Side Effects Of Remicade – What to Expect

David Fuller

Last Updated On: July 8, 2025

Infliximab (Remicade) is a biologic drug used to treat autoimmune conditions like Crohn’s disease, rheumatoid arthritis, and ulcerative colitis. While it offers significant benefits by reducing inflammation and disease activity, understanding its side effects is essential. Studies show that up to 10% of patients experience infusion-related reactions such as flushing, headache, and nausea, with serious events occurring in about 3% of cases.

In addition to infusion reactions, serious infections are reported in 4–8% of patients, which underscores the importance of monitoring during treatment. Remicade can also impact the immune system, making patients more susceptible to infections and requiring close medical supervision. Regular blood tests and vigilance are necessary to identify any changes in the patient’s health status early on.

This article will provide a comprehensive list of Remicade side effects, covering both common and rare reactions. It will also explain how to recognize warning signs, manage potential issues, and ensure the safest possible treatment outcome.

Key Takeaways

• Remicade is effective in managing autoimmune conditions, such as Crohn’s disease, rheumatoid arthritis, and ulcerative colitis, by reducing inflammation and offering symptom relief.
• Common infusion-related side effects include headache, fever, nausea, and dizziness, but these are typically mild and short-lived.
• Long-term use can increase the risk of serious infections, liver damage, heart problems, and blood disorders due to its immune suppression effect.
• Premedication with antihistamines or acetaminophen and monitoring vital signs during infusions can help manage common side effects.
• Healthcare providers regularly monitor patients for latent infections, liver function, and blood cell counts during treatment.
• Discontinuation or dosage adjustments may be necessary if serious side effects like frequent infections, liver issues, or antibody formation occur.
• Close communication with healthcare providers is essential for identifying and promptly managing any unusual symptoms to ensure safe treatment.

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Understanding How Remicade Affects the Immune System

Remicade works by targeting and neutralizing tumor necrosis factor-alpha (TNF-α), a substance involved in inflammation. By blocking TNF-α, Remicade helps reduce inflammation in autoimmune disorders like Crohn’s disease, rheumatoid arthritis, and ulcerative colitis. However, this action also suppresses the immune system, making it harder for the body to fight infections. Immune suppression is a known side effect of Remicade, increasing the risk of bacterial, viral, and fungal infections.

Clinicians often screen patients for latent infections, such as tuberculosis, before starting treatment. They administer Remicade through intravenous infusion, typically every 6 to 8 weeks after the initial doses.

While the medication takes effect within days to weeks, its prolonged impact on the immune system makes it crucial to monitor patients closely during and after treatment. This immune suppression is at the heart of many side effects that patients may face.

Common Reactions Observed with Remicade Infusions

Patients undergoing Remicade for ulcerative colitis or other conditions may experience specific side effects during or shortly after their infusion sessions. These reactions are often the body’s initial response to the medication entering the system. In most cases, they are mild, temporary, and manageable. Infusion-related reactions typically occur within the first two hours of administration and usually subside over time. 

Slowing the infusion rate or administering premedications, such as antihistamines and acetaminophen, can help reduce the intensity of these symptoms.

Infusion-Related Side Effects

• Headache: A mild to moderate headache may develop shortly after treatment. Tension typically causes this issue, which usually resolves within a few hours without intervention.
  
• Fever or Chills: A temporary rise in body temperature or sudden chills can occur, often due to the immune system’s immediate reaction to the biologic agent.
  
• Nausea: Some patients report a queasy or unsettled stomach during or after infusions. Eating a light meal beforehand may reduce this effect.
  
• Dizziness: Lightheadedness or a sensation of imbalance may occur, especially in patients new to infusion treatments or those with a history of low blood pressure.
  
• Skin Rash or Itching: Mild skin irritation, including redness, itching, or hives, can sometimes appear near the injection site or across the body. This is usually short-lived.
  
• Chest Tightness: A rare but notable reaction, patients may feel a slight pressure in the chest or difficulty breathing. Patients should report this immediately to the infusion staff for prompt assessment.

In addition to these, many patients also experience fatigue or joint pain after treatment. While these symptoms are uncomfortable, they generally subside within 24 to 48 hours and are not typically a cause for concern. Staying hydrated and resting after the infusion can help minimize these effects.

Serious Risks Linked to Long-Term Remicade Use

Although most patients tolerate Remicade well, its long-term use can pose serious risks. These adverse effects typically emerge over time and are related to immune suppression, which can affect multiple organ systems. Clinicians should not overlook these rare complications. 

Serious infections are a concern, as immune suppression increases vulnerability to infections like pneumonia, sepsis, and reactivation of latent conditions such as tuberculosis. Regular screenings for infections and prompt treatment are essential for managing these risks.

Other long-term risks include liver damage, which can cause elevated liver enzymes or severe liver injury. Symptoms may include jaundice (yellowing of the skin or eyes), dark urine, and abdominal pain. Heart problems such as shortness of breath and swelling may also occur, particularly in those with pre-existing heart conditions. Blood disorders, such as abnormal blood cell counts, are another concern, increasing the risk of infections or bleeding. 

Remicade treatment slightly increases the risk of certain cancers, including lymphoma and skin cancer, particularly in younger males.

Managing and Monitoring Remicade Side Effects in Practice

To minimize and manage Remicade side effects, healthcare providers follow a set of protocols designed to monitor patient health and prevent complications. Premedication with antihistamines or acetaminophen before infusions can help reduce mild reactions such as fever or itching. Vital signs are monitored closely during treatment to detect any early signs of adverse responses. 

Routine blood tests assess liver, kidney, and blood cell function, ensuring the body tolerates the medication well over time. For long-term users, clinicians may recommend chest X-rays or tuberculosis screenings to rule out latent infections.

Healthcare providers advise patients to avoid live vaccines during treatment due to the risk of immune suppression. Maintaining a healthy lifestyle, including proper hydration and diet, can also help minimize the risk of infections. Additionally, good communication between patients and healthcare providers is essential. 

Patients should report any unusual symptoms immediately to adjust dosages or pause treatment if needed. Effective monitoring allows doctors to adjust treatment plans, ensuring patient safety and comfort.

When to Discontinue or Adjust Remicade Treatment

Not all patients respond to Remicade the same way. Some may develop antibodies against the drug, making it less effective or increasing the risk of side effects. Others may experience complications that warrant stopping treatment.

Consider stopping or adjusting Remicade dosing if the following occurs:

• Side effects are severe or unmanageable
• Infections become frequent or life-threatening
• Liver or heart complications develop
• Infusion reactions become progressively worse
• Blood tests show concerning abnormalities

Conclusion

Remicade offers significant benefits in managing chronic autoimmune conditions by reducing inflammation and improving quality of life. However, understanding and managing its side effects—both mild and severe—are essential for maximizing its therapeutic benefits. From common infusion reactions to serious, long-term complications, patients and healthcare providers must work together to monitor and address any concerns that arise during treatment. 

By staying informed and vigilant, patients can help ensure the safe and effective use of Remicade throughout their therapy.

FAQs

1. How long do Remicade side effects last?

Mild side effects like fatigue or nausea usually last one to two days after infusion. Serious complications, such as infections or liver issues, may persist longer and require medical treatment.

2. Can I use Remicade during pregnancy?

Doctors sometimes prescribe Remicade during pregnancy, but only under close supervision. Discuss the risks and benefits with your healthcare provider if you’re pregnant or planning to become pregnant.

3. Does Remicade increase the risk of cancer?

There is a slightly elevated risk of lymphoma and certain skin cancers, especially in young males. Routine monitoring can help detect abnormalities early.

4. What should I do if I miss a Remicade infusion?

Contact your healthcare provider immediately. A missed dose can reduce treatment effectiveness and increase the risk of side effects if not correctly managed.

References

Birck MG, Lukusa L, Choquette D, et al. Incidence of serious infection among etanercept and infliximab initiators: safety comparison between biosimilars and bio-originators with Canadian population-based data. BMC Rheumatology. 2024;8(1). doi:10.1186/s41927-024-00415-5

Cullen G, Cheifetz AS. Infusion Reactions Related to Infliximab Therapy Are Not Usually Associated with Drug Discontinuation. The Journal of Rheumatology. 2012;39(8):1500-1502. doi:10.3899/jrheum.120649

Checkley LA, Kristofek L, Kile S, Bolgar W. Incidence and Management of Infusion Reactions to Infliximab in an Alternate Care Setting. Dig Dis Sci. 2019;64(3):855-862. doi:10.1007/s10620-018-5319-6