximab. Using these medicines together with infliximab may increase your chance of having serious unwanted effects.

What Are Reasons I Shouldn’t Take Remicade? 

Remicade should not be given to anyone who has had an anaphylactic reaction to the medication or is otherwise allergic to any ingredients. 

Those with severe heart failure before Remicade infusion should either not take it or receive a smaller dose.

Remicade has not been studied extensively in pregnant people. However, observational studies have not pointed to any increased risk of adverse outcomes for the infant after birth when Remicade is used during pregnancy. Remicade may also be present at low levels in breast milk; therefore, exposure to the breastfed infant is expected to be low. Discuss the risks with your healthcare team if you are pregnant or breastfeeding. 

What Other Medications Interact With Remicade?

Do not receive live vaccines if you are on Remicade. Make sure you are up-to-date on current vaccinations before starting treatment. Live vaccines include those that protect against:

  • Measles-mumps-rubella (MMR)
  • Rotavirus
  • Chicken pox

Other medications that should be avoided include:

  • Kineret (anakinra)
  • Orencia (abatacept)
  • Actemra (tocilizumab)
  • Other biologic medications that suppress the immune system

What Medications Are Similar?

There are many other TNF inhibitors available with overlapping indications. It is important to note that these are not taken together. Examples of other TNF inhibitors include:

There are also biosimilar medications similar to Remicade. Biosimilars are not generic medications. Because biologic medications like Remicade are made with living tissue, an exact copy of the medication (generic) can’t be made. Biosimilars work the same way and have the same dose as the original drug (also called reference products). These medications undergo a rigorous process to prove they are just as safe and effective as the original medication.

The three FDA-approved biosimilars for Remicade are:

Frequently Asked Questions

  • What is Remicade used for?

    Remicade is used to treat some autoimmune diseases, including:

    • Crohn’s disease in children and adults
    • Ulcerative colitis in children and adults
    • Plaque psoriasis
    • Psoriatic arthritis
    • Rheumatoid arthritis
  • How does Remicade work?

    In certain autoimmune disorders, a protein called TNF is produced in excess, which results in increased inflammation. Increased inflammation contributes to the symptoms experienced with these conditions. Remicade works to block the TNF protein, thereby decreasing inflammation.

  • What drugs should not be taken with Remicade?

    Remicade should not be given along with other TNF blockers. Additionally, avoid other medications that suppress the immune system.

  • How long does it take for Remicade to work?

    People receiving Remicade may notice an improvement in their symptoms a few days after the first dose. For others, it may take multiple doses before improvement is seen.

How Can I Stay Healthy While Taking Remicade?

Living with an autoimmune disorder can be difficult, especially if you have unpleasant or debilitating symptoms. Taking Remicade can help better control symptoms of several autoimmune diseases, improving day-to-day functioning.

While taking Remicade, pay attention to any side effects or reactions, either during your infusion or after. This can include signs of an infection or allergic reaction. Moreover, infusion site reactions can be delayed up to two hours after your infusion.

Although it’s not a cure, Remicade can be an effective treatment for many people. Talk to your healthcare team about any additional lifestyle modifications to help relieve any symptoms. Be sure to discuss any concerns you have with your healthcare team. 

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Remicade (infliximab) label.

  2. Sánchez-Cano D, Callejas-Rubio JL, Ruiz-Villaverde R, et al. Off-label uses of anti-TNF therapy in three frequent disorders: Behçet's disease, sarcoidosis, and noninfectious uveitis. Mediators Inflamm. 2013;2013:286857. doi: 10.1155/2013/286857

  3. Miura M, Kobayashi T, Igarashi T, et al. Real-world safety and effectiveness of infliximab in pediatric patients with acute Kawasaki Disease: a postmarketing surveillance in Japan (SAKURA Study). Pediatr Infect Dis J. 2020;39(1):41-47. doi: 10.1097/INF.0000000000002503

  4. Dahmus J, Rosario M, Clarke K. Risk of lymphoma associated with anti-TNF therapy in patients with inflammatory bowel disease: implications for therapy. Clin Exp Gastroenterol. 2020;13:339-350. doi:10.2147/CEG.S237646

  5. Geldhof A, Slater J, Clark M, et al. Exposure to infliximab during pregnancy: post-marketing experience. Drug Saf. 2020;43(2):147-161. doi:10.1007/s40264-019-00881-8

  6. Lis K, Kuzawińska O, Bałkowiec-Iskra E. Tumor necrosis factor inhibitors - state of knowledge. Arch Med Sci. 2014;10(6):1175-85. doi:10.5114/aoms.2014.47827

  7. Food and Drug Administration. Biosimilar and interchangeable biologics: more treatment choices.

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.