Nurses Compass
Drug Guide
Adalimumab-bwwd
Classification
Therapeutic: Immunosuppressant; TNF inhibitor
Pharmacological: Monoclonal antibody against tumor necrosis factor-alpha (TNF-α)
FDA Approved Indications
- Crohn's disease
- Ulcerative colitis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Plaque psoriasis
- Juvenile idiopathic arthritis
- Hidradenitis suppurativa
- Uveitis
- Malignancies associated with immunosuppressive therapy
Mechanism of Action
Adalimumab binds specifically to TNF-α, a pro-inflammatory cytokine, neutralizing its activity and thereby reducing inflammation and immune response.
Dosage and Administration
Adult: Dosing varies by indication; typically 40 mg subcutaneously every other week. Dosage adjustments may be necessary based on individual response and tolerability.
Pediatric: Dosing depends on weight and condition; specific pediatric dosing guidelines should be followed.
Geriatric: No specific dosage modifications, but age-related factors should be considered.
Renal Impairment: No specific adjustments required.
Hepatic Impairment: No specific data; use with caution.
Pharmacokinetics
Absorption: Subcutaneous absorption is slow and incomplete; peak serum concentrations occur approximately 4-8 days after injection.
Distribution: Distributed mainly within the vascular and interstitial spaces.
Metabolism: Metabolized via proteolytic pathways into small peptides and amino acids.
Excretion: Primarily degraded in the reticuloendothelial system; not renally excreted.
Half Life: Approximately 2 weeks (about 10-20 days).
Contraindications
- Hypersensitivity to adalimumab or any excipients.
- Active infections, including tuberculosis.
Precautions
- Screen for latent TB before initiating therapy.
- Caution in patients with demyelinating diseases, heart failure, or risk of malignancy. Monitor for infections and other adverse events.
Adverse Reactions - Common
- Injection site pain or reactions (Common)
- Infections (upper respiratory, urinary tract) (Common)
- Headache (Common)
Adverse Reactions - Serious
- Serious infections (e.g., tuberculosis, bacterial sepsis) (Serious)
- Lymphoma or other malignancies (Serious)
- Demyelinating diseases (Serious)
- Severe allergic reactions (anaphylaxis) (Serious)
Drug-Drug Interactions
- Other biologics, immunosuppressants, live vaccines
Drug-Food Interactions
- None specifically noted
Drug-Herb Interactions
- Caution with herbal supplements that may affect immune function.
Nursing Implications
Assessment: Monitor for signs of infection, neurological symptoms, and hypersensitivity reactions. Assess for tuberculosis prior to therapy.
Diagnoses:
- Risk for infection related to immunosuppression
- Risk for tissue injury due to allergic or adverse reactions
Implementation: Administer subcutaneously as prescribed. Educate patient to report signs of infection or adverse effects.
Evaluation: Evaluate treatment efficacy (reduction in symptoms). Monitor for adverse reactions.
Patient/Family Teaching
- Advise to report signs of infection immediately.
- Instruct on proper injection technique.
- Warn about increased risk of infections and malignancies.
- Inform about possible side effects and when to seek medical attention.
Special Considerations
Black Box Warnings:
- Serious infections, including tuberculosis, and malignancies, including lymphoma.
Genetic Factors: None specific.
Lab Test Interference: None noted.
Overdose Management
Signs/Symptoms: Possible increased risk of infection or adverse reactions.
Treatment: Supportive care; no specific antidote. Monitor vital signs and symptoms. Discontinue drug and provide appropriate therapy.
Storage and Handling
Storage: Store in refrigerator at 2°C to 8°C (36°F to 46°F); do not freeze.
Stability: Stable until the expiration date printed on the package when stored properly. Protect from light.