What is the administration protocol for infliximab (Remicade)?

From the Guidelines

Infliximab should be administered as an intravenous infusion at a dose of 5 mg/kg over 2 to 3 hours at weeks 0,2, and 6, and then every 8 weeks for the treatment of psoriasis and psoriatic arthritis, as this regimen has been shown to achieve a rapid and sustained clinical response in approximately 80% of patients 1. The standard dosing regimen for infliximab is:

• Initial doses: 5 mg/kg at weeks 0,2, and 6
• Maintenance: 5 mg/kg every 8 weeks thereafter The infusion is usually given over a period of 2 hours. Some patients may require dose adjustments or more frequent infusions based on their response. Before starting treatment, it is essential to:

1. Screen for tuberculosis and hepatitis B
2. Update vaccinations
3. Assess for any active infections During infusion, it is crucial to:
4. Monitor vital signs
5. Watch for infusion reactions Infliximab works by blocking tumor necrosis factor-alpha (TNF-α), reducing inflammation in conditions like rheumatoid arthritis, Crohn's disease, and ulcerative colitis. The loading doses help achieve therapeutic levels quickly, while maintenance dosing sustains the effect. Regular monitoring is essential to assess efficacy and detect potential side effects, such as infusion reactions and serum sickness, which can occur more commonly in patients who have developed antibodies against infliximab 1.

From the FDA Drug Label

Must reconstitute and dilute before intravenous infusion. Must infuse over at least 2 hours with an in-line filter. The administration protocol for infliximab (Remicade) is:

• Reconstitute and dilute before intravenous infusion
• Infuse over at least 2 hours
• Use an in-line filter 2

From the Research

Administration Protocol for Infliximab (Remicade)

The administration protocol for infliximab (Remicade) typically involves intravenous infusion, with the duration of infusion being a key consideration.

• Infliximab is typically administered intravenously via 2- to 3-h duration infusions 3.
• However, shorter duration infusions, such as 1-h infusions, have been shown to be safe and well-tolerated in selected patients who have previously tolerated standard infusions 3, 4, 5.
• The decision to shorten the infusion duration to 1 hour is often based on the absence of infliximab-related adverse reactions during previous standard infusions 6, 5.
• Studies have demonstrated that 1-h infusions are not associated with an increased risk of infusion reactions compared to standard 2- to 3-h infusions 3, 4, 5.
• In fact, some studies have reported a decreased risk of infusion reactions with 1-h infusions compared to standard infusions 3, 4.

Factors Influencing Infusion Duration

Several factors can influence the decision to shorten the infusion duration, including:

• Patient tolerance to previous infusions 6, 5
• Disease activity and severity 6
• Use of concomitant medications, such as immunosuppressors 4
• Patient demographics, such as age and sex 6

Quality of Life Considerations

Shortening the infusion duration to 1 hour has been shown to improve quality of life for patients with inflammatory bowel diseases, including:

• Better overall quality of life 6
• Improved work and social quality of life 6
• Reduced perception of infusion-related side effects 6