Inflectra
infliximab
infliximab
Keep this leaflet. You may need to read it again.
Your doctor will also give you a patient reminder card, which contains important safety information you need to be aware of before and during your treatment with Inflectra.
When starting a new card, keep this card as a reference for 4 months after your last dose of Inflectra.
If you have any further questions, ask your doctor.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. See section 4.
What Inflectra is and what it is used for
What you need to know before you use Inflectra
How Inflectra will be given
Possible side effects
How to store Inflectra
Contents of the pack and other information
Inflectra contains the active substance infliximab, which is of human and mouse origin. Infliximab is a monoclonal antibody - a type of protein that attaches to a specific target in the body called TNF (tumour necrosis factor) alpha.
Inflectra belongs to a group of medicines called ‘TNF blockers’. It is used in adults for the following inflammatory diseases:
Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis (Bechterew’s disease)
Psoriasis.
Inflectra is also used in adults and children 6 years of age or older for:
Crohn’s disease
Ulcerative colitis.
Inflectra works by selectively attaching to TNF alpha (tumour necrosis factor alpha) and blocking its action. TNF alpha is involved in inflammatory processes of the body so blocking it can reduce the inflammation in your body.
Rheumatoid arthritis is an inflammatory disease of the joints. If you have active rheumatoid arthritis you will first be given other medicines. If these medicines do not work well enough, you will be given Inflectra which you will take in combination with another medicine called methotrexate to:
reduce the signs and symptoms of your disease,
slow down the damage in your joints,
improve your physical function.
Psoriatic arthritis is an inflammatory disease of the joints, usually accompanied by psoriasis. If you have active psoriatic arthritis you will first be given other medicines. If these medicines do not work
well enough, you will be given Inflectra to:
reduce the signs and symptoms of your disease,
slow down the damage in your joints,
improve your physical function.
Ankylosing spondylitis is an inflammatory disease of the spine. If you have ankylosing spondylitis you will first be given other medicines. If these medicines do not work well enough, you will be given
Inflectra to:
reduce the signs and symptoms of your disease,
improve your physical function.
Psoriasis is an inflammatory disease of the skin. If you have moderate to severe plaque psoriasis, you will first be given other medicines or treatments, such as phototherapy. If these medicines or
treatments do not work well enough, you will be given Inflectra to reduce the signs and symptoms of
your disease.
Ulcerative colitis is an inflammatory disease of the bowel. If you have ulcerative colitis you will first be given other medicines. If these medicines do not work well enough, you will be given Inflectra to treat your disease.
Crohn’s disease is an inflammatory disease of the bowel. If you have Crohn’s disease you will first be given other medicines. If these medicines do not work well enough, you will be given Inflectra to:
treat active Crohn’s disease,
reduce the number of abnormal openings (fistulae) between your bowel and your skin that have not been controlled by other medicines or surgery.
you are allergic to infliximab or to any of the other ingredients of this medicine (listed in section 6),
you are allergic (hypersensitive) to proteins that come from mice,
you have tuberculosis (TB) or another serious infection such as pneumonia or sepsis(serious bacterial infection of the blood),
you have heart failure that is moderate or severe.
Do not use Inflectra if any of the above applies to you. If you are not sure, talk to your doctor before you are given Inflectra.
Talk to your doctor before or during treatment with Inflectra if you have: Hadtreatmentwithanymedicinecontaininginfliximabbefore
Tell your doctor if you have had treatment with medicines containing infliximab in the past and are now starting Inflectra treatment again.
If you have had a break in your treatment with infliximab of more than 16 weeks, there is a higher risk for allergic reactions when you start the treatment again.
Infections
Tell your doctor before you are given Inflectra if you have an infection, even if it is a very minor one.
Tell your doctor before you are given Inflectra if you have ever lived in or travelled to an area where infections called histoplasmosis, coccidioidomycosis, or blastomycosis are common. These infections are caused by specific types of fungi that can affect the lungs or other parts of your body.
You may get infections more easily when you are being treated with Inflectra. If you are 65 years of age or older, you have a greater risk.
These infections may be serious and include tuberculosis, infections caused by viruses, fungi, bacteria or other organisms in the environment and sepsis that may be life-threatening.
Tell your doctor straight away if you get signs of infection during treatment with Inflectra. Signs include fever, cough, flu-like signs, feeling unwell, red or hot skin, wounds or dental problems. Your doctor may recommend temporarily stopping Inflectra.
Tuberculosis(TB)
It is very important that you tell your doctor if you have ever had TB or if you have been in close contact with someone who has had or has TB.
Your doctor will test you to see if you have TB. Cases of TB have been reported in patients treated with infliximab, even in patients who have already been treated with medicines for TB. Your doctor will record these tests on your patient reminder card.
If your doctor feels that you are at risk for TB, you may be treated with medicines for TB before you are given Inflectra.
Tell your doctor straight away if you get signs of TB during treatment with Inflectra. Signs include persistent cough, weight loss, feeling tired, fever, night sweats.
HepatitisBvirus
Tell your doctor before you are given Inflectra if you are a carrier of hepatitis B or have ever had it.
Tell your doctor if you think you might be at risk of contracting hepatitis B.
Your doctor should test you for hepatitis B virus.
Treatment with TNF blockers such as Inflectra may result in reactivation of hepatitis B virus in patients who carry this virus, which can be life-threatening in some cases.
If you experience reactivation of hepatitis B, your doctor may need to stop your treatment and may give you medicines such as effective antiviral therapy with supportive treatment.
Heartproblems
Tell your doctor if you have any heart problems, such as mild heart failure.
Your doctor will want to closely monitor your heart.
Tell your doctor straight away if you get new or worsening signs of heart failure during treatment with Inflectra. Signs include shortness of breath or swelling of your feet.
Cancerandlymphoma
Tell your doctor before you are given Inflectra if you have or have ever had lymphoma (a type of blood cancer) or any other cancer.
Patients with severe rheumatoid arthritis, who have had the disease for a long time, may be at higher risk of developing lymphoma.
Children and adults taking Inflectra may have an increased risk of developing lymphoma or another cancer.
Some patients who have received TNF-blockers, including infliximab have developed a rare type of cancer called hepatosplenic T-cell lymphoma. Of these patients, most were teenage boys or young men and most had either Crohn’s disease or ulcerative colitis. This type of cancer has usually resulted in death. Almost all patients had also received medicines containing azathioprine or mercaptopurine in addition to TNF-blockers.
Some patients treated with infliximab have developed certain kinds of skin cancer. If there are any changes in your skin or growths on the skin during or after therapy, tell your doctor.
Some women being treated for rheumatoid arthritis with infliximab have developed cervical cancer. For women taking Inflectra including those over 60 years of age, your doctor may recommend regular screening for cervical cancer.
Lungdiseaseorheavysmoking
Tell your doctor before you are given Inflectra if you have a lung disease called chronic obstructive pulmonary disease (COPD) or if you are a heavy smoker.
Patients with COPD and patients who are heavy smokers may have a higher risk of developing cancer with Inflectra treatment.
Nervoussystemdisease
Tell your doctor before you are given Inflectra if you have or have ever had a problem that affects your nervous system. This includes multiple sclerosis, Guillain-Barré syndrome, if you have fits or have been diagnosed with ‘optic neuritis’.
Tell your doctor straight away if you get symptoms of a nerve disease during treatment with Inflectra. Signs include changes in your vision, weakness in your arms or legs, numbness or tingling in any part of your body.
Abnormalskinopenings
Tell your doctor if you have any abnormal skin openings (fistulae) before you are given Inflectra.
Vaccinations
Talk to your doctor if you recently have had or are due to have a vaccine.
You should receive recommended vaccinations before starting Inflectra treatment. You may receive some vaccines during treatment with Inflectra but you should not receive live vaccines (vaccines that contain a living but weakened infectious agent) while using Inflectra because they may cause infections.
If you received Inflectra while you were pregnant, your baby may also be at higher risk for getting an infection as a result of receiving a live vaccine during the first year of life. It is important that you tell your baby's doctors and other healthcare professionals about your Inflectra use so they can decide when your baby should receive any vaccine, including live vaccines such as the BCG vaccine (used to prevent tuberculosis).
If you are breast-feeding, it is important that you tell your baby’s doctors and other healthcare professionals about your Inflectra use before your baby is given any vaccine. For more information see section on Pregnancy and breast-feeding.
Therapeuticinfectiousagents
Talk to your doctor if you have recently received or are scheduled to receive treatment with a therapeutic infectious agent (such as BCG instillation used for the treatment of cancer).
Operationsordentalprocedures
Tell your doctor if you are going to have any operations or dental procedures.
Tell your surgeon or dentist that you are having treatment with Inflectra by showing them your patient reminder card.
Liverproblems
Some patients receiving infliximab have developed serious liver problems.
Tell your doctor straight away if you get symptoms of liver problems during treatment with Inflectra. Signs include yellowing of the skin and eyes, dark-brown coloured urine, pain or swelling in the upper right side of the stomach area, joint pain, skin rashes, or fever.
Lowbloodcounts
In some patients receiving infliximab, the body may not make enough of the blood cells that help fight infections or help stop bleeding.
Tell your doctor straight away if you get symptoms of low blood counts during treatment with Inflectra. Signs include persistent fever, bleeding or bruising more easily, small red or purple spots caused by bleeding under the skin, or looking pale.
Immunesystemdisorder
Some patients receiving infliximab have developed symptoms of an immune system disorder called lupus.
Tell your doctor straight away if you develop symptoms of lupus during treatment with Inflectra. Signs include joint pain or a rash on cheeks or arms that is sensitive to the sun.
Theinformationabovealsoappliestochildrenandadolescents.Inaddition:
Some children and teenage patients who have received TNF-blockers such as infliximab have developed cancers, including unusual types, which sometimes resulted in death.
More children taking infliximab developed infections as compared to adults.
Children should receive recommended vaccinations before starting Inflectra treatment. Children may receive some vaccines during treatment with Inflectra but should not receive live vaccines while using Inflectra.
Inflectra should only be used in children if they are being treated for Crohn’s disease or ulcerative colitis. These children must be 6 years of age or older.
If you are not sure if any of the above applies to you, talk to your doctor before you are given Inflectra.
Patients who have inflammatory diseases already take medicines to treat their problem. These medicines may cause side effects. Your doctor will advise you what other medicines you must keep using while you are having Inflectra.
Tell your doctor if you are using, have recently used or might use any other medicines, including any other medicines to treat Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or psoriasis or medicines obtained without a prescription, such as vitamins and herbal medicines.
In particular, tell your doctor if you are using any of the following medicines:
Medicines that affect your immune system.
Kineret (which contains anakinra). Inflectra and Kineret should not be used together.
Orencia (which contains abatacept). Inflectra and Orencia should not be used together.
While using Inflectra you should not receive live vaccines. If you were using Inflectra during pregnancy or if you are receiving Inflectra while breast-feeding, tell your baby’s doctor and other healthcare professionals caring for your baby about your Inflectra use before the baby receives any vaccines.
If you are not sure if any of the above applies to you, talk to your doctor or pharmacist before using Inflectra.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Inflectra should only be used during pregnancy or while breast-feeding if your doctor feels it is necessary for you.
You should avoid getting pregnant when you are being treated with Inflectra and for 6 months after you stop being treated with it. Discuss the use of contraception during this time with your doctor.
If you received Inflectra during your pregnancy, your baby may have a higher risk for getting an infection.
It is important that you tell your baby’s doctors and other healthcare professionals about your Inflectra use before your baby is given any vaccine. If you received Inflectra while pregnant, giving BCG vaccine (used to prevent tuberculosis) to your baby within 12 months after birth
may result in infection with serious complications, including death. Live vaccines such as the BCG vaccine should not be given to your baby within 12 months after birth, unless your baby’s
doctor recommends otherwise. For more information see section on vaccination.
If you are breast-feeding, it is important that you tell your baby’s doctors and other healthcare professionals about your Inflectra use before your baby is given any vaccine. Live vaccines should not be given to your baby while you are breast-feeding unless your baby’s doctor recommends otherwise.
Severely decreased numbers of white blood cells have been reported in infants born to women treated with infliximab during pregnancy. If your baby has continual fevers or infections, contact your baby’s doctor immediately.
Inflectra is not likely to affect your ability to drive or use tools or machines. If you feel tired, dizzy, or unwell after having Inflectra, do not drive or use any tools or machines.
Inflectra contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially ‘sodium-free’. However, before Inflectra is given to you, it is mixed with a solution that contains sodium. Talk to your doctor if
you are on a low salt diet.
The doctor will decide your dose and how often you will be given Inflectra. This will depend on your disease, weight and how well you respond to Inflectra.
The table below shows how often you will usually have this medicine after your first dose.
2nd dose | 2 weeks after your 1st dose |
3rd dose | 6 weeks after your 1st dose |
Further doses | Every 6 to 8 weeks depending on your disease |
The usual dose is 3 mg for every kg of body weight.
The usual dose is 5 mg for every kg of body weight.
Inflectra will be given to you by your doctor or nurse, in a hospital or clinic.
Your doctor or nurse will prepare the medicine for infusion.
The medicine will be given as an infusion (drip) (over 2 hours) into one of your veins, usually in your arm. After the third treatment, your doctor may decide to give your dose of Inflectra over
1 hour.
You will be monitored while you are given Inflectra and also for 1 to 2 hours afterwards.
In children (6 years of age or older) treated for Crohn’s disease or ulcerative colitis, the recommended dose is the same as for adults.
As this medicine is being given by your doctor or nurse, it is unlikely that you will be given too much. There are no known side effects of having too much of Inflectra.
If you forget or miss an appointment to receive Inflectra, make another appointment as soon as possible.
If you have any further questions on the use of this medicine, ask your doctor.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Most side effects are mild to moderate. However some patients may experience serious side effects and may require treatment. Side effects may also occur after your treatment with Inflectra has stopped.
mouth, throat, nose, genitals and eyes or small pus-filled bumps that can spread over the body. These skin reactions can be accompanied by fever.
Tell your doctor straight away if you notice any of the above. The following side effects have been observed with Inflectra:
Stomach pain, feeling sick
Viral infections such as herpes or flu
Upper respiratory infections such as sinusitis
Headache
Side effect due to an infusion
Pain.
Changes in how your liver works, increase in liver enzymes (shown in blood tests)
Lung or chest infections such as bronchitis or pneumonia
Difficult or painful breathing, chest pain
Bleeding in the stomach or intestines, diarrhoea, indigestion, heartburn, constipation
Nettle-type rash (hives), itchy rash or dry skin
Balance problems or feeling dizzy
Fever, increased sweating
Circulation problems such as low or high blood pressure
Bruising, hot flush or nosebleed, warm, red skin (flushing)
Feeling tired or weak
Bacterial infections such as blood poisoning, abscess or infection of the skin (cellulitis)
Infection of the skin due to a fungus
Blood problems such as anaemia or low white blood cell count
Swollen lymph nodes
Depression, problems sleeping
Eye problems, including red eyes and infections
Fast heart beat (tachycardia) or palpitations
Pain in the joints, muscles or back
Urinary tract infection
Psoriasis, skin problems such as eczema and hair loss
Reactions at the injection site such as pain, swelling, redness or itching
Chills, a build-up of fluid under the skin causing swelling
Feeling numb or having a tingling feeling.
Shortage of blood supply, swelling of a vein
Collection of blood outside the blood vessels (haematoma) or bruising
Skin problems such as blistering, warts, abnormal skin colouration or pigmentation, or swollen lips, or thickening of the skin, or red, scaly, and flaky skin
Severe allergic reactions (e.g. anaphylaxis), an immune system disorder called lupus, allergic reactions to foreign proteins
Wounds taking longer to heal
Swelling of the liver (hepatitis) or gall bladder, liver damage
Feeling forgetful, irritable, confused, nervous
Eye problems including blurred or reduced vision, puffy eyes or sties
New or worsening heart failure, slow heart rate
Fainting
Convulsions, nerve problems
A hole in the bowel or blockage of the intestine, stomach pain or cramps
Swelling of your pancreas (pancreatitis)
Fungal infections such as yeast infection or fungal infection of the nails
Lung problems (such as oedema)
Fluid around the lungs (pleural effusion)
Narrowed airway in the lungs, causing difficulty breathing
Inflamed lining of the lung, causing sharp chest pains that feel worse with breathing (pleurisy)
Tuberculosis
Kidney infections
Low platelet count, too many white blood cells
Infections of the vagina
Blood test result showing ‘antibodies’ against your own body.
Changes in cholesterol and fat levels in the blood.
A type of blood cancer (lymphoma)
Your blood not supplying enough oxygen to your body, circulation problems such as narrowing of a blood vessel
Inflammation of the lining of the brain (meningitis)
Infections due to a weakened immune system
Hepatitis B infection when you have had hepatitis B in the past
Inflamed liver caused by a problem with the immune system (autoimmune hepatitis)
Liver problem that causes yellowing of the skin or eyes (jaundice)
Abnormal tissue swelling or growth
Severe allergic reaction that may cause loss of consciousness and could be life-threatening (anaphylactic shock)
Swelling of small blood vessels (vasculitis)
Immune disorders that could affect the lungs, skin and lymph nodes (such as sarcoidosis)
Collections of immune cells resulting from an inflammatory response (granulomatous lesions)
Lack of interest or emotion
Serious skin problems such as toxic epidermal necrolysis, Stevens-Johnson syndrome and acute generalised exanthematous pustulosis
Other skin problems such as erythema multiforme, blisters and peeling skin, or boils (furunculosis)
Serious nervous system disorders such as transverse myelitis, multiple sclerosis-like disease, optic neuritis and Guillain-Barré syndrome
Inflammation in the eye that may cause changes in the vision, including blindness
Fluid in the lining of the heart (pericardial effusion)
Serious lung problems (such as interstitial lung disease)
Melanoma (a type of skin cancer)
Cervical cancer
Low blood counts, including a severely decreased number of white blood cells
Small red or purple spots caused by bleeding under the skin
Lichenoid reactions (itchy reddish-purple skin rash and/or threadlike white-grey lines on mucous membranes)
Abnormal values of a blood protein called ‘complement factor’ which is part of the immune system.
Cancer in children and adults
A rare blood cancer affecting mostly teenage boys or young men (hepatosplenic T-cell lymphoma)
Liver failure
Merkel cell carcinoma (a type of skin cancer)
Kaposi’s sarcoma, a rare cancer related to infection with human herpes virus 8. Kaposi’s sarcoma most commonly appears as purple lesions on the skin.
Worsening of a condition called dermatomyositis (seen as a skin rash accompanying muscle weakness)
Heart attack
Stroke
Temporary loss of sight during or within 2 hours of infusion
Infection due to a live vaccine because of a weakened immune system.
Children who took infliximab for Crohn’s disease showed some differences in side effects compared with adults who took infliximab for Crohn’s disease. The side effects that happened more in children
were: low red blood cells (anaemia), blood in stool, low overall levels of white blood cells (leucopenia), redness or blushing (flushing), viral infections, low levels of white blood cells that fight
infection (neutropenia), bone fracture, bacterial infection and allergic reactions of the breathing tract.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via thenationalreporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.
Inflectra will generally be stored by the health professionals at the hospital or clinic. The storage details should you need them are as follows:
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the label and the carton after “EXP”. The expiry date refers to the last day of that month.
Store in a refrigerator (2 °C – 8 °C).
This medicine can also be stored in the original carton outside of refrigerated storage up to a maximum of 25 °C for a single period of up to six months, but not beyond the original expiry date. In this situation, do not return to refrigerated storage again. Write the new expiry date on the carton including day/month/year. Discard this medicine if not used by the new expiry date or the expiry date printed on the carton, whichever is earlier.
It is recommended that when Inflectra is prepared for infusion, it is used as soon as possible (within 3 hours). However, if the solution is prepared in germ-free conditions, it can be stored in a refrigerator at 2 °C – 8 °C up to 60 days and for an additional 24 hours at 25 °C after removal from the refrigerator.
Do not use this medicine if it is discoloured or if there are particles present.
The active substance is infliximab. Each vial contains 100 mg of infliximab. After preparation each mL contains 10 mg of infliximab.
The other ingredients are sucrose, polysorbate 80, sodium dihydrogen phosphate monohydrate and disodium phosphate dihydrate.
Inflectra is supplied as a glass vial containing a powder for concentrate for solution for infusion. The powder is white.
Inflectra is produced in packs of 1, 2, 3, 4, or 5 vials. Not all pack sizes may be marketed
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The following information is intended for healthcare professionals only: Patients treated with Inflectra should be given the patient reminder card. Instructions for use and handling - storage conditions
Store at 2 °C – 8 °C.
Inflectra may be stored at temperatures up to a maximum of 25 °C for a single period of up to
6 months, but not exceeding the original expiry date. The new expiry date must be written on the carton. Upon removal from refrigerated storage, Inflectra must not be returned to refrigerated storage.
In order to improve the traceability of biological medicinal products, the tradename and batch number of the administered medicinal product should be clearly recorded.
The dose and the number of Inflectra vials have to be calculated. Each Inflectra vial contains 100 mg infliximab. The required total volume of reconstituted Inflectra solution has to be calculated.
Under aseptic conditions, each Inflectra vial should be reconstituted with 10 mL of water for injections, using a syringe equipped with a 21-gauge (0.8 mm) or smaller needle. The flip-top from the vial has to be removed and the top has to be wiped with a 70% alcohol swab. The syringe needle should be inserted into the vial through the centre of the rubber stopper and the stream of water for injections directed to the glass wall of the vial. The solution has to be gently swirled by rotating the vial to dissolve the powder. Prolonged or vigorous agitation must be avoided. THE VIAL MUST NOT BE SHAKEN. Foaming of the solution on reconstitution may occur. The reconstituted solution should stand for 5 minutes. The solution should be colourless to light yellow and opalescent. The solution may develop a few fine translucent particles, as infliximab is a protein. The solution must not be used if opaque particles, discolouration, or other foreign particles are present.
The required volume of the reconstituted Inflectra solution should be diluted to 250 mL with sodium chloride 9 mg/mL (0.9%) solution for infusion. Do not dilute the reconstituted Inflectra solution with any other diluent. The dilution can be accomplished by withdrawing a volume of the sodium chloride 9 mg/mL (0.9%) solution for infusion from the 250-mL glass bottle or infusion bag equal to the volume of reconstituted Inflectra. The required volume of reconstituted Inflectra solution should slowly be added to the 250-mL infusion bottle or bag and gently be mixed. For volumes greater than 250 mL, either use a larger infusion bag (e.g. 500 mL,
1000 mL) or use multiple 250 mL infusion bags to ensure that the concentration of the infusion solution does not exceed 4 mg/mL. If stored refrigerated after reconstitution and dilution, the infusion solution must be allowed to equilibrate at room temperature to 25 °C for 3 hours prior to Step 4 (infusion). Storage beyond 24 hours at 2 °C - 8 °C applies to preparation of Inflectra in the infusion bag only.
The infusion solution has to be administered over a period of not less than the infusion time recommended (see section 3). Only an infusion set with an in-line, sterile, non-pyrogenic, low protein-binding filter (pore size 1.2 micrometre or less) should be used. Since no preservative is present, it is recommended that the administration of the solution for infusion is to be started as soon as possible and within 3 hours of reconstitution and dilution. If not used immediately, in use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2 °C - 8 °C, unless reconstitution/dilution has been taken place in controlled and validated aseptic conditions. Any unused portion of the infusion solution should not be stored for reuse.
Inflectra should be visually inspected for particulate matter or discolouration prior to administration. If visibly opaque particles, discolouration or foreign particles are observed it should not be used.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.