An anti-TNF biologic
Infliximab
An anti-TNF biologic, usually given as an infusion, used for inflammatory arthritis and inflammatory bowel disease.
What is Infliximab?
Infliximab is a biologic medicine that blocks the inflammatory messenger TNF, used for rheumatoid arthritis and other inflammatory arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease such as Crohn's disease and ulcerative colitis. It is most often given as a drip into a vein in hospital, though a version under the skin also exists; it is not a tablet. Because it dampens the immune system, serious infection is the main risk, so you are screened for tuberculosis and hepatitis B and C before starting. Live vaccines must be avoided while on it, but routine jabs such as the flu vaccine are encouraged. Inflectra, Remsima and Flixabi are biosimilars of the original Remicade, prescribed by brand name.
Education and reference only. This is a plain-language guide to Infliximab — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Infliximab is a biologic medicine, made using living cells rather than as a chemical tablet, and is part of the anti-TNF group that calms an overactive immune system. It is used for rheumatoid arthritis and other inflammatory arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease such as Crohn's disease and ulcerative colitis. It is most commonly given as an infusion (a drip) into a vein at a hospital or clinic, where you are monitored during and after; some forms can be given under the skin. Several of its brands are biosimilars, highly similar versions of the original medicine.
How it works
Infliximab attaches to and blocks tumour necrosis factor (TNF), a central messenger that drives inflammation, helping to settle joint swelling, pain, stiffness, skin inflammation and gut inflammation. By reducing TNF it eases the damage caused by the overactive immune response. Because TNF also helps fight infection, blocking it lowers the body's defences, which is why infections such as tuberculosis can reactivate. When given as a drip, the dose is spaced out over time and the response is reviewed at follow-up.
Company & origin
Originated / developed by: Janssen (originator) and biosimilar makers.
An anti-TNF biologic, commonly given as a drip, used in the UK for inflammatory arthritis and bowel disease.
What it treats
Conditions Infliximab is used for
Practical use
How to take Infliximab
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is most often given as a drip into a vein at a hospital or clinic, not as a tablet.
- You will be monitored during and for a while after each infusion in case of a reaction.
- Attend all your scheduled infusion appointments, as the medicine is given on a planned timetable.
- If you are on a form given under the skin, you may be taught to inject it at home as prescribed.
- Avoid live vaccines while on treatment and tell any healthcare professional that you take a biologic.
- Contact your team promptly if you develop a fever, persistent cough, night sweats or other signs of infection.
Weighing it up
Advantages & disadvantages of Infliximab
Advantages
- Often very effective for inflammatory bowel disease and inflammatory arthritis when other treatments have not worked.
- Given in a supervised setting as a drip, so reactions can be managed promptly.
- Biosimilar brands have widened access while working in the same way as the original.
Disadvantages
- Lowers the body's defences, so serious infections are more likely and need prompt attention.
- Usually requires hospital or clinic visits for infusions, which takes time.
- Reactions can occur during the drip, and live vaccines must be avoided.
Practical use
Good to know
Infliximab dampens the immune system, so serious infection is the most important risk to understand. Before starting, you will be screened for tuberculosis and for hepatitis B and C, because these can reactivate during treatment. Live vaccines must be avoided while on it, but other vaccines such as the annual flu jab and pneumonia vaccine are encouraged and are best arranged before starting where possible. Report signs of infection, such as fever, persistent cough or night sweats, promptly. Because it is often given as a drip, reactions during the infusion can happen and you are watched closely. Like other anti-TNF medicines it is used cautiously in heart failure and in people with a history of nerve conditions affecting the brain or spinal cord, and there is a small, carefully discussed possible signal of certain cancers such as lymphoma. Inflectra, Remsima and Flixabi are biosimilars and your team may keep you on a particular brand.
Who should not take it / use with caution
- People with an active serious infection, including active or untreated tuberculosis, should not start it until this is treated.
- It is generally avoided in moderate to severe heart failure and used very cautiously where there is a history of demyelinating nerve disease.
- It should not be used by people who have had a severe allergic reaction to infliximab or its ingredients.
Monitoring
- Screening for tuberculosis and hepatitis B and C before starting, with watching for infection throughout.
- Observation during and after each infusion for reactions.
- Blood tests and regular review of how well the condition is responding.
Side effects
- Reactions during or soon after the infusion, such as flushing, chills or breathlessness, and an increased risk of infections.
- Headache, rash, nausea and feeling generally unwell can occur.
- Less commonly, reactivation of tuberculosis or hepatitis B, and rare serious infections or allergic reactions needing urgent care.
Key interactions
- Should not be combined with live vaccines, which must be avoided during treatment.
- Combining it with another immune-suppressing biologic raises infection risk and is generally avoided.
- It is often used alongside medicines such as methotrexate or azathioprine, which your team will monitor together.
Available as: Infusion (drip) into a vein; some brands also as an injection under the skin.
Answers
Infliximab: frequently asked questions
How is infliximab given?
It is most often given as a drip into a vein at a hospital or clinic, where you are monitored during and after; some forms can be given under the skin.
Why is screening done before treatment?
Because infliximab dampens the immune system, you are screened for tuberculosis and hepatitis B and C beforehand, as these can reactivate during treatment.
Can I have my usual vaccinations?
Live vaccines must be avoided while on infliximab, but non-live vaccines such as the flu and pneumonia jabs are encouraged, ideally before you start.
Is Remsima the same as Remicade?
Remsima, like Inflectra and Flixabi, is a biosimilar of the original Remicade, a highly similar version that works in the same way; your team prescribes by brand name.
What should I do if I feel unwell during the drip?
Tell the staff straight away if you feel flushed, chilled or short of breath during an infusion, as they monitor you closely and can manage reactions.
The wider class
About Anti-TNF biologic
Infliximab belongs to the anti-tnf biologic class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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