Nurses Compass
Drug Guide
Adalimumab-adaz
Classification
Therapeutic: Immunosuppressant / Anti-TNF alpha monoclonal antibody
Pharmacological: Tumor necrosis factor (TNF) inhibitor
FDA Approved Indications
- Rheumatoid arthritis
- Crohn's disease
- Ulcerative colitis
- Psoriasis (plaque psoriasis, psoriatic arthritis)
- Ankylosing spondylitis
- Hidradenitis suppurativa
- Juvenile idiopathic arthritis
- Ankylosing spondylitis
Mechanism of Action
Adalimumab-adaz is a monoclonal antibody that binds to and neutralizes tumor necrosis factor-alpha (TNF-alpha), thereby reducing inflammation and immune response associated with autoimmune diseases.
Dosage and Administration
Adult: Variable dosing depending on condition; typically 40 mg every other week subcutaneously.
Pediatric: Dosing varies by condition and weight; consult specific prescribing information.
Geriatric: No specific dosage adjustment necessary, but monitor closely due to potential increased risk of infection.
Renal Impairment: No specific dosage adjustment required.
Hepatic Impairment: No specific dosage adjustment required.
Pharmacokinetics
Absorption: Subcutaneous absorption with peak concentrations in about 4-8 days.
Distribution: Limited volume of distribution, primarily extracellular fluid.
Metabolism: Proteolytic catabolism to peptides and amino acids; not metabolized by cytochrome P450 enzymes.
Excretion: Excreted via proteolytic pathways, not renal excretion.
Half Life: Approximately 2 weeks (around 10-20 days).
Contraindications
- Hypersensitivity to adalimumab or its components.
- Active severe infections.
Precautions
- Screen for latent TB before initiation.
- Monitor for signs of infection during therapy.
- Potential for increased risk of lymphoma and other malignancies.
- Use with caution in patients with demyelinating disease, heart failure, or hepatic impairment.
Adverse Reactions - Common
- Injection site reactions (pain, erythema) (Common)
- Upper respiratory infections (Common)
- Headache (Common)
Adverse Reactions - Serious
- Serious infections (pneumonia, sepsis) (Rare but serious)
- Lymphoma or other malignancies (Rare)
- Demyelinating disorders (Rare)
- Hepatitis B reactivation (Rare)
Drug-Drug Interactions
- Other immunosuppressants (e.g., methotrexate, azathioprine)
- Live vaccines (avoid during therapy)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of infection, TB screening prior to therapy, liver function tests.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Administer as prescribed subcutaneously, educate patient about infection signs, ensure TB testing is current.
Evaluation: Monitor for effectiveness (reduction in disease symptoms), adverse effects, and signs of infection.
Patient/Family Teaching
- Report any signs of infection, unusual rash, or allergic reactions.
- Follow schedule for injections.
- Avoid live vaccines during therapy.
- Inform about possible side effects and when to seek medical attention.
Special Considerations
Black Box Warnings:
- Serious infections, including tuberculosis and invasive fungal infections.
- Lymphoma and other malignancies.
- Demyelinating disease.
Genetic Factors: Not specifically indicated.
Lab Test Interference: May affect inflammatory markers such as CRP and ESR.
Overdose Management
Signs/Symptoms: Injection site reactions, hypersensitivity.
Treatment: Supportive care; no specific antidote. Discontinue drug and provide symptomatic treatment.
Storage and Handling
Storage: Refrigerate at 2-8°C (36-46°F); do not freeze.
Stability: Stable until the expiration date on the vial. Protect from light.