What to expect during and immediately after the infusion
Infliximab is an anti-TNF (tumor necrosis factor) biologic medication administered via intravenous (IV) infusion at a healthcare facility. The infusion process itself can take a couple of hours or more. During and immediately after the infusion, healthcare providers closely monitor patients for any potential reactions.
Many patients experience mild or no issues during the infusion. However, some may have immediate infusion-related reactions. These reactions often occur within 24 hours of the treatment and may include:
- Headache
- Dizziness or lightheadedness
- Nausea
- Flushing or feeling warm
- Chills or fever
- Itching or rash
- Changes in blood pressure
- Shortness of breath
For mild to moderate reactions, the infusion rate may be slowed down to help symptoms subside. For more severe reactions, treatment may be paused or stopped. Your healthcare team may also premedicate you with acetaminophen, antihistamines, or corticosteroids to lessen the chance of a reaction during future infusions. After the infusion, it is common to feel a bit drowsy or fatigued. Many of these mild, immediate side effects will resolve on their own within a few hours to a day or two.
Delayed reactions: What to watch for
Some side effects of an infliximab infusion are not immediate. A delayed reaction can occur anywhere from 24 hours up to 14 days after the infusion.
Symptoms of a delayed reaction can include:
- Muscle or joint aches
- Fatigue
- Fever
- Rash or hives
- Headache
- Sore throat
- Swelling of the face or hands
If you experience any of these symptoms after your infusion, it is important to contact your healthcare provider. For mild symptoms, they may advise taking an over-the-counter medication like acetaminophen or an antihistamine. For more severe symptoms, further evaluation may be needed.
Common vs. Serious Side Effects
It is important to be aware of the difference between common, manageable side effects and rare but serious ones that require immediate medical attention.
| Side Effect Type | Common Examples | Rare, Serious Examples | What to Do |
|---|---|---|---|
| During/Post-infusion reactions | Headache, nausea, dizziness, flushing, fatigue, sinus or upper respiratory infections | Severe allergic reaction (hives, difficulty breathing), chest pain, changes in heartbeat, vision changes, seizures, numbness, weakness, liver injury, stroke | Common: Inform the infusion staff; may be treated with pre-meds next time. Rare/Serious: Get immediate medical help. |
| Immune System Effects | Increased risk of infections like colds or flu | Tuberculosis reactivation, sepsis, severe infections | All: Report new or worsening infections to your doctor immediately. |
| Cardiac | Changes in blood pressure | Heart attack, irregular heartbeat, worsening congestive heart failure | All: Inform your doctor. Serious: Get emergency medical help. |
| Other | Fatigue, joint pain, stomach pain, cough | Lupus-like syndrome (rash, joint pain, chest pain), liver damage (jaundice), nervous system issues | All: Report to your healthcare provider. Serious: Seek medical help. |
Managing symptoms at home
Most post-infusion symptoms are mild and can be managed effectively at home. Here are some tips:
- Rest: Prioritize rest, especially in the first day or two after your infusion. Feeling tired is a very common effect as your body processes the medication.
- Hydrate: Drink plenty of fluids to help flush your system and combat potential headaches or nausea.
- Eat Smart: Eat small, bland meals if you feel nauseated. A BRAT (bananas, rice, applesauce, toast) diet may be helpful.
- Pain Relief: For headaches or mild aches, ask your doctor about using over-the-counter medications like acetaminophen.
- Monitor: Keep track of any symptoms you experience, their severity, and their duration. This information is crucial for your healthcare team.
The long-term perspective on infliximab
While managing side effects after each infusion is important, the ultimate goal of infliximab therapy is to achieve long-term disease control and symptom remission. It is important to remember that:
- Effectiveness builds over time: The full therapeutic benefits may not be felt for several weeks or even months. It's vital to continue with your scheduled infusions, even if you feel well, to prevent flare-ups.
- Infusion reactions may lessen: For many, infusion-related reactions tend to become less frequent and less severe over time. Premedication can be a key strategy for managing these.
- Your team is your partner: Your healthcare team uses the information you provide about your symptoms to adjust future treatment plans and ensure the best possible outcome.
Conclusion
Feeling a range of symptoms, from mild fatigue and headache to less common but more severe reactions, is possible after an infliximab infusion. Many reactions are manageable and short-lived, while serious side effects are rare. By closely following your healthcare provider's instructions, communicating any symptoms you experience, and resting, you can navigate your infliximab treatment with greater confidence. Adherence to the treatment schedule is key to achieving long-term symptom relief and controlling your condition.
For more information on living with inflammatory conditions and biologic therapies, consider consulting the Crohn's & Colitis Foundation.(https://www.crohnscolitisfoundation.org/EMR/remicade-infliximab)
