This checklist includes a number of topics specific to the administration of REMICADE®. Use this page or download a PDF to assess your patients prior to their initial infusion to ensure they are healthy enough for REMICADE®.
In the past 2 weeks, have you felt very tired or experienced fever; night sweats; sore throat; runny nose; flu-like symptoms; warm, red, or painful skin; face pain; earache; tooth pain; cough; breathing problems; painful urination; urine with blood; antibiotic use; headache; an open cut or sore; or an infection that won’t go away or an infection that keeps coming back?
Have you had surgery in the past 2 weeks? If so, did you have any complications from your surgery?
Did you experience any drainage from your incision?
Do you currently have any symptoms of an active infection, even if very minor?
Do you have diabetes or an immune system problem?
Have you resided in regions where histoplasmosis (Ohio Valley, Mississippi River Valley), and coccidioidomycosis (Southwestern US, particularly Arizona and the San Joaquin Valley in California), or other opportunistic fungal infections are endemic?
Have you ever had tuberculosis (TB), or have you recently been near anyone who might have TB?
Were you born or have you lived in or traveled to countries where there is more risk of getting TB?
- When was your last chest x-ray?
- When was your last TB test, and what was the result?
Are you at risk of bacterial, viral, or other infections due to opportunistic pathogens, including Legionella and Listeria?
Made a thorough history, physical, and test for latent TB infection part of your regular examination?
- Please refer to the latest CDC guidelines and recommendations for TB testing in immunocompromised patients
Patients who have a history of latent or active TB in whom an adequate course of therapy cannot be confirmed should be considered for latent TB treatment
Treatment of latent TB infection should be initiated prior to treatment with REMICADE®
Antituberculosis therapy prior to initiating REMICADE® should also be considered in patients who have several or highly significant risk factors for TB infection and have a negative test for latent TB. The decision to initiate antituberculosis therapy in these patients should be made only following consultation with a physician with expertise in the treatment of TB, and taking into account both the risk for latent TB infection and the risks of antituberculosis therapy
Continue to evaluate risk factors, especially in patients 65 years and older, pediatric patients, patients with comorbid conditions, and/or patients taking concomitant immunosuppressant therapy. Monitor patients for signs and symptoms of TB, pneumonia, cellulitis, abscess, and skin ulceration
Do you have cancer or a history of cancer or other risk factors such as chronic obstructive pulmonary disease (COPD) or phototherapy for psoriasis?
Have you been treated for Crohn’s disease or ulcerative colitis with azathioprine (AZA) or 6-mercaptopurine (6-MP)?
Have you ever been diagnosed with congestive heart failure or other heart conditions?
- Have you experienced shortness of breath, swelling of the ankles or feet, or sudden weight gain?
HEPATITIS B REACTIVATION
Do you think you may be a carrier of hepatitis B virus infection?
Are you experiencing any signs of hepatitis B virus infection such as feeling unwell, poor appetite, tiredness, fever, skin rash, and/or joint pain?
Have you been tested or tested positive for hepatitis B virus?
Do you have a history of liver problems?
Have you ever been diagnosed with jaundice (yellowing of the skin and eyes)?
Is your urine dark brown?
Are you experiencing any right-side abdominal pain, fever, or extreme tiredness?
Do you have or have you ever had any ongoing blood problems?
Do you have a fever that does not go away?
Do you bruise or bleed easily?
Do you look very pale?
Do you have any drug allergies?
Have you had an allergic reaction to any of the ingredients in REMICADE®?
Do you have or have you ever had a condition that affects your nervous system, such as:
- Multiple sclerosis, optic neuritis, or Guillain-Barré syndrome, or
- Have you experienced numbness or tingling, or
- Have you had a seizure?
Do you have or have you ever had a lupus-like syndrome, with symptoms such as:
- Ongoing fever
- Persistent aching
USE WITH OTHER DRUGS
Are you currently taking, or have you recently received treatment with, anakinra, abatacept, or tocilizumab?
Have you recently received or are you scheduled to receive a vaccine?
Are pediatric patients up-to-date with all vaccinations?
- Have you recently given birth?
- Were you treated with REMICADE® during your pregnancy?
- Has your infant recently received, or is your infant scheduled to receive, a vaccine?
Are you pregnant or are you planning to become pregnant?
- Pregnancy checks should be performed before each infusion of REMICADE®
Are you breast-feeding or are you planning to breast-feed?
Are there any changes in your recent medical history?
Which medications are you currently taking?
What is your current weight?