Drug Interactions and Remicade: A Look at Other Medications, Alcohol, and More
Remicade, a popular biologic drug used to treat conditions such as ulcerative colitis, Crohn's disease, and rheumatoid arthritis, comes with certain interactions and precautions that patients and healthcare professionals should be aware of.
Firstly, it's crucial to note that Remicade may interfere with the results of a skin test for tuberculosis (TB), causing a false-negative result. This is not an exhaustive list, but here are some key interactions to consider:
- Combining Remicade with other biologic TNF inhibitors like Simponi (golimumab) or Humira (adalimumab) poses a significant risk of serious infections and major drug interactions. Coadministration with these drugs should be avoided due to increased risks of immunosuppression and infections.
- Using Remicade together with abatacept (Orencia), a biologic that modulates T-cell activation, increases the risk of serious infections. Dual biologic use raises infection risk substantially.
- Similarly, combining Remicade with Rituxan (rituximab) or Janus kinase inhibitors (e.g., upadacitinib) is advised against because of heightened infection risk, suggesting comparable precautions for Remicade with these agents.
In general, coadministration of Remicade with other immunosuppressive biologics or immunomodulators can potentiate immunosuppression, leading to increased vulnerability to infections, including serious and opportunistic infections, and possible lymphoma risk.
Remicade may also interact with methotrexate, warfarin, theophylline, and riluzole. While specific interactions with methotrexate or other non-biologic drugs were not extensively reported, methotrexate is commonly used with TNF inhibitors like Remicade to improve efficacy and modify pharmacokinetics, though it might increase side effects.
It's important to note that Remicade may increase the risk of infections when taken with other biologics, TNF blockers, corticosteroids, immunosuppressants, integrin receptor antagonists, and certain JAK inhibitors.
Certain medical conditions and factors may increase the risk of interactions with Remicade. These include heart failure, liver problems, nerve problems, hepatitis B or current infection, risk of serious infections and cancer, allergic reaction, and breastfeeding or pregnancy.
Moreover, Remicade may interact with live vaccines, as the drug may weaken the immune system and prevent the vaccine from working effectively. Examples of live vaccines to avoid during Remicade treatment include measles, mumps, rubella (MMR), chickenpox, and yellow fever.
Lastly, there are no known interactions between Remicade and alcohol, but a doctor may advise limiting alcohol consumption during Remicade treatment due to the risk of liver damage.
In summary, using Remicade concurrently with other biologic drugs is usually contraindicated or requires careful medical oversight, monitoring for infections, and consideration of alternative therapies. The table below provides a summary of the interactions and clinical recommendations for some common biologics:
| Biologic Combination with Remicade | Interaction Risk | Clinical Recommendation | |-----------------------------------|-----------------|------------------------------------| | Simponi (golimumab) | Major | Avoid coadministration | | Abatacept (Orencia) | Increased infections | Avoid or monitor closely | | Rituximab (Rituxan) | Increased infections | Avoid or monitor closely | | JAK inhibitors (e.g., upadacitinib) | Increased infections/lymphoma risk | Generally avoid |
Use of multiple biologics or immunosuppressants simultaneously should be approached cautiously and under specialist guidance due to elevated infection and other safety risks. Always consult with a healthcare professional before making any decisions about your medication.
