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Remicade (infliximab) Disease Interactions

There are 9 disease interactions with Remicade (infliximab):

Major

Infliximab (Includes Remicade) ↔ Heart Failure

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure

In a study of patients with moderate to severe heart failure (New York Heart Association [NYHA] Functional Class III/IV), an increase incidence of death and hospitalization due to worsening of heart failure was observed after treatment with infliximab at 10 mg/kg. Infliximab at doses > 5 mg/kg is contraindicated in patients with moderate to severe heart failure.

Major

Infliximab (Includes Remicade) ↔ Infections

Severe Potential Hazard, Moderate plausibility

Applies to: Sepsis, Infection - Bacterial/Fungal/Protozoal/Viral

There have been reports of serious infections, including sepsis, pneumonia, cellulitis, abscess, skin ulceration, and bacterial infection in patients receiving infliximab. Treatment with infliximab should not be initiated in patients with an active infection, including clinically important localized infections. Caution and close monitoring is recommended when considering the use of infliximab in patients with a history of recurrent infections, underlying conditions which may predispose them to infections, or chronic, latent, or localized infections. Administration of infliximab should be discontinued if a patient develops a serious infection or sepsis.

Major

Infliximab (Includes Remicade) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Severe hepatic reactions, including acute liver failure, jaundice, hepatitis and cholestasis, have been reported with the use of infliximab. Infliximab should be discontinued if jaundice and/or marked liver enzyme elevations (e.g., greater than or equal to 5 times the upper limit of normal) develop and a thorough investigation of the abnormality should be undertaken.

Major

Tnf Blocking Agents (Includes Remicade) ↔ Malignancies

Severe Potential Hazard, Moderate plausibility

Applies to: History - Skin Cancer, Skin Cancer, Lymphoma

In clinical trials malignancies have been observed in patients receiving TNF-blockers agents. Psoriasis patients should be monitored for nonmelanoma skin cancers (NMSCs), particularly those patients who have had prior prolonged phototherapy treatment. Melanoma and Merkel cell carcinoma have been reported in patients treated with TNF blocker therapy. Periodic skin examination is recommended for all patients, particularly those with risk factors for skin cancer. Postmarketing cases of fatal hepatosplenic T-cell lymphoma (HSTCL) have been reported in patients treated with TNF blockers. Caution should be exercised in considering these agents in the treatment of patients with a history of malignancy or in continuing treatment in patients who develop malignancy while receiving these agents.

Major

Tnf Blocking Agents (Includes Remicade) ↔ Neurologic Reactions

Severe Potential Hazard, Moderate plausibility

Applies to: CNS Disorder, Vasculitis, Seizures, Multiple Sclerosis, Optic Nerve Disorder, Guillain-Barre Syndrome

The use of TNF blocking agents has been associated with rare cases of CNS manifestations of systemic vasculitis, seizure and new onset or exacerbation of clinical symptoms and/or radiographic evidence of central nervous system demyelinating disorders, including multiple sclerosis and optic neuritis, and peripheral demyelinating disorders, including Guillain-Barré syndrome. Care should be exercised when considering the use of these agents in patients with neurologic disorders and discontinuing the agent is recommended if these disorders develop during therapy.

Major

Tnf Blocking Agents (Includes Remicade) ↔ Tuberculosis

Severe Potential Hazard, Moderate plausibility

Applies to: Tuberculosis -- Active, Tuberculosis -- Latent

Cases of reactivation of tuberculosis or new tuberculosis infections have been observed in patients receiving TNF blocking agents, including patients who have previously received treatment for latent or active tuberculosis. Cases of active tuberculosis have also occurred in patients being treated with these agents during treatment for latent tuberculosis. Prior to initiating TNF blocking agents, patients should be screened for latent tuberculosis infection with a tuberculin skin test and periodically during therapy. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy with TNF blocking agents. Anti-tuberculosis therapy should also be considered prior to initiation of therapy in patients with a past history of latent or active tuberculosis in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent tuberculosis but having risk factors for tuberculosis infection. Tuberculosis should be strongly considered in patients who develop a new infection during infliximab treatment, especially in patients who have previously or recently traveled to countries with a high prevalence of tuberculosis, or who have had close contact with a person with active tuberculosis.

Moderate

Infliximab (Includes Remicade) ↔ Copd

Moderate Potential Hazard, Moderate plausibility

Applies to: Chronic Obstructive Pulmonary Disease

In studies, patients with moderate to severe chronic obstructive pulmonary disease (COPD) treated with infliximab developed more malignancies, the majority of lung or head and neck origin than those treated with placebo. Caution should be exercised when considering the use of infliximab in patients with moderate to severe COPD.

Moderate

Infliximab (Includes Remicade) ↔ Hepatitis B

Moderate Potential Hazard, Moderate plausibility

Applies to: Infectious Hepatitis

Infliximab, has been associated with reactivation of hepatitis B, in some cases fatal, in patients who were previously infected with the hepatitis B virus (HBV) and had received concomitant TNF-blocking agents. Therefore, screening for viral hepatitis should be performed in accordance with published guidelines before starting therapy with infliximab. Monitor patients at risk or with evidence of current or prior HBV infection for clinical and laboratory signs of hepatitis or HBV reactivation. Prescribers should exercise caution in prescribing TNF blockers in patients previously infected with HBV. Monitor patients with evidence of current or prior HBV infection for clinical and laboratory signs of hepatitis or HBV reactivation during and for several months following infliximab therapy. In patients who develop HBV reactivation, infliximab should be stopped and antiviral therapy with appropriate supportive treatment should be initiated. The safety of resuming infliximab therapy after HBV reactivation is controlled is not known. Therefore, prescribers should weigh the risks and benefits when considering resumption of therapy.

Moderate

Tnf Blocking Agents (Includes Remicade) ↔ Hematologic Abnormalities

Moderate Potential Hazard, Moderate plausibility

Applies to: Pancytopenia, Anemia, Neutropenia, Thrombocytopenia, History - Blood Dyscrasias, Bone Marrow Depression/Low Blood Counts

Cases of leukopenia, neutropenia, thrombocytopenia, and pancytopenia, some with a fatal outcome, have been reported in patients treated with TNF blocking agents. Caution should be exercised when treating patients who have ongoing or a history of significant hematologic abnormalities. Discontinuation of therapy should be considered in patients with confirmed significant hematologic abnormalities.

Remicade (infliximab) drug Interactions

There are 471 drug interactions with Remicade (infliximab)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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