10 Remicade (Infliximab) Side Effects You Should Know About
Key takeaways:
Remicade (infliximab) is a biologic medication that treats inflammation caused by several autoimmune disorders. It’s given as an infusion into your vein.
Infusion-related reactions, like nausea, headache, and flushing, are common infliximab side effects.
Other possible infliximab side effects include upper respiratory infections and stomach pain. More serious, but rare, infliximab side effects include serious infection, heart or liver damage, and a higher risk of certain cancers.
Table of contents
If you’re living with an autoimmune disorder, you may have heard of the medication infliximab (Remicade). Infliximab treats several autoimmune disorders, including Crohn’s disease, rheumatoid and psoriatic arthritis, and ankylosing spondylitis. It’s an intravenous (IV) infusion given every 6 to 8 weeks by a healthcare professional.
Like any medication, infliximab can cause side effects. Here, we’ll discuss ten infliximab side effects you should know and how to manage them.
1. Infusion-related reactions
Remicade can cause infusion-related reactions. Most reactions are mild, and may include symptoms like itching, flushing, and headache. But some can be severe, and may cause fever, changes in blood pressure, and difficulty breathing.
Reactions tend to occur within the first few infusions. But they can happen at any point during treatment. And in some cases, you may still be able to receive infliximab even if you’ve had a reaction in the past. But if a severe allergic reaction occurs, you may have to stop taking it.
These reactions differ in symptoms and when they start in relation to receiving infliximab. Be sure to let your healthcare provider know if you experience any of the symptoms detailed in the table below during or after your infusion.
Infusion-related Reactions | Delayed Infusion Reaction | |
Onset | During or within 1-2 hours of infusion | 3-14 days after infusion |
Chest pain | ✗ | |
Chills | ✗ | |
Flushing | ✗ | |
Itching | ✗ | |
High or low blood pressure | ✗ | |
Fever | ✗ | ✗ |
Trouble breathing or swallowing | ✗ | ✗ |
Headache | ✗ | ✗ |
Rash or hives | ✗ | ✗ |
Sore throat | ✗ | |
Joint or muscle pain | ✗ | |
Swelling of face and hands | ✗ |
If you experience side effects during or after your infusion, tell your healthcare professional right away. They can adjust how fast they’re giving the infusion and/or give you medications to help manage the reaction. Sometimes, you’ll receive medications such as acetaminophen (Tylenol) or diphenhydramine (Benadryl) before your infusion to help lessen these side effects.
If you notice signs of a delayed reaction once you’re at home, call your provider. If your symptoms feel severe or you’re having trouble breathing, seek emergency care.
2. Infections
Infliximab lowers your ability to fight infections. In fact, Remicade has a boxed warning (the most serious type of FDA warning) about the risk of serious infections.
Upper respiratory infections, like the common cold, sinusitis, or the flu, are the most common. But more serious infections can also happen. Although rare, infliximab can also reactivate tuberculosis or hepatitis B infections if you’ve had them before. Be sure to tell your healthcare provider if you’ve had either of these in the past. Your provider will likely test you for both before starting infliximab.
Symptoms of infection you should be aware of include:
Fever
Feeling weak or tired
Cough that won’t go away
Trouble breathing
Contact your provider if you have any symptoms of an infection. They may delay your next dose to give your body a chance to fight it. It’s also important to make sure you’re up to date on your vaccines before you start treatment with infliximab.
3. Nausea
Nausea can occur while taking infliximab. If you’re feeling nauseated, your healthcare provider may give you an anti-nausea medication, like ondansetron (Zofran). They may also give you this medication, before your infusions to prevent this side effect.
You can also try the following to help manage your nausea at home:
Stay hydrated by drinking plenty of fluids
Stick to bland foods like bananas, rice, applesauce, and toast (BRAT diet)
Choose smaller, more frequent meals over larger ones
4. Headache
Headaches are one of the most common infliximab side effects. They may be caused by infusion reactions, but not always. If it happens during your infusion, let someone know. They may be able to make changes to manage it. If you’re at home and have other symptoms with your headache, such as a rash or difficulty breathing, seek medical attention — a delayed infusion reaction could be happening.
Otherwise, you can manage a headache with over-the-counter (OTC) acetaminophen or ibuprofen (Advil, Motrin) as you normally would. But if it’s severe or doesn’t go away, be sure to let your provider know.
5. Stomach pain
Remicade can cause stomach pain, especially in people with Crohn’s disease. It’s not clear why infliximab causes stomach pain. It’s possible it may be more related to the condition being treated, rather than infliximab itself.
Stomach pain can sometimes be related to gas or constipation. So be sure to stay hydrated and eat a well-balanced diet that’s high in fiber to keep your bowels moving. If it doesn’t go away, it’s a good idea to reach out to your healthcare provider. But severe or sudden stomach pain, especially if you also have a fever, needs immediate medical attention.
6. Cancer
Infliximab has a boxed warning that it may cause certain cancers. The chances, though, are quite rare. Lymphoma was the cancer seen most often in clinical studies, but others can occur. People younger than 18 have a greater risk of this side effect. And people living with certain autoimmune diseases seem to have a higher risk of developing cancer, whether they take infliximab or not.
Be sure to have periodic skin exams while taking infliximab to help detect skin cancer. Your healthcare provider may screen you for other types of cancer, too. Signs and symptoms of cancer that warrant a call to your provider include unexplained weight loss, swollen lymph nodes, or abnormal spots on your skin.
7. Liver damage
Rarely, infliximab can cause damage to your liver. Liver damage is usually mild and goes away after stopping the medication. But some cases can be severe.
Mild cases of liver damage don't always cause symptoms. So your healthcare provider may check your liver function regularly to screen for it. Tell your provider immediately if you have symptoms of severe liver damage. These can include confusion, pain or swelling of your stomach, or a yellow tint to your skin or the whites of your eyes (jaundice).
8. Heart problems
Heart failure occurs when your heart can’t beat well enough to keep up with your body’s need for oxygen. You could develop new or worsening symptoms of heart failure while taking Remicade. Symptoms of heart failure that require a call to your healthcare provider include:
Shortness of breath during physical activities, like climbing stairs
Feeling tired or weak
Coughing
Swelling in your legs, ankles, or stomach
Not being able to breathe while lying flat
There’s also a greater risk of having a stroke, heart attack, or abnormal heartbeat for the first 24 hours after your infusion. While rare, symptoms such as chest pain, trouble breathing or speaking, or a change in how fast your heart is beating can be serious. If you notice these symptoms, call 911 or get immediate medical attention.
Because of these risks, you shouldn’t receive infliximab if you’re living with moderate to severe heart failure.
9. Nervous system changes
While taking infliximab, you may experience new or worsening problems with your nervous system. These changes are rare, but can be serious. Symptoms can include vision changes, seizures, or muscle weakness. If you experience symptoms of possible nerve damage, be sure to let your provider know right away.
10. Low blood cell counts
Remicade may lower the amount of white blood cells and platelets in your body. This may make it harder for you to fight off infections and puts you at risk for bleeding.
While this is a rare side effect of infliximab, it can be a serious one. Seek medical care if you notice bruising or bleeding, or if you have a fever that won’t go away.
Are there long-term side effects of Remicade infusions?
There don’t seem to be any other serious side effects than the ones listed above if you’re taking Remicade for a long time. But your risk of developing a serious infection does go up the longer you receive infliximab infusions.
Over time, your body may develop antibodies to Remicade. These antibodies can lower your body’s response to infliximab, meaning it might not work as well. Infliximab antibodies also put you at greater risk of infusion-related reactions.
Changing your dose or how often you receive infliximab may help overcome or prevent these antibodies from forming. But if you notice that Remicade doesn’t seem to be working as well as it once did for your symptoms, let your healthcare provider know. They may need to switch you to a different medication.
When should I contact my healthcare provider about infliximab side effects?
Reach out to your healthcare provider if you have side effects that are bothersome or won’t go away. If it’s during your infusion, alert the medical staff right away. There are steps they can take to manage Remicade side effects during your infusion.
You should also let your provider know if the symptoms of your autoimmune disorder do not get better, worsen, or come back before your next infusion. They may want to check for Remicade antibodies, or adjust your dose or how often you receive it.
Notify your provider as soon as possible if you have any symptoms of an infection. But more serious infliximab side effects, like chest pain, difficulty breathing, or vision changes, warrant emergency medical care.
The bottom line
Infliximab is a medication used to treat autoimmune disorders. Infusion-related reactions are common with infliximab, but can often be managed. Other possible side effects include nausea, stomach pain, or upper respiratory infections.
Although rare, serious infliximab side effects can include damage to your nervous system, heart, or liver. Serious infection and certain cancers are also possible. Go to the nearest emergency room if you experience chest pain, difficulty breathing, or vision changes.
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References
Checkley, L. A., et al. (2019). Incidence and management of infusion reactions to infliximab in an alternate care setting. Digestive Diseases and Sciences.
Haque, E. K., et al. (2020). A real-world evaluation of the long-term safety efficacy of infliximab in the treatment of moderate-to-severe psoriasis. Dermatology and Therapy.
Janssen Biotech, Inc. (2022). REMICADE- infliximab injection, powder, lyophilized, for solution [package insert].
Janssen Biotech, Inc. (2021). Medication guide remicade (infliximab) for injection, for intravenous use [package insert].
Kunchok, A., et al. (2020). Association between tumor necrosis factor inhibitor exposure and inflammatory central nervous system events. JAMA Neurology.
Lichtenstein, G. R., et al. (2018). Infliximab for Crohn’s disease: More than 13 years of real-world experience. Inflammatory Bowel Diseases.
National Cancer Institute. (n.d.). Lymphoma—Patient version.
National Institute of Diabetes and Digestive and Kidney Diseases. (2012). Infliximab. LiverTox.
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