Protocol for administering Infliximab IV infusion

Inj. Remicade 5 mg/kg dose

The infusion is to be given under observation (pulse oxymetry, cardiac monitor- pulse, BP, temperature & RR every 15 min, initially) keeping resuscitation facilities handy (appropriate airway; and inj. Paracetamol, hydrocortisone & anti histamines).

Vials to be reconstituted using full aseptic precautions using distilled water injected towards the wall of the vial and dissolving gently till the solution is colorless. The solution is mixed in 250 ml of normal saline

Infusion is started through an IV set having a in-line low protein binding filter (1.2 um) into a cannula in a peripheral vein and aimed to finish within 2 hours. (the drug has no preservative) The infusion is to run isolated, and not to run mixing in a three-way with any other IV solution.

The patient is to be observed for another hour in ICU.

What to observe:

Early:

  • Injection site symptoms: edema, pain along infusion.
  • Flushing
  • Rash – red raised itchy patches.
  • Difficulty in breathing, tightness in the chest
  • Rise or fall in BP

Through the infusion:

  • Body ache and myalgia

Post infusion advice:

  • Serum sickness like syndrome (body ache, muscle & joint pains, fever & rash (between 1/10 to 1/100 cases) can happen even till 3-12 days post infusion.
  • Lupus like syndrome : chest discomfort, shortness of breath, joint pains, rash on the skin exposed to the sun
  • You may be prone to some symptoms that will need you to report to the doctor
  • Headache
  • Nausea, and tiredness
  • Stomach pain and diarrhea
  • Urinary tract infection like symptoms
  • Bronchitis, sinusitis, sore throat
  • Do not take any vaccines ( like swine flu, pneumococcal, etc.) without informing the doctor

Treatment status

Naïve for: steroids / MTX / AZA / CsAProtocol / on demand

Number of Infliximab doses already received

Investigation check list:

TB :symptoms( cough, wasting, fever, weight loss); TT, CXR PA, F/H

HBV, HCV, HIVLFTs

Abscesses

Smoker

Heart status NYHA III/ IV

Crohn’s Disease Activity Index

Severe disease CDAI450

Response to treatment CDAI fall > 70 points

Remission CDAI < 150

Infliximab indication: 220 </= CDAI >/= 400

Clinical or laboratory variable / Weighting factor
Number of liquid or soft stools each day for seven days / x 2
Abdominal pain (graded from 0-3 on severity) each day for seven days / x 5
General well being, subjectively assessed from 0 (well) to 4 (terrible) each day for seven days / x 7
Presence of complications*
One point each is added for each set of complications:
  • the presence of joint pains (arthralgia) or frank arthritis
  • inflammation of the iris or uveitis
  • presence of erythema nodosum, pyoderma gangrenosum, or aphthous ulcers
  • anal fissures, fistulae or abscesses
  • other fistulae
  • Fever during the previous week.
/ x 20
Taking Lomotil or opiates for diarrhea / x 30
Presence of an abdominal mass (0 as none, 2 as questionable, 5 as definite) / x 10
Hematocrit of <0.47 in men and <0.42 in women / x 6
Percentage deviation from standard weight / x 1