Remicade (infliximab) suppresses part of your immune system to control inflammation, which means certain medications, vaccines, foods, and exposures carry real risks while you’re on it. Knowing what to avoid helps you stay safe and get the most out of your treatment.
Live Vaccines
Live vaccines should not be given while you’re on Remicade. Because the drug suppresses your immune system’s ability to fight certain infections, a live vaccine (which contains a weakened but living version of a virus or bacteria) could potentially cause the very infection it’s meant to prevent. Common live vaccines include the MMR (measles, mumps, rubella), the nasal spray flu vaccine (FluMist), the yellow fever vaccine, the shingles vaccine Zostavax, and the oral typhoid vaccine. Inactivated vaccines, like the standard flu shot or the newer shingles vaccine Shingrix, are generally considered safe.
If you’re planning to start Remicade, get any needed live vaccinations beforehand, with enough time between your last vaccine and your first infusion for your body to build immunity. This is especially important for children, who should be fully up to date on their vaccination schedule before beginning treatment.
For pregnant women on Remicade, there’s an additional concern. Infliximab crosses the placenta and can be detected in a newborn’s blood for up to six months after birth. During that window, infants should not receive live vaccines, including the oral rotavirus vaccine typically given at two months of age. Your pediatrician needs to know about your Remicade use so they can adjust the baby’s vaccination schedule.
Certain Medications
Combining Remicade with other biologic drugs is one of the most important things to avoid. Specifically, drugs like anakinra (Kineret) and abatacept (Orencia), which are used for rheumatoid arthritis and other inflammatory conditions, should not be taken alongside Remicade. Clinical studies found this combination increases the risk of serious infections without providing any added benefit. The same applies to tocilizumab (Actemra). The underlying logic is straightforward: stacking multiple drugs that suppress different parts of your immune system leaves you significantly more vulnerable to infection.
High-Risk Foods
Your suppressed immune system is less equipped to fight off foodborne bacteria that a healthy immune system might handle easily. Listeria is a particular concern. There’s a documented case of a pediatric Crohn’s patient on Remicade developing listeria meningitis, a severe brain infection. To reduce your risk, avoid uncooked or undercooked meat, soft cheeses (like brie, camembert, and queso fresco), unpasteurized milk and juices, and ready-to-eat deli foods that may not have been handled hygienically. Cooking food thoroughly and practicing careful food hygiene makes a meaningful difference when your immune defenses are lowered.
Environmental Infection Risks
Remicade increases your susceptibility to certain fungal infections that most people’s immune systems keep in check. Histoplasmosis is a notable example. The fungus that causes it lives in soil contaminated with bird or bat droppings and is common in parts of the Ohio and Mississippi River valleys in the U.S., as well as regions of Central and South America. Breathing in fungal spores from disturbed soil, old barns, chicken coops, or caves can lead to a serious, disseminated infection in immunosuppressed patients.
If you live in or travel to areas where these fungi are common, avoid activities like cleaning chicken coops, exploring caves, or disturbing soil in areas with heavy bird or bat droppings. Other fungal infections to be aware of include coccidioidomycosis (valley fever, found in the southwestern U.S.) and cryptococcosis. If you develop a persistent fever, cough, or unexplained fatigue after potential exposure, bring it up with your doctor promptly, because these infections can mimic a flare of your underlying condition and get missed.
Smoking
If you have Crohn’s disease and smoke, there’s evidence that smoking may reduce how well Remicade works for you. One U.S. study of 100 Crohn’s patients found that nonsmokers with intestinal (luminal) disease had a 73% response rate to infliximab, compared to just 22% for smokers. Nonsmokers also stayed in remission longer: 59% maintained remission for at least two months, versus only 6% of smokers. A UK study of 74 patients found similar results, with smokers responding at a rate of 52% compared to 84% for nonsmokers, and smokers relapsing more than three times as often.
Not every study has confirmed this effect. Several larger European studies found no significant difference in response rates between smokers and nonsmokers. The inconsistency may reflect differences in study design, patient populations, or disease severity. Still, given that smoking independently worsens Crohn’s disease and that multiple studies suggest it may blunt Remicade’s effectiveness, quitting is worth serious consideration if you’re investing in this treatment.
Poorly Timed Surgery and Dental Work
If you need surgery, dental procedures, or any other invasive procedure, timing matters. The general recommendation is to schedule these between infusions, waiting a minimum of 14 days after your last Remicade infusion before the procedure. After the procedure, you should wait at least 14 days before your next infusion, and only restart once the wound has healed completely with no signs of infection. This window helps ensure your immune system has enough function to handle wound healing and fight off any bacteria introduced during the procedure.
Excessive Sun Exposure
People with inflammatory bowel disease already have an elevated risk of non-melanoma skin cancers, roughly 46% higher than the general population. Much of that increased risk appears to be driven by thiopurine medications (like azathioprine or 6-mercaptopurine), which nearly double the odds. Remicade on its own may not significantly add to skin cancer risk based on current data, but many patients take it alongside a thiopurine, and immunosuppression in general warrants extra caution. Sun-protective clothing, broad-spectrum sunscreen, and limiting time in direct sun are practical steps worth building into your routine, especially during prolonged outdoor activities.
Remicade and Heart Failure
If you have moderate or severe heart failure, higher doses of Remicade are formally contraindicated. The FDA label specifically states that doses above 5 mg/kg should not be used in these patients. Clinical trials found that Remicade did not improve heart failure outcomes and, at higher doses, worsened them. If you have any history of heart failure, your prescribing doctor needs to know before you start treatment.
Warning Signs of Nerve Problems
In rare cases, Remicade has been linked to demyelinating conditions, where the protective coating around nerves becomes damaged. Symptoms can include vision changes, numbness or tingling in the arms or legs, and weakness. Optic neuritis, an inflammation of the nerve connecting the eye to the brain, is a recognized rare side effect. In one documented case, a patient developed blurred vision and swelling of both optic nerves during treatment. If you experience new visual disturbances, persistent numbness, or unexplained weakness, these symptoms need prompt evaluation. Patients with a pre-existing demyelinating condition like multiple sclerosis should generally avoid Remicade entirely.