Remicade (Infliximab) Side Effects

If your medical team has recommended Remicade (infliximab) for a condition like Crohn’s disease, rheumatoid arthritis, or psoriasis, doing your research before your first infusion is a good idea.

Remicade is a well-established biologic therapy that has made a meaningful difference for many patients managing serious inflammatory conditions. But like any medication that works on the immune system, it can come with side effects worth knowing about and warning signs worth watching for.

Here are some of the most important side effects of Remicade, what to expect during and after infusions, and how to stay safe on therapy. If you’re new to biologic infusion therapy, getting to grips with your treatment ahead of time is always worthwhile.

What Is Remicade and How Does It Work?

Remicade (infliximab) is a biologic medication used to treat several serious inflammatory conditions. The FDA has approved it for a few different conditions, namely Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis. 

It works by targeting a protein called tumor necrosis factor-alpha (TNF-alpha). In autoimmune conditions, the body produces too much of this protein, triggering inflammation that damages joints, the gut lining, skin, and other tissues. Remicade binds to TNF-alpha and neutralizes it, helping reduce that overactive immune response.

Keep in mind, Remicade is not a form of chemotherapy. It is a targeted biologic immunotherapy with a very different mechanism and purpose than chemotherapy drugs. It’s given by IV infusion at a clinic or infusion center, lasting at least two hours per session. 

The team at Acelpa Health and its affiliated specialty pharmacies—California Specialty Pharmacy (CSP), ContinuumRx (CRx), Hawaii Specialty Pharmacy (HSP), Continuum Health (CH), and Integrated Care Systems (ICS)—can guide you through the process and help make sure your treatment is safe and comfortable.

Common Side Effects of Remicade

Most people tolerate Remicade reasonably well, but side effects can still occur. Knowing what’s common can help you tell the difference between a normal response and something that warrants a call to your care team.

Mild and Manageable Reactions

Some of the most frequently reported side effects are relatively minor and often improve on their own:

• Upper respiratory infections, such as runny nose, sore throat, or sinus pressure
• Headache, particularly around the time of the infusion
• Fatigue lasting a day or two after treatment
• Stomach pain, nausea, or mild digestive discomfort
• Skin reactions such as rash or itching, which often respond to antihistamines
• Joint or muscle aches between doses

Eating a light meal before your appointment, staying well hydrated, and letting your nurse know if symptoms persist can make a noticeable difference in how you feel during and after each session.

Infusion Reactions

Infusion reactions are among the most common side effects with Remicade, affecting roughly one in five patients. They can range from mild to serious, and your care team will monitor you throughout every appointment.

Reactions during the infusion may include:

• Flushing, chills, or mild fever
• Chest tightness or changes in blood pressure
• Hives or itching
• Shortness of breath or difficulty breathing in more serious cases

If you’ve had a previous reaction to Remicade, let your care team know ahead of time so they can adjust the protocol. Premedication with antihistamines or acetaminophen is commonly used to reduce risk, and slowing the infusion rate can help if symptoms develop mid-session.

Delayed Reactions

Not all reactions happen during the infusion itself. A delayed allergic reaction to Remicade can appear any time from 3 to 14 days after a dose and can look quite different from an immediate infusion reaction.

Symptoms of a delayed reaction may include:

• Joint or muscle aches
• Fatigue or low-grade fever
• Rash or skin changes
• Headaches
• Sore throat

If any of these symptoms appear after leaving the infusion center, contact your medical provider rather than waiting until your next scheduled appointment.

Swelling

Some reactions require emergency care right away, not a call to your care team, and not a wait-and-see approach. Call 911 or go to the nearest emergency room immediately if you experience:

• Swelling of the face, lips, tongue, or throat
• Swelling of the hands
• Difficulty swallowing
• Difficulty breathing, or a feeling that your throat is tightening

These are warning signs of a severe allergic reaction. They can happen during the infusion or in the hours after you leave your appointment. If swelling in the face or throat is accompanied by any trouble breathing, this is a medical emergency: do not drive yourself.

Serious Risks and FDA Warnings

Remicade carries a boxed warning from the Food and Drug Administration, the most serious type of warning the FDA issues for prescription medications. These risks are important to understand before starting treatment and to keep in mind throughout therapy.

Serious Infections

Because Remicade works by reducing immune activity, it may increase your risk of getting serious infections, including ones that can be difficult to treat.

Tuberculosis (TB) is one of the most significant concerns. Screening is required before your first dose, and your care team will monitor you for TB throughout treatment. If you have latent TB, it must be treated before beginning Remicade. The CDC’s tuberculosis resources offer additional guidance on what screening and treatment involve.

Hepatitis B virus reactivation is another serious risk. If you’ve ever had hepatitis B, the virus can become active again during treatment, potentially causing liver damage. Blood tests check for this before treatment begins, and any needed vaccines should be completed before starting therapy. Live vaccines must be avoided once treatment is underway.

Signs of infection to report to your care team as soon as possible:

• Persistent fever or chills
• A cough that won’t go away
• Night sweats
• Wounds that are slow to heal or worsening

Cancer Risk

Certain types of cancer have been reported in patients using TNF-alpha blockers like Remicade. This includes a rare but serious blood cancer called hepatosplenic T-cell lymphoma, which has been reported primarily in younger patients who are also taking other immune suppressing medications.

Skin cancers have also been reported with long-term use of TNF-alpha blockers.

Regular skin checks are an important safety measure. Let your medical team know about any new moles, unusual spots, or skin changes at every visit. Age-appropriate cancer screening should continue on the schedule your provider recommends.

Heart Failure and Liver Concerns

Remicade can cause worsening of existing heart failure, and new heart failure has been reported in rare cases. Watch for:

• Sudden weight gain 
• Swelling in the legs or ankles
• Unexplained shortness of breath

Liver function changes are also possible during treatment. Symptoms of liver problems can include yellowing of the skin or eyes, dark urine, or unusual fatigue. Regular lab work throughout therapy helps your care team catch these changes early, before they become more serious.

When to Contact Your Care Team

Some symptoms need attention right away. Don’t wait for your next scheduled appointment if any of the following appear:

• Fever or chills that don’t resolve on their own
• Persistent cough or shortness of breath
• Yellow skin or eyes (possible signs of liver problems)
• Unusual bruising or bleeding
• New skin lesions or changes you haven’t seen before
• Signs of an allergic reaction to Remicade, such as facial swelling or difficulty breathing
• Sudden weight gain or swelling in the legs
• Severe fatigue that limits your ability to carry out daily activities

You can also report side effects to the FDA at 1-800-FDA-1088. Reporting helps track safety data and may benefit other patients on the same therapy. If you’re looking for additional support tracking symptoms between appointments, the team at Acelpa Health’s affiliated pharmacies can help you stay connected with your clinical care throughout treatment.

Managing Remicade with Confidence

Starting a biologic therapy like Remicade takes preparation, but it doesn’t have to feel overwhelming.

Completing your TB and hepatitis B screening before your first dose, reviewing your vaccine history, attending regular monitoring appointments, and keeping a simple symptom log between sessions all help give you more control over your experience on therapy.

Acelpa Health and its affiliated specialty pharmacies work closely alongside patients and their healthcare providers to coordinate every part of the Remicade process, from insurance approvals and medication delivery to qualifying manufacturer-sponsored and foundation assistance financial coordination and ongoing support. 

We believe cost should never be a barrier to treatment. Our financial coordinators assess each patient’s individual situation and help explore options to cover medication costs, in accordance with all state, federal, and payor regulations.

Have questions about starting or managing your Remicade treatment? Contact the team at Acelpa Health. We’re here to help you navigate it with confidence.

Frequently Asked Questions (FAQ):

What are the most common side effects of Remicade?

The most frequently reported side effects include infusion reactions, upper respiratory infections, headache, fatigue, and stomach discomfort. Skin reactions like rash or itching can also occur. Most are mild and manageable, and your care team can help with premedication or infusion rate adjustments if needed.

What are the long-term side effects of Remicade?

Long-term use of infliximab may increase the risk of serious infections, including tuberculosis and hepatitis B reactivation, as well as certain cancers such as lymphoma and skin cancers. Worsening heart failure, liver changes, and neurological conditions have also been reported in rare cases. Some patients develop antibodies to the drug over time, which can reduce its effectiveness or trigger delayed reactions. Regular monitoring throughout treatment helps detect these issues early.

Is Remicade similar to chemotherapy?

No. Remicade is a targeted biologic immunotherapy, not chemotherapy. Chemotherapy is designed to kill rapidly dividing cells throughout the body, while infliximab specifically blocks a single immune protein, TNF-alpha, to reduce inflammation. Both are given by IV, but they work through very different mechanisms and are used for entirely different purposes.

What is a delayed reaction to Remicade?

A delayed allergic reaction to Remicade can appear 3 to 14 days after a dose. Common symptoms may include joint aches, muscle pain, fatigue, low-grade fever, and rash. It’s distinct from an infusion reaction, which typically happens during or shortly after the infusion itself. If symptoms appear in the days following your treatment, contact your medical provider rather than waiting for your next appointment.

Can Remicade cause cancer?

Certain cancers, including lymphoma and skin cancers, have been reported in patients taking TNF-alpha blockers like Remicade. A rare cancer called hepatosplenic T-cell lymphoma has been reported primarily in younger patients taking multiple immunosuppressant medications. The overall risk is considered low, but ongoing monitoring, regular skin checks, and age-appropriate cancer screening are recommended for everyone on long-term therapy.