Anti-Tumour Necrosis Factor (Anti-TNF)

Do I skip dose if I am sick?

• Seek prompt advice from your doctor when you develop any of the serious symptoms described above or is being treated with antibiotics for an infection.
• Your doctor will decide whether to stop anti-TNF on a case-by case basis.

When do I seek medical attention IMMEDIATELY?

• Allergic reactions: Rash, hives, blistered, wheezing, chest tightness, trouble breathing, swelling of mouth, face, lips, tongue
• High fever (38°C), chills and very bad sore throat
• Chest pain or pressure
• Shortness of breath or swelling of feet or ankles
• Unusual bruising or bleeding
• Yellow skin or eyes, dark urine, stomach pain

Can I take other MEDICINES or SUPPLEMENTS?

• DMARDs such as methotrexate, hydroxychloroquine, sulfasalazine or leflunomide can be used in combination with anti-TNF.
• Do not start a new drug, over the counter medicines and herbal supplements without informing your doctor.
• You should avoid live vaccine such as live polio, yellow fever, rubella (German measles), MMR (measles, mumps and rubella), typhoid and BCG (tuberculosis).
• Killed vaccines for pneumococcal, influenza, hepatitis B and human papillomavirus should be given to patients receiving anti-TNF therapy.

Can I get PREGNANT or BREASTFEED?

• The evidence about the safety of anti-TNF in pregnancy is still fairly limited.
• Therefore, the use of anti-TNF in pregnant women is not recommended.
• If you are considering having a child, it is important to discuss with your doctor before taking this drug.
• Recent studies have suggested infliximab is usually not detected in breast milk and absorption is unlikely in infants. However, in view of limited evidence, it was suggested not to breastfeed while receiving Infliximab.
• Limited evidence on the drug excretion in breast milk or lack of long term follow up data on infant breastfed while receiving other anti-TNF.

In SUMMARY… what you need to know about anti-TNF?

• Inject anti-TNF following the scheduled interval at home.
• Infliximab infusion is administered in hospital at scheduled interval.
• Always come for your BLOOD TESTS on the scheduled date.
• Beware of the SIDE EFFECTS and when to seek immediate medical attention.
• Never take medicines, supplements or herbal medicines OVER-THE-COUNTER without checking with your doctor or pharmacist first.
• If you intent to start a family, please inform your doctor as anti-TNF may not be appropriate in pregnancy.
• If you have further questions about Anti-TNF, please call ______________________ (office number) to discuss with your doctor / pharmacist / specialty nurse (please circle as appropriate).