Home Drug Guide Adalimumab

Drug Guide

Generic Name

Adalimumab

Brand Names Humira

Classification

Therapeutic: Immunosuppressant, Monoclonal Antibody

Pharmacological: Tumor Necrosis Factor (TNF) inhibitor

FDA Approved Indications

  • Rheumatoid arthritis
  • Crohn's disease
  • Ulcerative colitis
  • Plaque psoriasis
  • Ankylosing spondylitis
  • Juvenile idiopathic arthritis
  • Hidradenitis suppurativa
  • Uveitis

Mechanism of Action

Adalimumab is a recombinant human IgG1 monoclonal antibody that binds specifically to tumor necrosis factor-alpha (TNF-α), thereby inhibiting its interaction with p55 and p75 cell surface TNF receptors, resulting in downregulation of inflammatory processes.

Dosage and Administration

Adult: Dosage varies based on condition; typically 40 mg subcutaneously every other week. Sometimes initial doses are higher or more frequent, depending on the condition.

Pediatric: Dosing varies; usually 20 mg or 40 mg every other week subcutaneously, adjusted for weight and condition.

Geriatric: No specific dosage adjustment necessary, but caution advised due to comorbidities.

Renal Impairment: No specific adjustments needed.

Hepatic Impairment: No specific adjustments needed.

Pharmacokinetics

Absorption: Slowly absorbed after subcutaneous administration, with peak serum concentrations in 131 hours.

Distribution: Limited to the vascular and extravascular spaces; approximately 9-13 days half-life.

Metabolism: Metabolized via proteolytic enzymes into small peptides and amino acids.

Excretion: Eliminated via catabolism in reticuloendothelial system.

Half Life: Approximately 2 weeks (around 10-20 days).

Contraindications

  • Hypersensitivity to adalimumab or any of its components.
  • Active infections, including tuberculosis

Precautions

  • Screen for latent TB before initiation.
  • Monitor for signs of infection during therapy.
  • Use with caution in patients with heart failure.
  • Potential for demyelinating disorders, lymphoma, or other malignancies.

Adverse Reactions - Common

  • Injection site reaction (Frequent)
  • Upper respiratory infection (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Serious infection (e.g., sepsis, tuberculosis reactivation) (Rare)
  • Lymphoma and other malignancies (Rare)
  • Demyelinating disease (Very rare)

Drug-Drug Interactions

  • Live vaccines (avoid concomitant use)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, injection site reactions, and allergic responses. Regular screening for TB prior to therapy.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity

Implementation: Administer subcutaneously as directed. Educate patient about infection signs; maintain aseptic technique.

Evaluation: Assess for reduction in disease activity and monitor for adverse effects.

Patient/Family Teaching

  • Keep appointments for routine screening and injections.
  • Report signs of infection immediately.
  • Do not receive live vaccines during therapy.
  • Warn about possible injection site reactions and how to manage them.

Special Considerations

Black Box Warnings:

  • Serious infections and malignancies, including lymphoma.
  • TB reactivation.

Genetic Factors: No specific genetic testing required.

Lab Test Interference: May cause false-positive tests for tuberculosis via skin test (use interferon-gamma release assays for better accuracy).

Overdose Management

Signs/Symptoms: No specific overdose reports; potential for exaggerated immunosuppression leading to severe infection.

Treatment: Supportive care, monitoring, and infection management.

Storage and Handling

Storage: Store in a refrigerator (2°C to 8°C). Do not freeze.

Stability: Stable until the expiration date printed on the vial if unopened. Once opened, use promptly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.