Side Effects of Remicade

I was just thinking today that I am pretty fortunate that I don’t get any side effects from Remicade.  I roughly sort the side effects into two categories, side effects relating to the infusion of remicade, and side effects occurring after the infusion of remicade.  To make it confusing, it seems that websites can’t agree on ‘one list’ of side effects.  In fact, one particular site just seems to have written down every general ailment available! Look at this list from About.com with the heading “side effects of remicade”:

Always Notify Doctor:

More common

  • Abdominal pain
  • cough
  • dizziness
  • fainting
  • headache
  • muscle pain
  • nasal congestion
  • nausea
  • runny nose
  • shortness of breath
  • sneezing
  • sore throat
  • tightness in chest
  • unusual tiredness or weakness
  • vomiting
  • wheezing

Less Common

  • back pain
  • bloody or cloudy urine
  • cracks in skin at the corners of mouth
  • diarrhea difficult or painful urination
  • frequent urge to urinate
  • high blood pressure
  • low blood pressure
  • pain
  • pain or tenderness around eyes and cheekbones
  • skin rash
  • soreness or irritation of mouth or tongue
  • soreness or redness around fingernails or toenails
  • vaginal burning or itching and discharge
  • white patches in mouth and/or on tongue

Rare

  • abscess (swollen, red, tender area of infection containing pus)
  • back or side pain
  • black, tarry stools
  • blood in urine or stools
  • bone or joint pain
  • constipation
  • falls
  • feeling of fullness
  • general feeling of illness
  • hernia (bulge of tissue through the wall of the abdomen)
  • infection
  • irregular or pounding heartbeat
  • pain in rectum
  • pain spreading from the abdomen to the left shoulder
  • pinpoint red spots on skin
  • stomach pain (severe)
  • swollen or painful glands
  • tendon injury
  • unusual bleeding or bruising
  • weight loss (unusual)
  • yellow skin and eyes

Notify Doctor Immediately:

More common

  • chest pain
  • chills
  • fever
  • flushing of face
  • hives
  • itching
  • troubled breathing

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. This information is meant only as a guideline – always consult a physician or pharmacist for complete information about prescription medications

I mean, this list seems pretty damn useless.  Look at the items in the “more common” category which one is supposed to contact one’s doctor if they occur.  Cough?  Runny nose?  Muscle pain?  Sneezing?  Unusual tiredness?  Come on.  It looks like this list was written by either a doctor wanting to drum up some business, or a lawyer who is trying to cover every possible side effect so that no-one can take him to court.  Even the “less common” category is useless.  Back pain?  Who over the age of 35 doesn’t get some back pain these days?

I found a much more useful and informative list at rxlist.com.  Click on the “side effects” tab and it gives you all the results of the clinical studies:

The data described herein reflect exposure to REMICADE (infliximab) in 4779 adult patients (1304 patients with rheumatoid arthritis, 1106 patients with Crohn’s disease, 202 with ankylosing spondylitis, 293 with psoriatic arthritis, 484 with ulcerative colitis, 1373 with plaque psoriasis, and 17 patients with other conditions), including 2625 patients exposed beyond 30 weeks and 374 exposed beyond 1 year. One of the most-common reasons for discontinuation of treatment was infusion-related reactions (e.g., dyspnea, flushing, headache and rash). Adverse events have been reported in a higher proportion of rheumatoid arthritis patients receiving the 10 mg/kg dose than the 3 mg/kg dose, however, no differences were observed in the frequency of adverse events between the 5 mg/kg dose and 10 mg/kg dose in patients with Crohn’s disease.

Some interesting reading in there.  I was amused at the prevalence of the placebo effect.  For example:

Approximately 20% of REMICADE (infliximab) -treated patients in all clinical studies experienced an infusion reaction compared to approximately 10% of placebo-treated patients.

So even if one does experience a reaction while undergoing remicade infusion, or following it, it still doesn’t mean that remicade caused it!  Have a read of this regarding risk of infection while on remicade:

In REMICADE (infliximab) clinical studies, treated infections were reported in 36% of REMICADE (infliximab) -treated patients (average of 51 weeks of follow-up) and in 25% of placebo-treated patients (average of 37 weeks of follow-up).

So these results have me scratching my head on whether remicade does increase the risk of infection.  Sure in this study 36% of the patients taking remicade got an infection which needed treatment, however so did 25% of those who had the placebo!  And the placebo patients were only followed up for 37 weeks as opposed to 51 weeks for the remicade people.  How many more of the placebo patients would have got an infection from weeks 38 to 51 if they were still monitored?

I am not saying that I think that there isn’t an increased risk of infection, as I believe that there is.  However I believe that it is likely to be for those on a higher dose of remicade, say from 5mg to 10mg per kg of bodyweight.  They should do a study specifically targeting those on a higher dose.

As I mentioned at the beginning I’m fortunate that I don’t experience any side effects.  Sure I get sleepy during the infusion, but that is the result of the anti-histamine, not the remicade.  I feel fine afterwards, and in fact often would be happy to go to the gym and train if it weren’t for my doctor saying that I should take a rest from it for at least one day.

I have read on another blog about how one person found that they were sleepy for most of the week following a remicade infusion, and another person had an anaphylactic shock during infusion and had to have it immediately stopped.

I am fortunately that I am on the lower dose of remicade (3mg per kg), so this probably helps in avoiding side effects.

This entry was posted in Psoriasis, Psoriasis Treatment, Psoriatic Arthritis, Remicade, Remicade Administration, TNF Blocker and tagged . Bookmark the permalink.

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