Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
IV infusion
SC injection
Infusion centre
Home
Adult Dosing:
Weight-based dosing. Standard dose is 5 mg/kg. Dose escalation to 10mg/kg may be considered. Induction: wk 0, wk 2, wk 6, then maintenance every 8 wks*
Patients who experience a disease flare or are non-responsive, a shorter infusion interval may be considered.
Infliximab SC (Remsima) – For patients who have completed an induction.
IV infliximab: Maintenance dosing regimen of 120 mg (given as one subcutaneous injection) once every 2 wks, starting 4 wks following completion of an induction regimen.
For patients already receiving intravenous infliximab maintenance therapy: Maintenance therapy with IV infliximab and who are switching to SC maintenance therapy, the first dose of may be administered 8 wks after the last infusion.
Paediatric Dosing:
(≥ 9 years of age) with moderately to severely active Crohn’s disease:
5 mg/kg given as an induction regimen at 0, 2 and 6 wks followed by a maintenance regimen of 5 mg/kg every 8 wks.
The safety and efficacy of Remicade® has not been established in paediatric patients with Crohn’s disease <9 years of age.
3-4 hrs
Those who do not experience a reaction can be infused <2 hrs
SC Injection – 5 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
SC injection
Home
Injection support can be arranged.
Adult Dosing:
Induction: 160 mg, 80 mg, 40 mg,
wk 0, wk 2, wk 4,
then maintenance 40 mg every 2 wks*
Patients who experience a disease flare or are non-responsive, dose escalation may be considered.
Paediatric Dosing:
13 to 17 years of age
≥ 40 kg: 160 mg at Wk 0, 80 mg at Wk 2. Maintenance dose regimen is 20 mg every other week beginning at Wk 4.
For paediatric patients who experience a disease flare or non-response, dose escalation to 40 mg every other week may be considered.
<15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
IV infusion x 1 then SC injection
Infusion centre
Home
Induction: weight based at 6mg/kg
up to 55kg- 260mg
>55kg-85kg- 390mg
>85 kg- 520mg
then maintenance 90 mg SC every 8 wks*
Following the first SC dose at 8 wks, those with low inflammatory burden may receive 90mg SC every 12 wks at the discretion of the HCP.
Patients who experience a disease flare or are non-responsive, a shorter infusion interval (q 4 wks) may be considered.
1–2 hrs for initial IV infusion
SC injection <15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
TB screening should be considered.
IV infusion or SC injection
Infusion centre or Home
Induction: 300 mg IV wk 0, wk 2, wk 6,
then maintenance 300 mg every 8 wks OR
following at least 2 IV infusions, 108 mg SC every 2 wks†
Patients who experience a disease flare or are non-responsive, a shorter infusion interval (q 4 wks) may be considered.
1–2 hrs for infusion
< 5 min SC injection
Patients should be monitored for any new onset or worsening of neurological signs and symptoms
Liver enzymes – transaminases and bilirubin.
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
SC injection
Home
<15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended.
May consider therapeutic drug monitoring (TDM) if available.
Screening for osteoporosis with bone mineral density testing periodically after diagnosis.
TB skin test, blood work (baseline CBC, liver enzymes, lipids, CK, renal function, hepatitis B serology
Shingrix® zoster vaccination
Ensure all immunizations are current. Refer to CANIBD Vaccination Guidelines for further information.14
Recommend receiving live vaccines prior to starting therapy.
Oral
Home
5 min
TB skin test
Blood work (baseline CBC, liver enzymes, lipids, CK, renal function, Hepatitis B serology)
Shingrix® zoster vaccination
Recommend receiving live vaccines prior to starting therapy
Oral
Home
Induction: 45mg once daily for 12 wks.
then maintenance 15mg or 30mg once daily.
5 mins
Baseline blood work – CBC
Liver enzymes, lipids, CK, renal function and Hepatitis B serology
Blood work q 3 months
Including CBC, liver enzymes, lipids, CK, and renal function
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
Oral
Home
Induction/loading:
Days 1–4: 0.23 mg
Day 5–7: 0.46 mg
Day 8 / Maintenance: 0.92 mg
5 minutes
Before treatment initiation: Baseline ECG, LFTs, CBC, VZV, negative pregnancy test
Only for patients at risk: Ophthalmic evaluation, consult cardiologist, and 6-hr first dose observation
Patients should be monitored for any new onset of neurological or visual signs and symptoms and onset bradycardia.
LFTs and CBC
Infusion centre
Home
Induction:
300 mg IV wks 0, 4 and 8,
then maintenance 200 mg SC (2 consecutive injections of 100 mg each) at wk 12 and every 4 wks thereafter
Minimum 30-min infusion
Self-injection 5 min
Baseline ECG. In patients with pre-existing conditions, advice from a cardiologist should be sought.
Blood work (baseline CBC, renal and liver function)
Opthalmic assessment in patients with a history of diabetes, uveitis or retinal disease.
Ensure all immunizations are current. Refer to CANIBD Vaccination Guidelines for further information14
Contraindications: Last 6 months myocardial infarction, unstable angina, pectoris, stroke, transient ischemic attack, decompensated heart failure, Mobitz type II second-degree or third-degree atrioventricular block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemake,
immunocompromised, severe active infections, active malignancies
Oral
Home
2 mg tablet once daily
Due to risk of transient decreases in heart rate, first dose cardiac monitoring recommended.
Hourly pulse and blood pressure for 4-hr period. ECG prior to and at the end of this 4-hr period is recommended.
Please refer to product monograph for additional information.
5 min
Baseline bloodwork: Liver enzymes, ECG and ophthalmic evaluation. Follow up blood work as clinically indicated.
Blood pressure should be monitored during treatment and managed appropriately.
Patients with a history of diabetes mellitus, uveitis or retinal disease undergo follow up ophthalmologic evaluations while receiving therapy.
*Dose and frequency adjustments can be made at the discretion of the practitioner.
†Frequency of infusions can be adjusted at the discretion of the practitioner.
TB: Tuberculosis, CBC: complete blood count, HBV: hepatitis B virus, HAV: hepatitis A virus, HPV: Human papillomavirus, Tdap: tetanus, diphtheria, and pertussis, IV: intravenous, SC: subcutaneous, wk: week, hrs: hours, min: minutes.