Coadministeration of another TNF- alpha blocking agent, has  been associated with an increased risk of serious infections and neutropenia.

Combination has no additional benefit compared with when used  alone.
 

Ankylosing spondylitis

Crohns disease

Plaque psoriasis

Rhemutoid arthiritis

One of the most common reasons for discontinuation of treatment was infusion -related reactions eg. dyspnea, flushing, headache, rash

Adverse reactions have been reported  with RA receiving 10mg/kg dose  than 5mg/kg dose and 10mg/kg dose in patients with Crohns disease

Adverse reaction reported in 5% of RA patients

Cardiovascular-       Hypertension 5%

CNS-                          Fatigue  6%  headache  12%

Dermatologic -         Pruritis  2%  rash 4%

GI -                           Abdominal pain 6%   Diarrhea  10%    Dyspepsia 6%      Nausea  18%

GU-                         Moniliasis  3%   urinary tract infection  6%

Musculoskeletal -   Arthalgia  6%   Back pain  5%

Respiratory-       Bronchitis  8%   Coughing  8%  Pharyngitis 7%   Rhinitis 5% 

                            Sinusitis  7%    upper respiratory tract infection  25%

Miscellaneous-    Fever  4%  Pain  7%

Do not administer inflaximab at doseshigher than 5mg/kg to patients with severe heart failure

Do not administer to patients  who have experienced a severe hypersensitivity reaction to
infliximab

Special precautions-

Risk of infection- serious infections including sepsis and pneumonia  have been reported in patients receiving TNF- b;pcking agent. Some of these infections have been fatal.

Hepatitis  B virus-  use of TNF blockers including infliximab have been associated with reactivation of HBV in patients with chronic carriers of this virus.  Evaluate patients at risk for HBV infection for  prior evidence of HBV  infection before initiating TNF blockers therapy

Hepatotoxicity -  severe hepatic infections including acute liver failure , jaundice, hepatitis, and cholestasis have been reported rarely in patients receing infliximab

Heart failure- infiximab has been associated with adverse outcomes in patients with heart failure. If required to be administered closely monitor patients during therapy and discontinue if new or worsening symptoms of heart failure appear.

Hypersensitivity reactions-  infiximab has been associated with hypersensitivity reactions . Most  reactions include, urticaria, dyspnea and or hypotension have occured during or within 2 hrs of infliximab infusion

Pregnancy - not enough data available. Use only if required

Lactation- decide whether to discontinue breast feeding or the drug depending on the important  of the drug to the mother.

Elderly- because of the possibility of higher incidence of infection in elderly population, use caution in treating elderly

Indication-

Ankylosing spondylitis

Crohns disease

Plaque psoriasis

Rhemutoid arthiritis

Dosage-

RA patients not previuosly treated by infliximab
3mg/kg by i.v. infusion repeated 2 weeks and 6 weeks after first infusion then every 8 weeks  infusion given 2 hours for first 3 doses then over 1 hour or more if tolerated

1. If you develop signs and symtoms of infection, consult your doctor immediately

2. Excercise caution in administering inflaximab to patients developing important active
   infection.

Pharmacology-

Infliximab neutralises the biological activity of tumor necrosis factor- alpha TNF by binding wih high affinity to the soluble and transmembrane forms of  TNF -alpha and inhibits binding of TNF alpha  with its receptors

Pregnancy -
Not enough data available. Use only if required

Lactation-
Decide whether to discontinue breast feeding or the drug depending on the important  of
the drug to the mother.

Elderly-
Because of the possibility of higher incidence of infection in elderly population, use caution
in treating elderly