Nurses Compass
Drug Guide
Adalimumab-adbm
Classification
Therapeutic: Immunosuppressant, TNF inhibitor
Pharmacological: Monoclonal antibody (recombinant DNA origin)
FDA Approved Indications
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Crohn's disease
- Ulcerative colitis
- Plaque psoriasis
- Hidradenitis suppurativa
- Juvenile idiopathic arthritis
- Ankylosing spondylitis
Mechanism of Action
Adalimumab is a recombinant monoclonal antibody that binds specifically to tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine, thereby inhibiting its activity and reducing inflammation.
Dosage and Administration
Adult: Varies depending on condition; typical starting dose for rheumatoid arthritis is 40 mg subcutaneously every other week.
Pediatric: Dosing varies; consult specific guidelines for pediatric use.
Geriatric: Adjust as necessary based on tolerability and response; no specific dosage adjustments solely based on age.
Renal Impairment: No specific adjustment recommended.
Hepatic Impairment: No specific adjustment recommended.
Pharmacokinetics
Absorption: Subcutaneous administration leads to slow absorption with peak levels typically in 131 hours.
Distribution: Wide distribution including inflamed tissues, low volume of distribution.
Metabolism: Metabolized via proteolytic degradation; not CYP450 involved.
Excretion: Eliminated primarily via proteolytic catabolism; no significant renal excretion.
Half Life: Approximately 2 weeks (around 10-20 days).
Contraindications
- Hypersensitivity to adalimumab or its components
Precautions
- Risk of infections, including tuberculosis; screening recommended before initiation.
- Use with caution in patients with demyelinating diseases, heart failure, and during pregnancy; consult current guidelines.
Adverse Reactions - Common
- Injection site reactions (Common)
- Infections (upper respiratory, urinary tract) (Common)
Adverse Reactions - Serious
- Sepsis or severe infections (Less common)
- Demyelinating disease (Rare)
- Liver damage or hepatitis B reactivation (Rare)
- Lymphoma or other malignancies (Rare)
Drug-Drug Interactions
- Other immunosuppressants, live vaccines
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Screen for infections before administering. Monitor for signs of infection, hypersensitivity, and injection site reactions.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Inject subcutaneously as prescribed. Educate patient on injection technique and side effects.
Evaluation: Assess for improvement in condition and adverse effects; monitor injection sites and infection signs.
Patient/Family Teaching
- Report any signs of infection promptly.
- Do not administer live vaccines during treatment.
- Be aware of potential side effects and when to seek medical attention.
- Follow proper injection technique and storage instructions.
Special Considerations
Black Box Warnings:
- Increased risk of serious infections and malignancies, including lymphoma.
Genetic Factors: N/A
Lab Test Interference: May cause false-positive test results for tuberculosis or other infections.
Overdose Management
Signs/Symptoms: Increased risk of infection, injection site reactions.
Treatment: Supportive care; no specific antidote. Discontinue drug and manage symptoms.
Storage and Handling
Storage: Refrigerate at 2°C to 8°C (36°F to 46°F). Do not freeze.
Stability: Stable until the expiration date provided on the packaging when stored properly.