Patients on immunosuppressive therapy have an increased risk of infections. Since infections have a potential to trigger acute porphyric attacks vigilance is motivated regarding signs or symptoms of infection and/or possible symptoms of a porphyric attack. Side effects like nausea and vomiting may potentially be porphyrinogenic through reduction in carbohydrate intake.

Infections are common in patients using immunosuppressants and since infections might trigger an acute porphyric attack, vigilance regarding signs and symptoms of an infection and/ or a porphyric attack is recommended. Common adverse reactions of infliximab that can be confused with an acute porphyric attack are gastrointestinal discomfort and nausea. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Infliximab is an antibody preparation not metabolized by CYP. No pharmacokinetic porphyrinogenic effects are suspected.

Infliximab is a chimeric human-murine immunoglobulin G1 kappa (IgG1 kappa) monoclonal antibody that has a high affinity for human tumor necrosis factor (TNF; TNF-alpha).

Infliximab is a biologic response modifier, used in the treatment of patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, and Crohns disease and ulcerative colitis. It is administered by intravenous infusion.

Mechanisms for elimination of monoclonal antibodies are not well documented but are reported to include proteolysis by the liver and the reticuloendothelial system, target-mediated elimination and nonspecific endocytosis (Keizer 2010).