Infliximab-dyyb (Intravenous, Subcutaneous)

Infliximab-dyyb injection is used to lessen the symptoms of moderate to severe active Crohn's disease and ulcerative colitis in adults and children who have not responded well to previous treatments. It is also used as a maintenance treatment for moderate to severe active Crohn's disease and ulcerative colitis after receiving an infliximab medicine from your doctor.

Infliximab-dyyb injection is also used along with other medicines (like methotrexate) to reduce symptoms and stop the progression of moderate to severe active rheumatoid arthritis.

Infliximab-dyyb injection is also used to reduce symptoms and prevent the progression of active ankylosing spondylitis. It is also used to reduce symptoms and prevent the progression of psoriatic arthritis.

Infliximab-dyyb injection is also used to treat chronic severe (extensive or disabling) plaque psoriasis, which is a skin condition characterized by red patches and white scales that do not go away. It is used in patients who may benefit from other treatments. This medicine is a monoclonal antibody that affects the immune system.

This medicine is available only with your doctor's prescription.

It is very important for your doctor to check your or your child's progress during regular visits to ensure this medicine is working properly. Blood tests may be needed to look for unwanted effects.

Infliximab-dyyb may cause an infusion reaction while you are receiving it or right after the infusion ends. Contact your doctor or nurse immediately if you experience chest pain, fever, chills, itching, hives, rash, dizziness, fainting, lightheadedness, headache, joint pain, trouble swallowing, shortness of breath, difficulty breathing, or swelling of the face, tongue, and throat.

Your body's ability to fight infections may be reduced while using infliximab-dyyb. It is crucial to call your doctor at the first sign of any infection. Contact your doctor right away if you have a fever, chills, cough, flu-like symptoms, or unusual tiredness or weakness.

You will need a skin test for tuberculosis before starting this medicine. Inform your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.

A small number of people (including children and teenagers) who have used this medicine have developed certain types of cancer. This is more common in patients with lung diseases (e.g., COPD) or heavy smokers, and in psoriasis patients who have had long-term phototherapy treatment. Phototherapy treatment involves ultraviolet light or sunlight combined with oral medicine to make your skin sensitive to light. Some teenagers and young adults with Crohn disease or ulcerative colitis have also developed a rare type of cancer called hepatosplenic T-cell lymphoma. Talk to your doctor if you notice unusual bleeding, bruising, or weakness, swollen lymph nodes in the neck, underarms, or groin, unexplained weight loss, or red, scaly patches, or raised bumps with pus on the skin.

Receiving this medicine may increase your risk of skin cancer (e.g., melanoma, Merkel cell carcinoma) or cervical cancer. If you notice any changes or growths on your skin, abnormal vaginal bleeding, or pelvic pain, consult your doctor immediately.

It is important to have your heart monitored closely if you receive infliximab-dyyb. Call your doctor right away if you have difficulty breathing, swelling in the ankles and feet, or a sudden weight gain.

This medicine may increase your risk of developing a lupus-like syndrome or a liver disease called autoimmune hepatitis. Contact your doctor immediately if you experience dark brown urine, fever or chills, a general feeling of discomfort or weakness, joint pain, light-colored stools, nausea and vomiting, a rash on the cheeks or arms that worsens in the sun, severe tiredness, upper right stomach pain, or yellowing of the eyes and skin.

While being treated with infliximab-dyyb, do not receive any immunizations (vaccines) without your doctor's approval. Live virus vaccines should not be given with infliximab-dyyb. Ensure your child's vaccinations are up to date before receiving infliximab-dyyb. Speak to your child's doctor if you have any questions about this.

If you have a baby while receiving infliximab-dyyb, inform the baby's doctor that you were receiving this medicine. You will need to wait a few months before giving certain vaccines to your baby. Consult the baby's doctor if you have questions.

Serious skin reactions can occur with this medicine. Consult your doctor immediately if you experience blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while on this medicine.

Do not take other medicines unless discussed with your doctor. This includes abatacept (Orencia®), anakinra (Kineret®), tocilizumab (Actemra®), or other biologics used to treat the same conditions as infliximab-dyyb. Using these medicines together with infliximab-dyyb may increase your risk of serious unwanted effects.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the benefits it will provide. This is a decision you and your doctor will make together. For this medicine, the following should be considered:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, let your healthcare professional know if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies have not shown any specific problems in children 6 years of age and older that would limit the usefulness of infliximab-dyyb injection for treating Crohn disease or ulcerative colitis. However, safety and effectiveness have not been established in children younger than 6 years.

Studies have not been done on how age affects the use of infliximab-dyyb vial in children with juvenile rheumatoid arthritis and infliximab-dyyb prefilled pen, prefilled syringe, and prefilled syringe with needle shield in the pediatric population. Safety and effectiveness have not been established.

Geriatric

Studies have not shown any specific problems in the elderly that would limit the usefulness of infliximab-dyyb vial. However, older patients are more likely to have infections, which may require caution when using infliximab-dyyb injection.

Studies have not shown any specific problems in the elderly that would limit the usefulness of infliximab-dyyb prefilled pen, prefilled syringe, and prefilled syringe with needle shield.

Breast Feeding

There are no adequate studies in women for determining the risk to infants when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Certain medicines should not be used together at all, while in other cases, two different medicines may be used together even if an interaction might happen. In these cases, your doctor may want to adjust the dose or take other precautions. When taking this medicine, it is especially important that your healthcare professional knows if you are taking any of the medicines listed below. The following interactions are significant but may not include all possible interactions.

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you take one or both of the medicines.

• Abatacept
• Adalimumab
• Adenovirus Vaccine, Live
• Alefacept
• Anakinra
• Anifrolumab-fnia
• Bacillus of Calmette and Guerin Vaccine, Live
• Baricitinib
• Brodalumab
• Certolizumab Pegol
• Cholera Vaccine, Live
• Cyclosporine
• Dengue Tetravalent Vaccine, Live
• Ebola Zaire Vaccine, Live
• Etanercept
• Fosphenytoin
• Golimumab
• Guselkumab
• Influenza Virus Vaccine, Live
• Ixekizumab
• Levoketoconazole
• Measles Virus Vaccine, Live
• Methotrexate
• Mumps Virus Vaccine, Live
• Natalizumab
• Paclitaxel
• Phenytoin
• Poliovirus Vaccine, Live
• Quinidine
• Rilonacept
• Rituximab
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Sarilumab
• Sirolimus
• Smallpox Monkeypox Vaccine, Live Non-Replicating
• Smallpox Vaccine
• Tacrolimus
• Tocilizumab
• Tofacitinib
• Typhoid Vaccine, Live
• Ustekinumab
• Varicella Virus Vaccine, Live
• Vedolizumab
• Warfarin
• Yellow Fever Vaccine
• Zoster Vaccine, Live

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used around the time of eating food or certain types of food due to potential interactions. Using alcohol or tobacco with certain medicines may also cause interactions. Discuss with your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical problems may affect the use of this medicine. Make sure to inform your doctor if you have any other medical issues, especially:

• Blastomycosis (fungus infection), history of or
• Blood or bone marrow problems (e.g., pancytopenia), or history of or
• Candidiasis (fungus infection), history of or
• Coccidioidomycosis (fungus infection), history of or
• Diabetes or
• Guillain-Barré syndrome (nervous system disorder), history of or
• Hepatitis B, active or history of or
• Histoplasmosis (fungus infection), history of or
• Legionellosis (bacterial infection), history of or
• Leukopenia or neutropenia (low white blood cells) or
• Listeriosis (bacterial infection), history of or
• Liver disease or
• Multiple sclerosis, history of or
• Optic neuritis (eye problem) or
• Pneumocystosis (fungus infection), history of or
• Psoriasis (skin disease) or
• Seizures, history of or
• Thrombocytopenia (low platelets in the blood)—Use with caution. May worsen these conditions.

• Cancer, active or history of or
• Chronic obstructive pulmonary disease (COPD)—Use with caution. May increase the chance of developing new cancers.

• Congestive heart failure, moderate to severe—Should not be given to patients with this condition.

• Tuberculosis, history of—Use with caution. Patients may need additional treatment for tuberculosis.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Black, tarry stools
• bladder pain
• bloody or cloudy urine
• blurred vision
• body aches or pain
• chest pain or tightness
• chills
• cough
• cough producing mucus
• difficult, burning, or painful urination
• difficulty breathing
• dizziness
• dryness or soreness of the throat
• ear congestion
• fever
• frequent urge to urinate
• headache
• hoarseness
• itching, rash
• loss of voice
• lower back or side pain
• nervousness
• pain or swelling in the arms or legs
• pain or tenderness around the eyes and cheekbones
• painful or difficult urination
• pale skin
• pounding in the ears
• slow or fast heartbeat
• sneezing
• sores, ulcers, or white spots on the lips or in the mouth
• stuffy or runny nose
• swollen glands
• tender, swollen glands in the neck
• trouble swallowing
• trouble breathing
• unusual bleeding or bruising
• unusual tiredness or weakness
• voice changes

Rare

• Bleeding gums
• blood in the stool
• blue lips and fingernails
• blurred vision
• changes in skin color or tenderness of the foot or leg
• chest discomfort
• confusion
• coughing that sometimes produces a pink frothy sputum
• dark urine
• decreased urination
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• dry mouth
• fast or noisy breathing
• feeling of discomfort
• general feeling of illness
• general tiredness and weakness
• high fever
• hives
• increase in heart rate
• increased sweating
• inflammation of the joints
• irregular heartbeat
• light-colored stools
• muscle aches
• nausea
• pinpoint red spots on the skin
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• rapid, shallow breathing
• sunken eyes
• thirst
• upper right abdominal pain
• vomiting
• weight loss
• wrinkled skin
• yellow eyes and skin

Incidence not known

• Back pain, sudden and severe
• blistering, peeling, loosening of the skin
• bloody nose
• burning, tingling, numbness or pain in the hands, arms, feet, or legs
• change in mental status
• clay-colored stools
• diarrhea
• difficulty speaking
• dilated neck veins
• double vision
• heavier menstrual periods
• inability to move the arms, legs, or facial muscles
• inability to speak
• loss of appetite
• muscle weakness, sudden and progressing
• red, irritated eyes
• red skin lesions, often with a purple center
• seizures
• sensation of pins and needles
• slow or irregular breathing
• slow speech
• stabbing pain
• temporary vision loss
• vomiting of blood
• weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Belching
• difficulty in moving
• feeling of warmth
• heartburn
• indigestion
• muscle stiffness
• redness of the face, neck, arms and occasionally, upper chest

Less common

• Constipation, severe

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Inflectra
• Zymfentra

Available Dosage Forms:

• Powder for Solution

Therapeutic Class: Immunological Agent

Pharmacologic Class: Infliximab

Find detailed information on biosimilars for this medication.

This medicine is available in 4 forms: vial, prefilled syringe, prefilled syringe with needle shield, and prefilled pen.

Vial: A doctor or other trained health professional will give you this medicine in a medical facility. It is given through an IV that is placed into one of your veins. It must be given slowly, so the needle will have to remain in place for at least 2 hours.

This medicine comes with a Medication Guide and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have questions.

Prefilled syringe, prefilled syringe with needle shield, or prefilled pen: You may also be taught how to give your medicine at home. It is usually given as a shot under the skin of your stomach, thigh, or upper arm. Make sure you understand all instructions before you give yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.

Do not inject into skin areas that are red, bruised, tender, damaged, hard, or areas with scars.

To use the prefilled pen:

• Wash your hands with soap and water before and after using this medicine.
• Allow 30 minutes for the pen to warm up to room temperature. Do not warm using other heat sources (eg, hot water or microwave).
• Check the liquid in the pen. It should be clear, colorless to pale brown. Do not use it if it is cloudy, discolored, or has particles in it. Do not use the pen if it is cracked or damaged. It is normal to see air bubbles in the liquid. Do not shake.
• Gently pull the cap straight off. Do not recap the prefilled pen. Do not touch the needle.
• Hold the pen so that you can see the window. Without pinching or stretching the skin, place the pen over the skin at a 90 degree angle.
• Press the pen firmly against the skin. When the injection starts, you will hear the first loud "click" and the purple plunger rod will begin to fill the window.
• Keep holding the pen firmly and listen for the second loud "click". This can take up to 10 seconds. Do not change the position of the pen after injection has started.
• After you hear the second loud "click" continue to hold the pen firmly and slowly count to 5 to make sure you have received the full dose.
• Make sure that the purple plunger rod is filling the window completely.

To use the prefilled syringe:

• Wash your hands with soap and water before and after using this medicine.
• Allow 30 minutes for the pen to warm up to room temperature. Do not warm using other heat sources (eg, hot water or microwave).
• Check the liquid in the syringe. It should be clear, colorless to pale brown. Do not use it if it is cloudy, discolored, or has particles in it. Do not use the syringe if it is damaged or has been dropped. It is normal to see air bubbles in the liquid. Do not shake.
• Gently pull the cap straight off. Do not pull back on plunger rod. Do not touch the needle.
• Hold the syringe in one hand between your thumb and index finger. Pinch the skin around the injection site with one hand. With a quick "dart-like" motion, insert the needle completely at a 45 degree angle. Do not change the position of the syringe.
• Push the plunger down slowly and as far as it will go until the syringe is empty. Remove the needle from the skin at the same angle it was inserted.

To use the prefilled syringe with needle shield:

• Wash your hands with soap and water before and after using this medicine.
• Allow 30 minutes for the pen to warm up to room temperature. Do not warm using other heat sources (eg, hot water or microwave).
• Check the liquid in the syringe. It should be clear, colorless to pale brown. Do not use it if it is cloudy, discolored, or has particles in it. Do not use the pen if it is cracked or damaged. It is normal to see air bubbles in the liquid. Do not shake.
• Gently pull the cap straight off. Do not pull back on plunger rod. Do not touch the needle.
• Hold the syringe in one hand between your thumb and index finger. Pinch the skin around the injection site with one hand. With a quick "dart-like" motion, insert the needle completely at a 45 degree angle. Do not change the position of the syringe.
• Push the plunger down slowly and as far as it will go until the syringe is empty. Slowly lift your thumb from the plunger until the needle is completely covered by the needle guard.

You may also receive medicines (eg, allergy medicine, fever medicine, steroids) to help prevent possible unwanted effects during the injection.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For injection dosage form (prefilled pen, prefilled syringe, or prefilled syringe with needle shield):For Crohn's disease and ulcerative colitis: Adults—The first 3 doses are given by a doctor through an IV placed in one of your veins at Week 0, Week 2, and Week 6. Then starting at Week 10, you may receive 120 milligrams (mg) injected under your skin and every 2 weeks thereafter. Children—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store in the refrigerator. Do not freeze.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

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