II. Indications

III. Contraindications

V. Precautions

  1. See TNF Inhibitor
  2. TNF Inhibitors predispose to serious infections and malignancy
  3. Prepare for TNF Inhibitor use with infection screening (e.g. Tuberculosis) and Immunizations
    1. See Monoclonal Antibody

VI. Medications

  1. Humira (Adalimumab)
    1. Original prototype drug with release in 2003 for Rheumatoid Arthritis, with expanding indications since
  2. Multiple biosimilar agents pending release in 2023
    1. Abrilada (Adalimumab-afzb)
    2. Amjevita (Adalimumab-atto)
    3. Cyltezo
    4. Hulio
    5. Hyrimoz
    6. Yusimry

VII. Dosing

  1. See Monoclonal Antibody for preparation for use
  2. Background
    1. Injection sites include thigh or Abdomen
    2. Refrigerate and protect from light
    3. Stable at room Temperature for up to 14 days
    4. Allow to warm to room Temperature for 15 to 30 minutes before injection (decreased pain)
  3. General adult (and children weight >40 to 60 kg) dosing protocol
    1. Dosing protocols vary by indication and in children
    2. Active Disease (Induction)
      1. Start 160 mg SQ as a single dose (or split, given 80 mg on 2 consecutive days)
    3. Maintenance
      1. Every other week: 40 mg SQ

VIII. Adverse Effects

  1. See Tumor Necrosis Factor Inhibitor
  2. Immunosuppression
    1. Use caution in any patient prone to infection
  3. Headache
  4. Rash
  5. Injection site inflammation
  6. Gastrointestinal upset
  7. Other effects
    1. Hypertension
    2. Hyperlipidemia

IX. Safety

  1. Considered safe in Lactation
  2. Pregnancy
    1. First trimester use benefit outweighs risk if indicated
    2. Unknown safety after first trimester, but exposure risk increases after 20 weeks (monitored by registry)

X. Pharmacokinetics

  1. Metabolism by proteolysis

XII. References

  1. (2003) Lexi-Comp Drug Database
  2. (2023) Biologics for Crohn's Disease, Presc Lett, #390826
  3. (2023) Drugs for Inflammatory Bowel Disease, Med Lett Drug Ther 65: 105-12

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

humira (on 6/21/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
HUMIRA 40 MG/0.8 ML SYRINGE $3,121.27 each
HUMIRA PEN 40 MG/0.8 ML $3,119.47 each
HUMIRA PEN CROHN'S-UC-HS STARTER 40 MG/0.8 ML $3,115.25 each
HUMIRA PEN PSORIASIS-UVEITIS-ADOL HS STARTER 40 MG/0.8 ML $3,115.30 each
HUMIRA(CF) 40 MG/0.4 ML SYRINGE $3,123.51 each
HUMIRA(CF) PEN 40 MG/0.4 ML $3,121.75 each
HUMIRA(CF) PEN 80 MG/0.8 ML $6,721.88 each

Ontology: adalimumab (C1122087)

Definition (NCI) A recombinant, human IgG1 monoclonal antibody directed against tumor necrosis factor-alpha (TNF-alpha), with immunomodulating activity. Upon administration, adalimumab binds to TNF-alpha, thereby preventing its binding to the p55 and p75 TNF cell surface receptors and inhibiting TNF-mediated immune responses. TNF-alpha, a pro-inflammatory cytokine, is upregulated in various autoimmune diseases.
Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129) , Amino Acid, Peptide, or Protein (T116)
MSH C453439
SnomedCT 398728003, 407317001
LNC LP173592-9, MTHU047400
English adalimumab (medication), tumor necrosis factor alpha blockers adalimumab, ADALIMUMAB, adalimumab [Chemical/Ingredient], antibody d2e7, Immunoglobulin G1, anti-(human tumor necrosis factor) (human monoclonal D2E7 heavy chain), disulfide with human monoclonal D2E7 light chain, dimer, D2E7, adalimumab, D2E7 antibody, Adalimumab (product), Adalimumab, Adalimumab (substance)
Spanish adalimumab (producto), adalimumab, adalimumab (sustancia)

Ontology: Humira (C1171255)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSH C453439
LNC LA16779-3
English Humira, adalimumab (Humira), humira, Abbott brand of adalimumab