Generic Name

Infliximab

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Classification

FDA Approved Indications

• Crohn's disease
• Ulcerative colitis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Psoriatic arthritis
• Plaque psoriasis

Mechanism of Action

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

Dosage and Administration

Adult: Varies by condition; typically 3-10 mg/kg IV at weeks 0, 2, and 6, then every 8 weeks.

Pediatric: Dosing based on weight; administered IV, frequency similar to adults; specific schedules depend on condition.

Geriatric: Adjustments based on renal and hepatic function, with careful monitoring due to increased infection risk.

Renal Impairment: No specific dose adjustment, but caution advised.

Hepatic Impairment: No specific guidelines; caution recommended.

Pharmacokinetics

Absorption: Not absorbed orally; administered IV.

Distribution: Widely distributed; penetrates inflamed tissues.

Metabolism: Metabolized into peptides and amino acids via proteolytic catabolism.

Excretion: Renal and non-renal routes.

Half Life: Approx. 7-10 days.

Contraindications

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

Precautions

• Screen for latent TB prior to initiation.
• Monitor for signs of infection during therapy.
• Use with caution in patients with heart failure, demyelinating diseases, or hepatitis B virus infection.

Adverse Reactions - Common

• Infusion reactions (fever, chills, pruritus) (Common)
• Infections (upper respiratory, sinusitis) (Common)
• Headache (Common)

Adverse Reactions - Serious

• Serious infections (pneumonia, sepsis) (Serious, less common)
• Demyelinating disorders (Rare)
• Lupus-like syndrome (Rare)
• Liver injury (Rare)

Drug-Drug Interactions

• Other immunosuppressants, live vaccines, antibiotics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection immediately.
• Understand infusion schedule and importance of adherence.
• Notify healthcare provider of any allergic reactions or side effects.

Special Considerations

Black Box Warnings:

• Serious infections, including tuberculosis and invasive fungal infections.
• Malignant lymphoma and other malignancies.

Genetic Factors: Genetic predisposition may influence response and risk.

Lab Test Interference: Can suppress signs of inflammation, potentially affecting lab tests.

Overdose Management

Signs/Symptoms: Unknown, but may include exaggerated immunosuppressive effects.

Treatment: Supportive care, monitor vital signs, and manage symptoms.

Storage and Handling

Storage: Store vials refrigerated at 2-8°C, do not freeze.

Stability: Stability varies by manufacturer; use within specified shelf life.