Summary for Practice

This guide is based on a sample institutional protocol: after three standard 120-minute infusions with no infusion-related reactions, the fourth infusion may be given over 90 minutes. If tolerated, the fifth infusion and beyond may be given over 60 minutes. Any infusion-related reaction at any time requires restarting at the standard 120-minute protocol.

Stepwise: 120 → 90 → 60 min Apply only if prior doses tolerated Revert to 120 min after any IRR

Institutional Protocol — Infusion Duration

Infusion # Duration Rate Type Criteria & Notes
1–3 120 minutes Titrated (see Admin Instructions) Standard infusions. Monitor closely; document vitals and any symptoms.
4 90 minutes Accelerated (flat-rate per order) Permitted only if infusions 1–3 were uneventful (no infusion-related reactions).
5+ 60 minutes Accelerated (flat-rate per order) Permitted only if infusion #4 (90 min) was tolerated without reaction.
Reversion Return to 120 minutes Titrated Any infusion-related reaction (IRR) at any time ⇒ revert to standard 120-minute protocol for subsequent dose(s).

IRR = infusion-related reaction. Document all events; consider premedication per local policy.

Administration Instructions — Doses 1–3 (Titrated 120 min)

Segment Infusion Rate Duration Notes
Start 20 mL/hr 15 minutes Assess tolerance; observe closely.
Step 2 40 mL/hr 15 minutes Continue monitoring vitals and symptoms.
Step 3 80 mL/hr 15 minutes Escalate per protocol if tolerated.
Step 4 120 mL/hr 30 minutes Proceed if stable.
Final 150 mL/hr Until infusion complete Complete standard 120-minute infusion as ordered.

Apply this exact titration schedule for doses 1–3. If any IRR occurs, stop the infusion, treat per anaphylaxis/IRR protocol, and notify the provider. Future doses revert to standard 120-minute protocol until tolerance re-established.

Admin Instruction: Start infusion at 20 mL/hr x 15 min, then increase to 40 mL/hr x 15 min, then 80 mL/hr x 15 min, then 120 mL/hr x 30 min, then 150 mL/hr till completed. Approximate infusion time is 2 hr and 17 min.

Monitoring & Readiness

  1. Before: verify eligibility (tolerance of prior doses), check vitals, confirm premeds per local policy.
  2. During: vitals at baseline → mid-infusion → end; watch for flushing, pruritus, dyspnea, chest tightness, hypotension.
  3. After: observe ≥ 30–60 min after first 90-min and first 60-min infusions; document outcomes.
Emergency readiness: epinephrine, corticosteroids, antihistamines, IV fluids, oxygen, and immediate ability to pause/slow infusion.

Acute Infusion Reaction — Quick Algorithm

1) Recognize & Stop

  • Pause infusion; assess airway/breathing/circulation.
  • Vitals & symptom check immediately.
  • For mild cutaneous symptoms, consider slow restart once fully resolved.

2) Treat

  • Anaphylaxis: IM epinephrine promptly; O2, IV fluids, bronchodilator, corticosteroid per protocol.
  • Mild–moderate: H1 antihistamine ± corticosteroid; consider rate reduction.

3) Decide & Document

  • Restart at reduced rate only if symptoms resolve and provider agrees.
  • Document severity, timing, interventions, disposition.
  • Flag chart: future doses revert to 120 min; reconsider premeds.

This pocket guide reflects the institutional protocol provided. It supports—but does not replace—prescribing information and institutional policies.

Key Sources (for background safety evidence)

  1. Abushamma S, et al. Accelerated Infliximab Infusion Safety and Tolerability (RCT). 2023. NCT05340764. PMC10243871
  2. Neef HC, et al. Meta-analysis: Rapid infliximab infusions are safe. Aliment Pharmacol Ther. 2013;38:365–376. PDF
  3. Mazzuoli S, et al. Accelerated infliximab infusion: Safety, satisfaction, cost. PLoS One. 2016. PLOS ONE
  4. REMICADE® Prescribing Information. PI