Humira (adalimumab)

How is Humira Used?

Humira is a subcutaneous medication that requires injection of the medicine underneath the skin, usually on the abdomen or the thigh. This medication is commonly injected once per week or bi-weekly, and this will be determined by the patient’s doctor and the condition being treated.

When removing your Humira from the refrigerator for use, it should be left to adjust to room temperature before injection. This typically takes about 15 to 30 minutes. Users of Humira should never attempt to warm up their medication with hot water, by placing it in the microwave, or by any other such means.

Patients should not use this medication if the liquid has discoloration, appears cloudy, or has any solid particles or flakes present. Do not shake the medication for any reason.

Users will need to use rubbing alcohol to clean their preferred injection site before using this medication to avoid contamination or possible infection. It is also recommended that patients change the site of the injection to reduce the risk of damage in certain areas of the body. When injecting into a new area on the body, this should be done at least a minimum of 1 inch (or 2.5 cm) from a prior injection site.

Patients should not inject Humira into any areas that are red, bruised, sore, or hard.

Storage

Humira is required to be refrigerated when stored and kept in a temperature range of 36°F to 46°F until it is used. Patients will also need to be sure the medication is stored in its original container as well as kept away from light. Humira that has been properly refrigerated can be used until the printed expiration date on the packaging has been reached.

If a patient is traveling and refrigeration is not possible, Humira may be allowed to reach a maximum temperature of 77°F for a duration of just 14 days. It will still need to be kept out of the light despite the allowance of increased temperatures during this time period. However, your medication will need to be discarded after the 14-day period of higher temperature storage has ended.

Humira should never be frozen or stored in a freezer. If your medication has been frozen, do not use it even if it has been thawed.

Keep this medication out of the reach of children at all times.

Uses

Humira is prescribed for a variety of inflammatory conditions in adults, including but not limited to:

• ankylosing spondylitis
• autoimmune disorders
• collagen vascular disease
• Crohn’s disease
• Felty’s Syndrome
• Herpes zosters iridocyclitis
• hidradenitis suppurativa
• panuveitis
• plaque psoriasis
• psoriatic arthritis
• rheumatoid arthritis
• ulcerative colitis
• uveitis

Humira may also be prescribed for children with the following conditions:

• Crohn’s disease
• hidradenitis suppurativa
• juvenile idiopathic arthritis
• ulcerative colitis
• uveitis

Doctors may also prescribe Humira for other symptoms and conditions not listed above.

How Does Humira Work?

Humira is a TNF (Tumor Necrosis Factor) blocker. TNF is a protein that is inflammatory in nature and can result in patients experiencing cellular damage along with pain and inflammation. Being a TNF blocker, Humira blocks the production of this particular protein to reduce the symptoms present in those prescribed and taking this medication.

Humira may take 4 to 12 weeks to improve the symptoms of a patient’s inflammatory condition resulting from TNF-alpha proteins.

Dosage

Humira is available in two forms: prefilled pens and prefilled syringes.

Prefilled Humira pens come in dosages sizes of:

• 40 mg/0.8 mL (40 mg of adalimumab/0.8 mL of sterile solution)
• 80 mg/0.8 mL (80 mg of adalimumab/0.8 mL of sterile solution)

Humira prefilled syringes come in the following dosage sizes:

• 10 mg/0.1 mL (10 mg of adalimumab/0.1 mL of sterile solution)
• 20 mg/0.2 mL (20 mg of adalimumab/0.2 mL of sterile solution)
• 40 mg/0.8 mL (40 mg of adalimumab/0.8 mL of sterile solution)
• 80 mg/0.8 mL (80 mg of adalimumab/0.8 mL of sterile solution)

Additionally, Humira may also come in a vial for use in pediatric patients. A dose of 50 mg of adalimumab is contained in each milliliter of sterile solution.

Overdose

Only take Humira as prescribed by your doctor based on the treatment plan discussed for your personal healthcare situation. Taking too much Humira or additional doses can result in severe side effects. If you have taken too much Humira, contact your doctor or your local Poison Control Center. If you are experiencing severe side effects, call 911 and seek emergency attention immediately.

Side Effects

Due to its immunosuppressant qualities, patients are at an increased risk of infection when taking Humira.

The most common side effects of taking Humira are as follows:

• rashes
• infections
• headaches
• reactions at the site of injection
  • bleeding
  • pain
  • itching
  • swelling
  • redness

Some of the following side effects may occur and should be discussed with your doctor if they remain persistent or increase in severity while taking Humira:

• headache
• nausea
• weakness
• fatigue
• scarring
• rash
• upper respiratory infections (i.e., sinus infections or colds)
• severe or persistent reactions at the injection site

Please contact your doctor for further information if you experience any of the following rare side effects as these can potentially lead to serious health concerns:

• double vision
• chest pain
• cough
• difficulties with breathing
• pain or weakness in the limbs
• abdominal pain
• night sweats
• joint pain
• fever
• flu-like symptoms
• pus-filled bumps on the skin
• red or scaley skin patches
• cold sores
• oral ulcers (sores)
• changes in skin color
• numbness or tingling sensations
• weight loss
• difficulty with swallowing

Patients should also be wary of any symptoms when taking Humira that may indicate heart problems, liver trouble, a urinary tract infection, anemia, or generalized infection. Unusual bleeding (such as bleeding gums, blood in the urine, nosebleeds, coughing up blood, cuts that will not stop bleeding, or unusual or excessive bruising) may also indicate a serious medical condition that needs to be addressed with a healthcare professional.

If any of the following symptoms occur when taking this medication, patients should stop taking Humira and immediately seek out medical attention as soon as possible:

• shortness of breath accompanied by swelling of the feet or hands
• signs of severe infection (rapid heartbeat, skin rash, fever, chills, shakiness, rapid breathing, confusion)
• symptoms of a severe allergic reaction
  • anaphylaxis: trouble breathing, facial swelling, swelling of the throat
  • hives
• indications of a blood clot in the leg, arm, or lungs
  • limbs: pain, tenderness, redness, swelling, warmth
  • lungs: coughing, trouble breathing, sweating, coughing up blood, sharp chest pain worsened by inhalation, unconsciousness

Additionally, there may also be side effects caused by Humira that have not been documented. Contact your doctor with any questions regarding symptoms you may experience after taking Humira.

Warnings & Precautions

Before patients begin using Humira, they need to inform their doctor of any medications they are currently taking as well as any allergies and medical conditions they may have, whether they are pregnant or planning on becoming pregnant, whether they are currently or planning to breastfeed, and any other relevant or notable information about their health and lifestyle.

Patients taking Humira who develop sepsis or a serious infection during use should have their treatment with Humira discontinued.

Allergic Reactions

As with any medication, some individuals have reported experiencing allergic reactions when taking Humira. If you begin taking this medication and experience symptoms of anaphylaxis or other signs of a severe allergic reaction (i.e., rash, hives, breathing difficulties), contact your doctor immediately.

Patients should also notify their prescribing physician of any latex or rubber allergies as the prefilled syringes come with a needle cover made with dry natural rubber.

Cancer

Individuals taking Humira have been documented to have a slightly increased risk of developing lymphoma after taking this medication. Lymphoma is a cancer of the immune system. This risk is further elevated if these same patients have also been treated with azathioprine, infliximab, or mercaptopurine. Patients taking immunosuppressant medications for the long term to treat conditions such as severe rheumatoid arthritis are also at an elevated risk of lymphoma development even without including Humira in their treatment plan. Contact your doctor if you experience any weight loss, night sweats, unusual fatigue, enlarged lymph node, chills, fever, or a decrease in appetite.

Children

Although children may be prescribed Humira for certain conditions, it should not be administered to any child younger than two years of age. For children receiving treatment for Crohn’s disease, this age restriction applies to those six years of age and under. Additionally, any child taking this medication should be up to date on all of their immunizations. For children that may be on an alternative vaccination schedule, please consult with a pediatrician regarding the safety and appropriate use of this medication.

Infections

Individuals taking Humira will experience an increased risk of infections, particularly fungal and bacterial infections such as pneumonia and tuberculosis. Any symptoms of infection should be immediately reported to the patient’s prescribing physician. Patients’ doctors should be informed of any preexisting infections or any history of recurring infections that may be aggravated by the administration of this medication. Additionally, individuals with hepatitis B are likely to have a relapse of this condition when taking a medication such as Humira. This risk needs to be discussed with and monitored by the patient’s prescribing physician during the duration in which the patient is taking Humira. Notify your doctor if you experience any symptoms associated with liver problems while taking this medication.

Nervous System Disorders

Patients should contact their doctor immediately if experiencing weakness, dizziness, vision trouble, tingling sensations, or numbness as these symptoms may be indicative of nervous system disorders. These disorders are rare but may occur when patients take TNF blockers such as Humira.

Immune System Disorders

Some patients taking Humira may develop a lupus-like autoimmune condition in response to the effects of the medication. This may be indicated by symptoms occurring such as a sun-sensitive rash on the skin, breathing difficulties, joint pain, and chest pain. Contact your doctor if you experience any of these symptoms while taking Humira.

Heart Failure

Humira may potentially cause the development of congestive heart failure or worsen symptoms of CHF in some patients. If you have already been diagnosed with this condition, you will need to be closely monitored for the duration of your treatment with Humira. Contact your physician immediately if you experience symptoms such as shortness of breath or swelling of the ankles or feet.

Blood Disorders

Humira may occasionally cause certain blood cell deficiencies in some patients taking the medication. Patients should seek immediate medical attention if experiencing symptoms of infection, anemia, or issues associated with bleeding.

Surgery

If patients taking Humira require surgery, they should disclose to all relevant healthcare professionals that they are currently taking this medication. These individuals may be at an increased risk of infection due to the immunosuppressant qualities of Humira, and there is very little information currently available regarding patient safety when having surgical procedures while taking this medication.

Breastfeeding

Humira may possibly be passed through breast milk. Patients taking this medication and either currently or planning on breastfeeding should discuss the risks and any other options available with their doctor.

Pregnancy

Humira should not be used during pregnancy, and patients that become pregnant while taking Humira should contact their doctor immediately. In some cases, the benefits may outweigh the risks of taking this medication during pregnancy, but proper use should be determined by a healthcare professional based on the patient’s preexisting condition(s) being treated with Humira as well as their tolerance for the medication.

Psoriasis

Some individuals taking Humira have reported worsening or even new development of psoriasis while taking this medication. Contact your doctor if you begin to experience pus-filled bumps or scaly red patches on your skin while taking Humira.

Seniors

Individuals above the age of 65 years old may be at an increased risk of side effects when taking Humira.

Vaccines

Patients should be current with all of the recommended vaccinations before beginning Humira or any medications similar to Humira. When taking this medication, individuals should not receive any live vaccines (i.e., typhoid, cholera, BCG, yellow fever, varicella).

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Humira. Discuss any concerns you may have with your doctor or a trusted pharmacist.

Drugs That May Interact with Humira

The following are indicated to potentially cause interactions when used while taking Humira:

• abatacept
• anakinra
• azathioprine
• bacillus Calmette-Guérin (BCG)
• baricitinib
• belimumab
• certolizumab
• cladribine
• cyclosporine
• denosumab
• echinacea
• etanercept
• fingolimod
• golimumab
• infliximab
• leflunomide
• mercaptopurine
• natalizumab
• ozanimod
• rituximab
• roflumilast
• sarilumab
• siponimod
• tacrolimus
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• thioguanine
• tocilizumab
• tofacitinib
• upadacitinib
• vaccines
• vedolizumab
• warfarin

Drugs That Should Not Be Used with Humira

The following medications should not be used alongside Humira:

• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Kineret (anakinra)
• Orencia (abatacept)
• Remicade (infliximab)
• Simponi (golimumab)

Speak to your doctor before starting Humira if you currently take any supplements or additional medications, including any prior use of Imuran (azathioprine), Purinethol (mercaptopurine, 6-MP), or Rituxan (rituximab).

Alternative Medications

For patients who are unable to take Humira or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

• Actemra (tocilizumab)
• Arava (leflunomide)
• Azulfidine (sulfasalazine)
• Benlysta (belimumab)
• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Imuran (azathioprine)
• Kevzara (sarilimumab)
• Kineret (anakinra)
• Methotrexate
• Neorol (cyclosporine)
• Olumiant (baricitinib)
• Orencia (abatacept)
• Plaquinil (hydroxychloroquine)
• Remicade (infliximab)
• Rinvoq (upadacitinib)
• Rituxan (rituximab)
• Simponi (golimumab)
• Taltz (ixekizumab)
• Xeljanz (tofacitinib)