What Is Remicade (Infliximab)?

Remicade (infliximab) is a biologic medication that suppresses inflammation. It was originally approved by the FDA in 1998 to treat patients with Crohn’s disease. Since then, its uses have expanded, and it is now prescribed to children and adults for a variety of autoimmune diseases, including ulcerative colitis, rheumatoid arthritis, plaque psoriasis, ankylosing spondylitis, and psoriatic arthritis. Remicade is typically prescribed when other medications or types of treatments have not been effective in reducing symptoms. (Source, Source)

While it can be effective in treating these conditions and is generally considered safe, Remicade can also cause side effects, some of which can last for several weeks or months. The duration of side effects varies among individuals depending on several factors, including overall health, other medications, and specific reaction type. In this article we’ll look at how long Remicade side effects last and how they might be mitigated or reduced.

How Does Remicade Work?

Remicade is a type of immunotherapy that works by blocking the action of tumor necrosis factor alpha (TNF-α), a pro-inflammatory cytokine, or signaling protein, that is often released in excess in people with inflammatory autoimmune conditions. By doing this, it helps to reduce inflammation and relieve associated symptoms. (Source, Source)

Remicade Infusion Schedule

Remicade is administered via intravenous infusion, usually through a vein in the arm. Treatment typically starts with infusions at 0, 2, and 6 weeks. After these initial infusions, maintenance treatment is typically every 8 weeks, but may be every 4 or 6 weeks depending on the individual and specific autoimmune condition. Each infusion usually takes about 2 hours. (Source)

What Are the Side Effects of Remicade?

Remicade is often associated with side effects, which can range from mild and common to severe and rare. For some patients, side effects may present immediately following the injection, while others may experience them later. Remicade also carries a "black box warning" indicating severe health risks, including potentially fatal fungal infections, liver damage, and certain cancers. (Source, Source)

Common Remicade Side Effects

Common side effects during and after infusion may include fever, dizziness, itching or rash, and shortness of breath. In general, these infusion reactions occur within 24 hours. Other side effects include muscle and joint pain, fever, fatigue, and rash, which can occur up to 14 days after the infusion. (Source, Source)

Serious Remicade Side Effects

In some cases, more serious side effects may occur that can last longer and require further medical intervention. Most severe side effects are noted under the FDA's “black box” warning and can include:

• allergic reactions
• breathing difficulties, such as shortness of breath
• vision changes
• seizures
• infection, including fungal infection
• liver damage or failure
• stroke symptoms
• heart failure
• decreased white blood cell count
• unexplained bleeding or bruising

(Source, Source, Source, Source)

Persistent or severe side effects should always be reported to a health care provider. They can provide advice on managing these symptoms, or may decide to adjust the dosage or switch to a different medication.

Remicade Risks and Contraindications

There are also certain risks and contraindications associated with Remicade. 

Remicade and Pregnancy

If taken during the third trimester of pregnancy, infliximab can cross the placenta and stay in a baby's body for up to 6 months after birth. This may potentially lead to neutropenia (lower levels of neutrophils, a type of white blood cells) in the baby. However, while there is evidence to suggest a correlation between Remicade administered during the third trimester and neutropenia in the infant, there is no definitive research that shows infliximab causes neutropenia. It is generally recommended to stop Remicade treatment during the third trimester of pregnancy as a precaution. (Source, Source, Source)

Remicade and Live Vaccines

There are also precautions against receiving live vaccines, which are made from microbes that are weakened but still alive, while being treated with Remicade. Since infliximab is an immunosuppressant, live vaccines carry a risk of causing infection. It is recommended that infants exposed to infliximab in the uterus not receive live vaccines for 6 months after birth, or until there is no infliximab detectable in their blood. Similarly, adults are advised to obtain any needed live vaccines before starting treatment with infliximab. Remicade should also not be used in patients with conditions such as heart failure or active infections. (Source, Source)

Remicade and Allergic Reactions

As severe side effects are often related to allergic reactions or serious systemic responses, their duration can vary widely based on the individual’s overall health and the specific adverse reaction in question. For example, acute allergic reactions can occur rapidly but resolve quickly with appropriate treatment, while systemic effects such as infection or liver failure can persist over a long time period and require more complex treatment.

How Long Do Remicade Side Effects Last?

The duration of Remicade side effects can vary greatly depending on several factors, including the individual's overall health, the presence of any other medical conditions, the dosage of the medication, and how well the individual's body metabolizes the drug. Some side effects can begin during or shortly after the infusion, while others might not appear until days or weeks later.

Generally speaking, mild side effects are likely to last for a few hours to a few days, and diminish over time as the body acclimatizes to the medication. Many common, less severe side effects will improve on their own and should resolve within a few days or weeks of starting treatment. More severe side effects may last longer, sometimes up to several weeks or months, and can become more severe over time.

Infusion Reactions

When receiving Remicade treatment, infusion reactions may be immediate or late, depending on the timing and characteristics of the side effects that can occur in response to Remicade. Both types of reactions can vary greatly in severity and should be monitored carefully. (Source)

Immediate Infusion Reactions

Immediate side effects usually occur during the infusion or within a few hours after the infusion is completed. The quick onset of these symptoms is due to the body's immediate response to Remicade entering the body. Although most of these reactions are mild and transient, resolving on their own within a few hours to a few days, severe cases can occur. Therefore, it's important to inform your health care provider if you experience any of these symptoms. (Source)

Immediate infusion reactions often subside within a few days to a week after receiving the medication, and can include:

• fever
• chills
• headache
• nausea
• dizziness
• fatigue
• itching
• trouble breathing
• chest discomfort
• flushing or redness in the skin
• hypertension

(Source, Source, Source)

Late Infusion Reactions

Side effects from Remicade may also appear more than 24 hours after an infusion. Late infusion reactions, also called delayed reactions, typically develop 3 to 12 days after the treatment and are likely due to production of antibodies against the drug. Like immediate infusion reactions, these side effects usually resolve within a few days to a week. However, any prolonged or severe symptoms should be reported to your health care provider. (Source)

Late infusion reactions can include:

• headache
• sore throat
• fever
• general feeling of discomfort
• chest pain
• muscle or joint pain
• rash
• hives
• itchy, stinging, or burning skin
• fever
• swelling of the hands, face, or lips
• difficulty swallowing 

(Source, Source, Source)

Long-Term Side Effects

Certain side effects of Remicade might not appear until weeks after an infusion and can persist for the duration of treatment, or until the drug is fully cleared from the body. Remicade can be detected in the body at least 8 weeks after an infusion treatment. Symptoms such as fatigue, joint or muscle pain, respiratory infections, or sinusitis can last anywhere from a few weeks to several months. It's essential to communicate these symptoms to your health care provider as they might be a sign that the medication's dose needs to be adjusted or that an alternative treatment should be considered. (Source)

Severe Side Effects

Serious side effects can occur at any time during treatment and should be addressed immediately. These can include signs of liver damage, heart problems, severe infections (new or reactivated), certain cancers (including skin, cervical, and lymphoma), or severe allergic reactions. 

The onset and duration of these severe side effects can greatly vary depending on the individual and the specific reaction. For example, liver damage might develop slowly over several weeks or months and persist for a prolonged period, even after discontinuation of the drug. On the other hand, severe allergic reactions typically occur shortly after the infusion and require immediate medical attention. Due to the serious nature of these side effects, it's crucial to remain vigilant for any signs and to seek immediate medical care if they develop. (Source)

What Can You Do to Manage Remicade Side Effects?

If you are experiencing side effects from Remicade, there are several steps you can take to help manage them. First, it’s important to talk to your health care provider about any side effects you are experiencing, as they may be able to suggest ways to reduce or manage them. During treatment, side effects may be managed by slowing the rate of the infusion or stopping the infusion. Additionally, you may be able to take over-the-counter medications to help reduce the severity of the side effects. (Source, Source)

While you should always consult with a health care professional if you are experiencing side effects from Remicade, here are 6 general tips that may lessen the severity of these symptoms.

• pre-medication: Your health care provider may recommend taking certain medications before the Remicade infusion. These can include antihistamines, acetaminophen, and corticosteroids. Pre-medication can often help mitigate the likelihood of an allergic reaction, reduce inflammation, and help manage side effects.
• hydration: Drink plenty of fluids, particularly water, before and after your infusion. This can potentially alleviate some minor side effects such as headaches and fatigue.
• healthy lifestyle: Balanced nutrition, physical activity, and stress management are a few of the lifestyle changes that can help in managing autoimmune conditions, even while in treatment. 
• rest: Be sure to get enough rest, particularly after your infusion. Rest allows your body to recover and can help decrease feelings of fatigue that might be associated with Remicade treatment.
• monitor and report side effects: Keeping a record of any side effects you experience — noting their severity, duration, and frequency — can be valuable when talking to your health care provider. They might be able to adjust your dosage, change the frequency of your infusions, or suggest other strategies to help manage side effects.
• avoid infections: As infliximab can lower your body's ability to fight infections, try to avoid close contact with people who are ill. Regularly washing your hands and keeping up to date with your vaccinations (except live vaccines) can also help protect you from infections.

(Source, Source, Source)

Remember, each person's body responds differently to medication, and what works best for you will depend on your personal health history, the severity of your side effects, and other factors. Always discuss these strategies with your health care provider to ensure they're safe and effective for you.

Alternatives to Remicade

While infliximab is often a critical part of treatment for many individuals with inflammatory autoimmune conditions, it is not the only option available. There are other TNF inhibitors, such as Humira (adalimumab), Cimzia (certolizumab), and Enbrel (etanercept), which work similarly to Remicade. Biologic drugs also target different parts of the immune system and include medications such as Rituxan (rituximab), Orencia (abatacept), and Xeljanz (tofacitinib).

The Bottom Line

Remicade is a biologic drug used to treat several autoimmune diseases, such as Crohn’s disease and rheumatoid arthritis. While it can be effective in treating these conditions, it can also cause side effects. These side effects can vary in duration depending on the individual, and while some may subside shortly after the infusion, others may persist for weeks or months. Strategies such as pre-medicating, maintaining a healthy lifestyle, resting, and avoiding infections can help manage these side effects. However, you should always report any concerning symptoms to your health care provider. 

If Remicade proves not to be a suitable treatment, there are several alternatives available. These alternatives, and many diet and lifestyle changes, can be discussed thoroughly with WellTheory’s Care Team to choose the best course of action for your individual case.