Remicade is the brand name for the anti-inflammatory drug infliximab. This drug is prescribed as a treatment for arthritis, psoriasis, Crohn's disease and other autoimmune disorders. Once injected, it blocks a protein called tumor necrosis factor-alpha that causes inflammation-related symptoms such as pain and swelling. As with many drugs, there are contraindications that make it unsuitable for certain individuals.
Medical Conditions
According to MedlinePlus, an information service of the National Institutes of Health, women who are breast feeding should not use infliximab. The drug can be transferred through breast milk from mother to baby and affect the baby's immune system. Women who become pregnant while taking infliximab should notify their physician.
In addition, individuals who have been exposed to tuberculosis but are not experiencing symptoms of the virus may not be able to take infliximab. The Merck Manual notes that infliximab has been known to activate the virus within six months of beginning treatment.
Furthermore, since infliximab suppresses the immune system it may be contraindicated in individuals suffering from chronic infections.
Abatacept
Abatacept, a drug used to treat arthritis, becomes more toxic when used in combination with infliximab. Individuals taking both drugs may be at even more risk of infection. The Merck Manual recommends avoiding the combination of abatacept and infliximab.
Anakinra
Like abatacept, anakinra is also prescribed for rheumatoid arthritis. The American Society for Microbiology reports that serious infections have occurred when anakinra was used in combination with etanercept. Because etanercept is a tumor necrosis factor-alpha inhibitor like infliximab, a similar effect may occur between infliximab and anakinra.
Rilonacept
Rilonacept, a drug used for familial cold autoinflammatory syndrome, may also interact with infliximab. MayoClinic.com notes that the dose of both medicines may need to be adjusted to prevent adverse side effects.
Tumor Necrosis Factor-alpha Inhibitors
Using other tumor necrosis factor-alpha inhibitors together with infliximab can enhance side effects. There is an increased risk of infections with canakinumab, certolizumab pegol and natalizumab. In the case of canakinumab, the Merck Manual notes that there is an increased risk of neutropenia, a condition in which the number of white blood cells is abnormally low. This leaves the body susceptible to life-threatening infections.
Vaccines
The effectiveness of live vaccines---those containing a live virus---may decrease if the vaccine is received while an individual is taking infliximab. Also, the Merck Manual notes that infliximab may increase vaccine-related infections. In the case of children, the National Library of Medicine recommends that they receive all vaccinations before starting treatment with the drug.
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