Adalimumab is an anti TNF (anti-tumour necrosis factor) drug which has been approved by NICE for AS.
Adalimumab is only available on prescription from a consultant rheumatologist.
The usual dose of adalimumab is 40 mg every other week (once every 2 weeks), given by an injection under the skin (subcutaneous injection). You, your partner, or another member of your family can learn to give the injections. If this is not possible, the injections can be given by your rheumatology nurse specialist or district nurse.
If you are being prescribed adalimumab it is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on adalimumab and that you are therefore at risk of its side-effects, including infections.
Time adalimumab takes to work
If you respond to adalimumab you will probably feel better in 2-12 weeks.
Possible risks or side effects
Reactions at the injection site (e.g. redness, swelling or pain) may occur. These reactions are usually not serious.
Adalimumab has effects on the body's own defence system (the immune system), and therefore may make you more likely to develop infections. You should tell your doctor or rheumatology nurse straight away if you develop any of the following after starting adalimumab:
- a sore throat
- a fever
- any other symptoms of infection
- any other new symptoms or anything else that concerns you.
You should stop adalimumab and see your doctor immediately if:
- any of the symptoms listed above are severe
- you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
- you develop chickenpox or shingles. Chickenpox and shingles can be severe in people who are on treatments such as adalimumab which affect the immune system. Therefore you may need antiviral treatment, which your doctor will be able to prescribe.
Very rarely, people taking adalimumab may develop a condition called drug-induced lupus, which is usually mild. The symptoms are a rash, fever and increased joint pain. Your doctor will check for this with a blood test. If you develop drug-induced lupus, the adalimumab will be stopped and the condition usually then disappears.
It is possible that there may be a slightly increased risk of certain types of cancer in patients using anti-TNF drugs. Such a link has not been proven but is the subject of current research. Please discuss this with your doctor if you are concerned.
Anti-TNF drugs have been associated with certain types of skin cancer - these can be treated when diagnosed early.
As yet, the long-term side-effects of adalimumab are not fully understood because it is a relatively new drug.
Reducing the risk of infection
Because of its effects on the immune system, adalimumab may make you more likely to pick up food-borne infections such as salmonella and listeria, which can result in food poisoning and other serious illnesses. You can lower this risk by avoiding foods such as:
- raw eggs or products made from raw eggs (such as mayonnaise, although many commercially available products are likely to be safe)
- unpasteurised milk
- mould-ripened soft cheeses (e.g. Brie and Camembert) and blue cheeses (whether pasteurised or unpasteurised), feta and goat's cheese
- undercooked meat and poultry
- all types of pâté.
You should also wash all raw fruit and vegetables and make sure that chilled ready meals are thoroughly cooked before eating. For further advice see the NHS Choices web page on food safety.
Checks needed while on adalimumab
You will have a chest x-ray and blood tests before starting treatment. You may also have further blood tests while you are on adalimumab to monitor its effects.
Taking other medicines along with adalimumab
Adalimumab may be prescribed along with other medicines. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are on adalimumab.
Adalimumab is not a painkiller. If you are already on a non-steroidal anti inflammatory drug (NSAID) or painkillers you can carry on taking these as well as adalimumab, unless your doctor advises otherwise.
Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.
If you are on adalimumab it is recommended that you should not be immunised with ‘live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.
Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines are safe and recommended.
Adalimumab and surgery
If you are going to have an operation please inform your doctor, as you are likely to be advised to stop the adalimumab temporarily before and after surgery.
Adalimumab and fertility or pregnancy
No-one knows the risk of adalimumab to an unborn baby. Women of childbearing age therefore must use contraception while on adalimumab. If you are planning to become pregnant, you should continue to use contraception for 5 months after stopping adalimumab.
You should not breastfeed if you are on adalimumab. The drug may pass into the breast milk and could be harmful to your baby.
Adalimumab and travelling
Adalimumab should be kept in a cool environment (2-8 degrees centigrade). Transporting adalimumab in a cooler with ice packs should maintain the drug at the right temperature. You may want to test the cool bag with a thermometer before travelling. Abbott (the manufacturer of adalimumab) does NOT have any recommendations on cool bags. A company called MedActiv sell cooling travel bags specicially designed for anti TNF pens.
Once you arrive at your destination, adalimumab should be kept at 2-8 degrees centigrade until you need to use it.
Adalimumab should then be used in the usual way, as stated in the Patient Information Leaflet. You are advised to keep your adalimumab patient alert card with you at all times.
Before you leave you may wish to contact your airline / sea carrier regarding its policy on the storage and carriage of prescription medicines (including syringes) on board its vessels. Some carriers may make provision to store medications for customers at the right temperature during travel.
Useful travel tips
- If you need to take adalimumab with you when travelling, it should be stored in a cool carrier with an ice pack and protected from light.
- Test the selected container system before you go with ice packs to see if it keeps to the right temperature over the travel time.
- Be sure to put adalimumab in a plastic zip lock bag to ensure that the product is not exposed to moisture or condensation.
- Make sure there is a pharmacy label on the adalimumab carton when travelling.
- If travelling by sea/air, obtain a note from your healthcare provider stating that you are on this medication.
- If allowed by airport security, carry on your adalimumab rather than putting it in your luggage and checking it in.
- Confirm the availability of refrigeration during travel and at your final destination.
- Once you arrive at your destination, adalimumab should be kept in the fridge until it is required for injection.
Last reviewed: October 2010
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