Nurses Compass
Drug Guide
Infliximab-dyyb
Classification
Therapeutic: Immunosuppressant, Monoclonal Antibody
Pharmacological: TNF-alpha inhibitor
FDA Approved Indications
- Crohn's disease
- Ulcerative colitis
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Plaque psoriasis
Mechanism of Action
Infliximab-dyyb binds to tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory cytokine, preventing it from interacting with its receptors, thereby reducing inflammation and immune response.
Dosage and Administration
Adult: Dose varies by indication; typically 3 mg/kg IV infusion at weeks 0, 2, 6, then every 8 weeks
Pediatric: Dosing varies; consult specific guidelines for age-dependent dosing
Geriatric: Use with caution; consider renal, hepatic, and cardiac comorbidities
Renal Impairment: Adjustments not typically necessary, but monitor closely
Hepatic Impairment: Use with caution; no specific dosage adjustments
Pharmacokinetics
Absorption: Not applicable (administered IV)
Distribution: Widely distributed in body fluids and tissues
Metabolism: Metabolized via catabolism into smaller peptides and amino acids
Excretion: Eliminated via proteolytic degradation pathways
Half Life: Approximately 7-10 days varies by patient and condition
Contraindications
- Hypersensitivity to infliximab or excipients
- Active infection, including tuberculosis
Precautions
- Screen for latent TB before initiation
- Risk of serious infections, malignancies, demyelinating disease, heart failure, and hepatotoxicity
Adverse Reactions - Common
- Infusion site reactions (Common)
- Infections, including respiratory and urinary tract infections (Common)
- Headache, nausea (Common)
Adverse Reactions - Serious
- Serious infections, including sepsis and opportunistic infections (Uncommon to rare)
- Malignancies, including lymphoma (Rare)
- Demyelinating disease (Rare)
- Hepatosplenic T-cell lymphoma (Very rare, primarily in young males with Crohn's or ulcerative colitis)
Drug-Drug Interactions
- Other immunosuppressants, live vaccines, certain biologics
Drug-Food Interactions
- None specifically identified
Drug-Herb Interactions
- Limited data; caution advised with herbal supplements affecting immune response
Nursing Implications
Assessment: Monitor for signs of infection, allergic reactions, and infusion reactions; baseline TB screening required.
Diagnoses:
- Risk for Infection
- Impaired Skin Integrity
Implementation: Administer via IV infusion with appropriate premedication if necessary; monitor vital signs during and after infusion.
Evaluation: Assess for adverse reactions; monitor disease activity; ensure patient education regarding infection risk.
Patient/Family Teaching
- Report signs of infection (fever, chills, cough), infusion reactions, or allergic responses.
- Keep all follow-up appointments for infusions and monitoring.
- Inform about the importance of TB screening before therapy.
Special Considerations
Black Box Warnings:
- Serious infections leading to hospitalization or death.
- Malignancies, including lymphoma and other cancers.
- Hepatosplenic T-cell lymphoma (rare).
Genetic Factors: Certain genetic predispositions may influence immune response; genetic testing not routine.
Lab Test Interference: May interfere with certain laboratory assays; always inform lab personnel when ordering tests.
Overdose Management
Signs/Symptoms: Unusual infusion reactions or symptoms of infection.
Treatment: Supportive care; no specific antidote—manage symptoms; discontinue infliximab-dyyb.
Storage and Handling
Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F). Do not freeze.
Stability: Stable for up to 24 hours at room temperature for prepared solutions, following specific guidelines.