Parenteral Manual

InFLIXimab

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
REMICADE®
Classification: 
Chimeric monoclonal antibody
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Severe Crohn's disease or fistulizing Crohn's disease
Reconstitution and Stability: 

VIAL SIZE

STERILE WATER for INJECTION REQUIRED

FINAL CONCENTRATION

100 mg

10 mL

10 mg/mL

  • Refrigerate unreconstituted vials
  • Inject Sterile Water for Injection on vial wall; do not use if no vacuum; DO NOT SHAKE; swirl; let solution stand for 5 minutes and slowly add to NS and mix gently
  • Reconstituted solution stable 24 hours at room temperature
  • Diluted solution stable 24 hours when stored in fridge
  • Infusion should begin within 3 hours of preparation
Compatibility: 

- Solutions Compatible: NS

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

IncompatibleDO NOT infuse with any other medications

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES:  Large Volume Pump ONLY
Usual dilution: Add dose to a 250 mL minibag of 0.9% NaCl
Infusion time: >2 hours
Infusion rate: see NOTES section

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric/Adult:
- Crohn's disease:

  • 5 mg/kg given as a single IV infusion

- Fistulizing Crohn's disease:

  • Three separate infusions of 5 mg/kg at weeks 0,2 and 6
  • The dose may be increased to 10 mg/kg in patients with an initial response but a subsequent lack of response
  • Patients may be retreated within 14 weeks of last infusion
Potential hazards of parenteral administration: 
  • Hypersensitivity reactions (during or within 2 hours after infusion): urticaria, dyspnea, hypotension
  • Headache, nausea, abdominal pain, vomiting, flu-like symptoms
  • Susceptibility to infections: upper respiratory tract infection, urinary tract infection, invasive fungal infections, sepsis
Notes: 
  • Monitor vital signs pre-infusion, q30 minutes during infusion and 1 hour post-infusion
  • Patient should be monitored for at least 1-2 hours following end of infusion
  • Infusion must be administered through a 0.22 micron in-line filter
  • Patients are required to have a tuberculin skin test prior to initiation of therapy
  • Infliximab should not be administered in the setting of active tuberculosis and should be used with caution if latent disease is present
  • Patients who develop a new infection while receiving infliximab should be monitored closely
  • If a patient develops a serious infection while on infliximab, discontinue treatment.
  • Monitor CBC with differential, albumin, serum creatinine, BUN, LFTs, electrolytes and total protein, signs and symptoms of lupus
  • DO NOT administer live vaccines concurrently with infliximab

INFUSION GUIDELINES:

  • 10 mL/hr x 15 minutes
  • 20 mL/hr x 15 minutes
  • 40 mL/hr x 15 minutes
  • 80 mL/hr x 15 minutes
  • 150 mL/hr x 30 minutes
  • 250 mL/hr x 30 minutes
  • Then 250 mL/hr until finished.
  • Then flush with IV solution at ______ mL/hr (100 mL/m2/hr) x ½ hour
  • Have Epinephrine Anaphylaxis kit at bedside and in portable kit for patient transport off unit

 

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