Drugs used in IBD
Infliximab Infusion
Infliximab is a monoclonal antibody which is used in the treatment of moderately to severe Crohns for the reduction of signs and symptoms which have shown an inadequate response to conventional therapy. It is also indicated for the treatment of fistulising Crohns disease in the reduction of the number of draining enterocutaneous fistula(s).
Infliximab acts by binding to and neutralising Tumour Necrosis Factor ( (TNF() and so interrupts the inflammatory signalling pathways that are affected by this cytokine.
Dosage and administration
Patients with fistulising Crohns disease are prescribed infusions of 5mg/kg infliximab at 0, 2 and 6 weeks.
The infliximab formulation does not contain a preservative and it is recommended that infliximab is administered to the patient immediately after reconstitution.
The infusion should run for a minimum of 2 hours and a maximum of 3 hours.
The treating doctor must be present for at least 10 minutes following the initiation of any infusion.
Pre-medication
The decision to pre-medicate is at the discretion of the medical staff.
Consider chlorpheniramine, hydrocortisone and paracetamol.
All prophylactic medication administered should be documented in the patients notes.
Monitoring
| Blood Pressure | Pulse | Temperature | |
| Prior to infusion | 4 | 4 | 4 |
| Start infusion | |||
| 30min | 4 | 4 | 4 |
| 60min | 4 | 4 | 4 |
| 90min | 4 | 4 | 4 |
| 120 min | 4 | 4 | 4 |
| Stop infusion | |||
| 30 min | 4 | 4 | 4 |
| 60 min | 4 | 4 | 4 |
| 90 min | 4 | 4 | 4 |
| 120 min | 4 | 4 | 4 |
Side-effects
Flu like symptoms.
Headache, hypotension, transient fever, chills.
GI symptoms, skin rashes.
Anaphylaxis
Concomitant medication
Immunosuppressants and corticosteroids
The following drugs have been used during treatment with infliximab
– cyclosporin, aminosalicylates, 6-mercaptopurine, azathioprine and corticosteroids.
Anti-diarrhoeal agents
Anti-diarrhoeal and antispasmodic drugs maybe taken as required.