Infliximab

Abstract

Infliximab Panic attacks: 6 case reportsIn a retrospective study of 141 patients, four women and two men, aged 33-75 years, were identified after they developed panic attacks while receiving infliximab [Remicade].The six patients, who had either psoriatic arthritis or plaquetype psoriasis, were receiving IV infusions of infliximab 5 mg/kg over 2-3 hours at weeks 0, 2 and 6 during induction, and every 8 weeks thereafter. After the first 20 minutes of each administration, the infusion rate was increased from 60 mL/h to 120 mL/h. All patients experienced panic attacks during infliximab infusions, with the first episode developing during either the first, second, tenth, 20th or 24th infusion. The panic attacks occurred in each case after the infusion rate was increased. The symptoms included intense discomfort, palpitations, accelerated heart rate, nausea, muscle tension, hot flashes, a shortness of breath sensation, cough, trembling, sweating and a fear of dying. These symptoms would peak after 5 minutes and resolve within 10 minutes. Psychiatric and psychological consultations confirmed the diagnosis in each case. Infliximab was interrupted for 30-40 minutes to differentiate the presence of panic attacks with and without infusion reactions. After resolution of symptoms, infliximab infusions were restarted at a lower rate; five patients received diazepam. Two patients experienced recurrent panic attacks with each infusion. These patients received premedication with diazepam, after which they had a lower rate of episodes with reduced symptom intensity. Author comment: "[I]n all cases, the clinical manifestations of panic disorders followed the acceleration of the infusion rate (after the first 20 min of intravenous [infliximab] administration). This temporal correlation underlines the possible pathogenetic role of [infliximab] intriggering the panic attack." Saraceno R, et al. Prevalence and management of panic attacks during infliximab infusion in psoriatic patients. Dermatology 225: 236-241, No. 3, 2012. Available from: URL: http://dx.