Remicade (infliximab) is a medication injection first approved by the U.S. Food and Drug Administration (FDA) in 1998 to suppress inflammation in patients with Crohn’s disease. In addition to Crohn’s, Remicade is now used in both children and adults to manage symptoms from active immune disorders such as ulcerative colitis, rheumatoid arthritis, plaque psoriasis, and ankylosing spondylitis.

Remicade may be brought in when other drug treatments have not worked to reduce active disease symptoms. Clinical studies have shown this immunosuppressive drug to be effective in managing inflammatory autoimmune conditions, but side effects are likely to occur with use. 

If you are considering or currently receiving Remicade injections, you should be closely monitored by a health care professional for adverse symptoms and how they may affect your health. (Source, Source)

What Does Remicade Do?

Remicade is an injection prescribed and administered by a health care professional to manage inflammatory disease symptoms by suppressing a kind of pro-inflammatory cytokine, or signaling protein, known as tumor necrosis factor (TNF). Tumor necrosis factor is normally released into serum and tissue for a short time in response to injury or infection, but in those with inflammatory autoimmune conditions such as inflammatory bowel disease (IBD) and rheumatoid arthritis it may be released continuously, resulting in increased inflammation. Remicade reduces inflammation by blocking, or inhibiting, TNF. (Source, Source)

Infliximab was the first approved monoclonal antibody geared toward improving immune system function in those with chronic disease. Monoclonal antibodies are man-made proteins that mimic antibodies made by our own immune system. Each monoclonal antibody is designed to attack a specific antigen, or foreign substance that stimulates an immune response. This is different from medications that have a more general effect. The Remicade injection introduces foreign protein substances to the immune system repeatedly with the intention of lessening the immune response and reducing inflammation. (Source, Source)

Side Effects of Remicade

Though Remicade is generally well tolerated, there are a number of side effects that may immediately follow the injection or occur later. You may have an increased risk of possible side effects if you are 60 years of age or older or any time your dosage is increased. (Source, Source)

Side Effects During and After Injection

Adverse effects ranging from mild to severe may occur during or just after infliximab injection. Medications may be given before Remicade is received to counteract the possibility of adverse effects, including allergy and fever reducing drugs or steroids.

Possible side effects during and right after injection may include:

• shortness of breath
• fever
• dizziness
• chills
• itching/rash
• joint pain
• trouble swallowing
• swelling in the face, tongue, or throat
• fainting/lightheadedness
• heart attack
• stroke
• blood pressure changes
• heart arrhythmia

(Source)

Most Severe Side Effects

The FDA requires Remicade to carry a “black box” warning indicating it may pose serious risks to your health. This warning alerts your prescribing health care provider to the potential for the most severe side effects, but does not mean you will necessarily experience any of them. As with all medications, you must weigh Remicade’s benefits in managing your inflammatory disease against the risks it may pose for you. (Source)

Severe side effects of infliximab infusion may include:

• allergic reactions such as rash, itching, hives, swelling in the face, lips, or tongue (anaphylaxis)
• breathing issues or difficulty
• vision changes
• chest pain
• skin rash or abnormalities such as red, blistering, or peeling skin (even inside the mouth)
• seizures
• signs of infection such as fever, chills, cough, sore throat, extreme exhaustion, and difficult or painful urination
• signs of liver failure such as feeling generally weak or ill, dark brown or dark yellow urine, light colored bowel movements, loss of appetite, pain in the right upper side of the abdomen, or yellow eyes or skin
• signs of stroke such as vision changes, confusion, difficulty speaking and/or comprehending speech, numbness or weakness of the face or extremities, trouble walking, dizziness, or lack of balance and/or coordination
• unexplained bleeding and/or bruising

(Source, Source)

Bothersome Side Effects

Not all side effects of Remicade need to be reported to your provider for medical care. As long as these uncomfortable side effects don’t stick around for long, they may not be a cause for alarm.

Bothersome but not serious side effects include:

• headache
• nausea
• abdominal pain
• diarrhea or constipation

(Source, Source)

Rare Side Effects

In addition to severe and bothersome side effects, there are also rare symptoms that may occur with use. These rare side effects may include:

• bleeding gums
• bloody stool
• blue lips and fingernails
• pale skin
• tenderness in the foot or leg area
• coughing with a pink frothy mucus
• dizziness, lightheadedness, or fainting when rising from a laying down position
• dry mouth
• fast, noisy breathing or rapid and shallow breathing
• a general feeling of unusual tiredness, unwellness, or weakness
• high fever
• hives
• sweating
• irregular heartbeat
• muscle pain
• tiny, pin-prick red spots on the skin
• puffy skin on the face
• joint swelling
• sunken eyes
• excessive thirst
• vomiting
• unexpected weight loss

(Source)

Remicade Interactions

Be sure to let your health care provider know all the medications you are taking, because infliximab interacts with many other drugs as well as with some vaccines. Your initial infliximab dosing and timing of injections may be adjusted to avoid interactions and reduce adverse reactions and risk of infection. If you use tobacco or alcohol you should also discuss this with your provider before using Remicade, as they may interfere with your body’s response to the medication.

Remicade reacts negatively with many other drugs used to treat autoimmune diseases, including, but not limited to:

• abatacept (Orencia)
• adalimumab (Taltz)
• alefacept (Amevive)
• anakinra (Kineret)
• anifrolumab-fnia (Saphnelo)
• baricitinib (Olumiant)

Because infliximab makes it hard for your immune system to fight infection, you should not receive live vaccines — which are made with weakened, but not killed, viruses and bacteria — while being treated with Remicade. These include live vaccines for:

• rotavirus
• measles, mumps, and rubella
• smallpox
• typhoid
• yellow fever
• chickenpox
• influenza (nasal spray version) 

 (Source)

Risks of Remicade

As with any pharmaceutical, there are risk factors associated with the use of immunosuppressants like Remicade. There are also some medical conditions that make unwanted effects more likely.

For example, if you take Remicade while you are pregnant, it may cross the placenta and enter your baby’s bloodstream. The drug may stay in the baby’s body for up to 6 months after birth, and live vaccines should not be given during that time. Some infants exposed to infliximab in the uterus have developed agranulocytosis, a low white blood cell count that leaves the immune system weakened and unable to fight infection. (Source)

Contraindications to Remicade

Remicade is contraindicated with certain serious medical conditions, meaning that if you have one of these conditions it is not safe for you to receive infliximab. These conditions include:

• heart failure or myocardial infarction
• a previous reaction to infliximab
• a present and serious infection such as tuberculosis or sepsis
• an active viral, bacterial, fungal, or parasitic infection

There are other conditions with which Remicade is not necessarily contraindicated but must be used with great care, such as:

• a pre-existing demyelinating disorder — such as multiple sclerosis — that damages the protective covering of the nerve fibers in the brain, eyes, and spinal cord 
• mild to moderate signs of heart failure
• active seizures or a history of seizures
• over the age of 65
• uncontrolled diabetes
• moderate or severe chronic obstructive pulmonary disease (COPD)

(Source, Source)

Alternatives and Additions to Remicade

Remicade may be helpful for suppressing inflammation, but other lifestyle factors may play a role in reducing your inflammation as well. Consuming a well balanced, anti-inflammatory diet full of nutrient dense foods, colorful fruits and vegetables packed with fiber, healthy fats, and high quality protein is a great addition to taking inflammatory suppressing medication.

The health of your gut is directly related to your immune system, so consuming whole foods, adding in fermented foods, and limiting packaged and processed snacks and meals may improve your gut microbiota. In addition to diet, getting quality sleep, enjoying appropriate movement, and managing stress regularly are some choices you can make to help reduce inflammation and manage your condition. (Source)

The Bottom Line on Remicade Side Effects

If you struggle with Crohn’s disease, ulcerative colitis, rheumatoid arthritis, plaque psoriasis, or active ankylosing spondylitis, you may be considering Remicade and its benefits for treatment of your condition. Though infliximab has proven to be effective in managing inflammatory conditions and could even help you achieve remission, it does come with a long list of possible side effects ranging from mild to severe. Your health care provider can help you decide whether the potential benefits of Remicade outweigh your individual risks. If you are interested in learning about natural and complementary options to utilize alongside your prescription medications to help manage your condition, WellTheory’s Care Team is here to help.