Biologic Medications π
On-call reference for biologic medications: when to hold, infection risk, and common Irish brands/biosimilars for NCHDs.
β οΈ Educational note
- Biologics are usually started and dose-adjusted by specialty teams (rheumatology, gastroenterology, dermatology, haematology). This page is for ward recognition, infection risk, and when to hold β not for initiating therapy.
- Always confirm dosing, premedication, and hold rules with the responsible specialty and local protocols / pharmacy.
- Many Irish hospitals use biosimilars (e.g. adalimumab or infliximab biosimilars) rather than originator brands β check the drug chart / pharmacy label.
π When to hold / escalate
- Active serious infection (e.g. sepsis, pneumonia, abscess, severe cellulitis): hold biologic and escalate to the prescribing specialty + treat infection.
- Fever or unexplained CRP rise on a biologic: consider opportunistic / atypical infection; do not restart until specialty advice.
- Planned major surgery: hold timing is drug- and procedure-specific β ask the prescribing specialty early (often weeks before elective surgery).
- Live vaccines (e.g. MMR, yellow fever, live zoster): contraindicated while immunosuppressed on biologics β check vaccination status before elective dosing; seek specialty/pharmacy advice.
- New neurological symptoms on anti-TNF (e.g. demyelinating features), severe infusion reaction, or suspected drug-induced lupus / hepatitis: hold and escalate same day.
- Rituximab: check hepatitis B status and local PJP prophylaxis policy before / during courses; escalate if cytopenias or hypogammaglobulinaemia with recurrent infection.
π¦ Infection & monitoring (on call)
- All biologics increase infection risk. Anti-TNF agents: screen/reactivation risk for TB and hepatitis B β do not start without specialty clearance.
- IL-17 inhibitors (e.g. secukinumab): higher candida / fungal infection risk.
- IL-6 blockade (tocilizumab): can blunt CRP and fever β infection may present atypically; also watch LFTs, FBC (neutropenia), and lipids.
- Vedolizumab is relatively gut-selective with lower systemic immunosuppression than anti-TNF, but infection still occurs β do not ignore fever.
- Shingles / VZV: higher risk on immunosuppression β see Shingles topic; involve specialty if disseminated or ophthalmic.
π Overview
- Biologics target specific immune pathways (e.g. TNF-Ξ±, interleukins, B cells, gut integrins).
- Common indications: rheumatoid arthritis, IBD, psoriasis / PsA, axial spondyloarthritis, vasculitis, and selected haematological uses for rituximab.
- Table below is a recognition aid with typical maintenance regimens β loading schedules and indication-specific doses vary.
π Commonly used biologics
- See interactive table for common agents, routes, and safety notes. Prefer the electronic drug chart / SmPC / specialty letter for the patientβs actual regimen.
π Related
Biologic Medications
Recognition aid β confirm specialty protocol
| Drug | Mechanism | Indications | Route | Frequency | Dosing | Notes |
|---|---|---|---|---|---|---|
| TNF-Ξ± Inhibitors | ||||||
| Adalimumab (Humira / biosimilars) | TNF-Ξ± inhibitor | RA, PsA, IBD, Psoriasis, AS | SC | Usually every 2 weeks (after loading) | RA/PsA often 40 mg SC q2w; IBD has loading (e.g. 160/80) β confirm indication | TB + Hep B screening; infection risk; biosimilars common in Ireland |
| Etanercept (Enbrel / biosimilars) | TNF-Ξ± receptor fusion protein | RA, PsA, AS, Psoriasis | SC | Weekly | Typically 50 mg SC once weekly | TB + Hep B screening; not used for IBD |
| Infliximab (Remicade / biosimilars) | TNF-Ξ± inhibitor | RA, IBD, Psoriasis, AS | IV | q8w after loading (0, 2, 6 weeks) | RA often 3 mg/kg; IBD often 5 mg/kg β indication-specific | Infusion reactions; TB + Hep B; biosimilars common |
| IL Inhibitors | ||||||
| Tocilizumab (RoActemra) | IL-6 receptor blocker | RA, Giant Cell Arteritis | SC / IV | SC weekly (or q2w); IV typically q4w | IV often 8 mg/kg (commonly capped at 800 mg); SC fixed dose per protocol | LFTs, FBC (neutropenia), lipids; may blunt CRP/fever |
| Secukinumab (Cosentyx) | IL-17A inhibitor | Psoriasis, PsA, AS | SC | Monthly after weekly loading | Psoriasis often 300 mg; AS/PsA often 150 mg β after loading weeks | Candida / fungal infections β |
| Ustekinumab (Stelara) | IL-12/23 inhibitor | IBD, Psoriasis, PsA | IV load (IBD) then SC; psoriasis often SC | q8β12w after loading (protocol-specific) | IBD: weight-based IV load then SC; psoriasis weight-banded SC | Confirm IBD vs dermatology regimen |
| Other Mechanisms | ||||||
| Rituximab (MabThera / biosimilars) | Anti-CD20 (B cells) | RA, vasculitis, lymphoma / haem | IV | Course-based (not PRN βas neededβ) | RA often 1 g Γ 2 (day 1 & 15); vasculitis protocols vary; lymphoma often 375 mg/mΒ² | Hep B reactivation; PJP prophylaxis per local policy |
| Vedolizumab (Entyvio) | Integrin Ξ±4Ξ²7 blocker | UC, Crohn's | IV (SC maintenance also used) | q8w after loading (0, 2, 6 weeks) | IV often 300 mg; SC maintenance per specialty protocol | Gut-selective; still monitor for infection |
TNF-Ξ± Inhibitors
Adalimumab (Humira / biosimilars)
SCTNF-Ξ± inhibitor
Indications: RA, PsA, IBD, Psoriasis, AS
Frequency: Usually every 2 weeks (after loading)
Dosing: RA/PsA often 40 mg SC q2w; IBD has loading (e.g. 160/80) β confirm indication
Notes: TB + Hep B screening; infection risk; biosimilars common in Ireland
Etanercept (Enbrel / biosimilars)
SCTNF-Ξ± receptor fusion protein
Indications: RA, PsA, AS, Psoriasis
Frequency: Weekly
Dosing: Typically 50 mg SC once weekly
Notes: TB + Hep B screening; not used for IBD
Infliximab (Remicade / biosimilars)
IVTNF-Ξ± inhibitor
Indications: RA, IBD, Psoriasis, AS
Frequency: q8w after loading (0, 2, 6 weeks)
Dosing: RA often 3 mg/kg; IBD often 5 mg/kg β indication-specific
Notes: Infusion reactions; TB + Hep B; biosimilars common
IL Inhibitors
Tocilizumab (RoActemra)
SC / IVIL-6 receptor blocker
Indications: RA, Giant Cell Arteritis
Frequency: SC weekly (or q2w); IV typically q4w
Dosing: IV often 8 mg/kg (commonly capped at 800 mg); SC fixed dose per protocol
Notes: LFTs, FBC (neutropenia), lipids; may blunt CRP/fever
Secukinumab (Cosentyx)
SCIL-17A inhibitor
Indications: Psoriasis, PsA, AS
Frequency: Monthly after weekly loading
Dosing: Psoriasis often 300 mg; AS/PsA often 150 mg β after loading weeks
Notes: Candida / fungal infections β
Ustekinumab (Stelara)
IV load (IBD) then SC; psoriasis often SCIL-12/23 inhibitor
Indications: IBD, Psoriasis, PsA
Frequency: q8β12w after loading (protocol-specific)
Dosing: IBD: weight-based IV load then SC; psoriasis weight-banded SC
Notes: Confirm IBD vs dermatology regimen
Other Mechanisms
Rituximab (MabThera / biosimilars)
IVAnti-CD20 (B cells)
Indications: RA, vasculitis, lymphoma / haem
Frequency: Course-based (not PRN βas neededβ)
Dosing: RA often 1 g Γ 2 (day 1 & 15); vasculitis protocols vary; lymphoma often 375 mg/mΒ²
Notes: Hep B reactivation; PJP prophylaxis per local policy
Vedolizumab (Entyvio)
IV (SC maintenance also used)Integrin Ξ±4Ξ²7 blocker
Indications: UC, Crohn's
Frequency: q8w after loading (0, 2, 6 weeks)
Dosing: IV often 300 mg; SC maintenance per specialty protocol
Notes: Gut-selective; still monitor for infection
Premedications for infusion biologics
Typical examples only β follow the local infusion protocol / specialty letter.
Rituximab: Often hydrocortisone 100 mg IV, chlorphenamine 10 mg IV, Β± paracetamol 1 g PO
Infliximab: Premedication varies; chlorphenamine Β± paracetamol Β± hydrocortisone if prior reaction
Tocilizumab (IV): Consider paracetamol / antihistamine if prior infusion reaction