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(adalimumab) Subcutaneous Administration
SERIOUS INFECTIONS AND MALIGNANCY
Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death [see WARNINGS AND PRECAUTIONS]. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
Discontinue HUMIRA if a patient develops a serious infection or sepsis.
Reported infections include:
- Active tuberculosis (TB), including reactivation of latent TB. Patients with TB have frequently presented with disseminated or extrapulmonary disease. Test patients for latent TB before HUMIRA use and during therapy. Initiate treatment for latent TB prior to HUMIRA use.
- Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Consider empiric anti-fungal therapy in patients at risk for invasive fungal infections who develop severe systemic illness.
- Bacterial, viral and other infections due to opportunistic pathogens, including Legionella and Listeria.
Carefully consider the risks and benefits of treatment with HUMIRA prior to initiating therapy in patients with chronic or recurrent infection.
Monitor patients closely for the development of signs and symptoms of infection during and after treatment with HUMIRA, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS].
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers including HUMIRA [see WARNINGS AND PRECAUTIONS]. Post-marketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers including HUMIRA. These cases have had a very aggressive disease course and have been fatal. The majority of reported TNF blocker cases have occurred in patients with Crohn's disease or ulcerative colitis and the majority were in adolescent and young adult males. Almost all these patients had received treatment with azathioprine or 6-mercaptopurine (6–MP) concomitantly with a TNF blocker at or prior to diagnosis. It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in
HUMIRA (adalimumab) is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). HUMIRA was created using phage display technology resulting in an antibody with human derived heavy and light chain variable regions and human IgG1:k constant regions. Adalimumab is produced by recombinant DNA technology in a mammalian cell expression system and is purified by a process that includes specific viral inactivation and removal steps. It consists of 1330 amino acids and has a molecular weight of approximately 148 kilodaltons.
HUMIRA is supplied as a sterile, preservative-free solution of adalimumab for subcutaneous administration. The drug product is supplied as either a single-use, prefilled pen (HUMIRA Pen), as a single-use, 1 mL prefilled glass syringe, or as a single-use institutional use vial. Enclosed within the pen is a single-use, 1 mL prefilled glass syringe. The solution of HUMIRA is clear and colorless, with a pH of about 5.2.
Each 40 mg/0.4 mL prefilled syringe delivers 0.4 mL (40 mg) of drug product. Each 0.4 mL of HUMIRA contains adalimumab 40 mg, mannitol 16.8 mg, polysorbate 80 0.4 mg, and Water for Injection, USP.
Each 40 mg/0.8 mL prefilled syringe, prefilled pen, or single-use institutional use vial delivers 0.8 mL (40 mg) of drug product. Each 0.8 mL of HUMIRA contains adalimumab 40 mg, citric acid monohydrate 1.04 mg, dibasic sodium phosphate dihydrate 1.22 mg, mannitol 9.6 mg, monobasic sodium phosphate dihydrate 0.69 mg, polysorbate 80 0.8 mg, sodium chloride 4.93 mg, sodium citrate 0.24 mg and Water for Injection, USP. Sodium hydroxide is added as necessary to adjust pH.
Each 20 mg/0.4 mL prefilled syringe delivers 0.4 mL (20 mg) of drug product. Each 0.4 mL of HUMIRA contains adalimumab 20 mg, citric acid monohydrate 0.52 mg, dibasic sodium phosphate dihydrate 0.61 mg, mannitol 4.8 mg, monobasic sodium phosphate dihydrate 0.34 mg, polysorbate 80 0.4 mg, sodium chloride 2.47 mg, sodium citrate 0.12 mg and Water for Injection, USP. Sodium hydroxide is added as necessary to adjust pH.
Each 10 mg/0.2 mL prefilled syringe delivers 0.2 mL (10 mg) of drug product. Each 0.2 mL of HUMIRA contains adalimumab 10 mg, citric acid monohydrate 0.26 mg, dibasic sodium phosphate dihydrate 0.31 mg, mannitol 2.4 mg, monobasic sodium phosphate dihydrate 0.17 mg, polysorbate 80 0.2 mg, sodium chloride 1.23 mg, sodium citrate 0.06 mg and Water for Injection, USP. Sodium hydroxide is added as necessary to adjust pH.
What are the possible side effects of adalimumab (Humira, Humira Pen, Humira Pen Crohns Disease/Ulcerative Colitis Starter Package)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using adalimumab and call your doctor right away if you have any of these symptoms of lymphoma:
- fever, night sweats, weight loss, tiredness;
- feeling full after eating only a small amount;
- pain in your upper stomach that may spread to your shoulder;
- easy bruising or bleeding, pale skin, feeling...
What are the precautions when taking adalimumab injection solution for subcutaneous administration (Humira)?
See also Warning section.
Before using adalimumab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as natural rubber/latex), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: current/past/recurrent infections (such as hepatitis B, TB infection, histoplasmosis), decreased bone marrow function, seizures, certain brain/spinal cord/nerve disorders (demyelinating disorders such as multiple sclerosis, Guillain-Barre syndrome), history of cancer (e.g., lymphoma), a certain type of heart disease (heart failure), lupus.
Last reviewed on RxList: 2/1/2016
This monograph has been modified to include the generic and brand name in many instances.
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