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MEDICATION GUIDE

HUMIRA®
(Hu-MARE-ah)
(adalimumab) injection

Read the Medication Guide that comes with HUMIRA (adalimumab) before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment.

What is the most important information I should know about HUMIRA (adalimumab) ?

HUMIRA (adalimumab) is a medicine that affects your immune system. HUMIRA (adalimumab) can lower the ability of your immune system to fight infections. Serious infections have happened in people taking HUMIRA (adalimumab) . These serious infections include tuberculosis (TB) and infections caused by viruses, fungi or bacteria that have spread throughout the body. Some people have died from these infections.

• Your doctor should test you for TB before starting HUMIRA (adalimumab) .
• Your doctor should check you closely for signs and symptoms of TB during treatment with HUMIRA (adalimumab) .

You should not start taking HUMIRA (adalimumab) if you have any kind of infection unless your doctor says it is okay.

Before starting HUMIRA (adalimumab) , tell your doctor if you:

• think you have an infection or have symptoms of infection such as:

• are being treated for an infection
• get a lot of infections or have infections that keep coming back
• have diabetes
• have TB, or have been in close contact with someone with TB
• were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure.
• live or have lived in certain parts of the country (such as the Ohio and Mississippi River valleys) where there is an increased risk for getting certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, or blastomycosis). These infections may happen or become more severe if you use HUMIRA (adalimumab) . Ask your doctor if you do not know if you have lived in an area where these infections are common.
• have or have had hepatitis B
• use the medicine ORENCIA® (abatacept), KINERET® (anakinra), RITUXAN® (rituximab), IMURAN® (azathioprine), or PURINETHOL® (mercaptopurine, 6-MP).
• are scheduled to have major surgery

After starting HUMIRA (adalimumab) , call your doctor right away if you have an infection, or any sign of an infection.

HUMIRA (adalimumab) can make you more likely to get infections or make any infection that you may have worse.

Cancer

• For children and adults taking TNF-blockers, including HUMIRA (adalimumab) , the chances of getting cancer may increase.
• There have been cases of unusual cancers in children, teenagers, and young adults using TNF-blockers.
• People with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma.
• If you use TNF blockers including HUMIRA (adalimumab) your chance of getting two types of skin cancer may increase (basal cell cancer and squamous cell cancer of the skin). These types of cancer are generally not life-threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
• Some people receiving TNF blockers including HUMIRA (adalimumab) developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. Most of these people were male teenagers or young men. Also, most people were being treated for Crohn's disease or ulcerative colitis with another medicine called IMURAN® (azathioprine) or PURINETHOL® (6-mercaptopurine).

See the “What are the possible side effects of HUMIRA (adalimumab) ?” section.

What is HUMIRA (adalimumab) ?

HUMIRA (adalimumab) is a medicine called a Tumor Necrosis Factor (TNF) blocker. HUMIRA (adalimumab) is used to:

• Reduce the signs and symptoms of:
  • moderate to severe rheumatoid arthritis (RA) in adults. HUMIRA (adalimumab) can be used alone, with methotrexate, or with certain other medicines.
  • moderate to severe polyarticular juvenile idiopathic arthritis (JIA) in children 4 years and older. HUMIRA (adalimumab) can be used alone, with methotrexate, or with certain other medicines.
  • psoriatic arthritis (PsA) in adults. HUMIRA (adalimumab) can be used alone or with certain other medicines.
  • ankylosing spondylitis (AS) in adults.
  • moderate to severe Crohn's disease (CD) in adults when other treatments have not worked well enough.
• Treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

What should I tell my doctor before taking HUMIRA (adalimumab) ?

HUMIRA (adalimumab) may not be right for you. Before starting HUMIRA (adalimumab) , tell your doctor about all of your health conditions, including if you:

• have an infection. See “What is the most important information I should know about HUMIRA (adalimumab) ?”
• have or have had cancer.
• have any numbness or tingling or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome.
• have or had heart failure.
• have recently received or are scheduled to receive a vaccine. You may receive vaccines, except for live vaccines while using HUMIRA (adalimumab) . Children with juvenile idiopathic arthritis should be brought up to date with all vaccines before starting HUMIRA (adalimumab) .
• are allergic to rubber or latex. The needle cover on the prefilled syringe contains dry natural rubber. Tell your doctor if you have any allergies to rubber or latex.
• are allergic to HUMIRA (adalimumab) or to any of its ingredients. See the end of this Medication Guide for a list of ingredients in HUMIRA (adalimumab) .
• are pregnant or planning to become pregnant. It is not known if HUMIRA (adalimumab) will harm your unborn baby. HUMIRA (adalimumab) should only be used during a pregnancy if needed.
  Pregnancy Registry: Abbott Laboratories has a registry for pregnant women who take HUMIRA (adalimumab) . The purpose of this registry is to check the health of the pregnant mother and her child. Talk to your doctor if you are pregnant and contact the registry at 1–877–311–8972.
• breastfeeding or plan to breastfeed. You and your doctor should decide if you will breastfeed or use HUMIRA (adalimumab) . You should not do both.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Especially tell your doctor if you use:

• ORENCIA® (abatacept), KINERET® (anakinra), REMICADE® (infliximab), ENBREL® (etanercept), CIMZIA® (certolizumab pegol) or SIMPONI® (golimumab), because you should not use HUMIRA (adalimumab) while you are also taking one of these medicines.
• RITUXAN® (rituximab). Your doctor may not want to give you HUMIRA (adalimumab) if you have received RITUXAN® (rituximab) recently.
• IMURAN® (azathioprine) or PURINETHOL® (mercaptopurine, 6-MP).

Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.

How should I take HUMIRA (adalimumab) ?

• HUMIRA (adalimumab) is given by an injection under the skin. Your doctor will tell you how often to take an injection of HUMIRA (adalimumab) . This is based on your condition to be treated. Do not inject HUMIRA (adalimumab) more often than you were prescribed.
• See the Patient Instructions for Use inside the carton for complete instructions for the right way to prepare and inject HUMIRA (adalimumab) .
• Make sure you have been shown how to inject HUMIRA (adalimumab) before you do it yourself. You can call your doctor or 1-800-4HUMIRA (adalimumab) (1-800-448-6472) if you have any questions about giving yourself an injection. Someone you know can also help you with your injection after he/she has been shown how to prepare and inject HUMIRA (adalimumab) .
• Do not try to inject HUMIRA (adalimumab) yourself until you have been shown the right way to give the injections. If your doctor decides that you or a caregiver may be able to give your injections of HUMIRA (adalimumab) at home, you should receive training on the right way to prepare and inject HUMIRA (adalimumab) .
• Do not miss any doses of HUMIRA (adalimumab) unless your doctor says it is okay. If you forget to take HUMIRA (adalimumab) , inject a dose as soon as you remember. Then, take your next dose at your regular scheduled time. This will put you back on schedule. In case you are not sure when to inject HUMIRA (adalimumab) , call your doctor or pharmacist.
• If you take more HUMIRA (adalimumab) than you were told to take, call your doctor.

What are the possible side effects of HUMIRA (adalimumab) ?

HUMIRA (adalimumab) can cause serious side effects, including:

See “What is the most important information I should know about HUMIRA (adalimumab) ?”

• Serious Infections.
  Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA (adalimumab) and during treatment with HUMIRA (adalimumab) . Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA (adalimumab) . People who had a negative TB skin test before receiving HUMIRA (adalimumab) have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA (adalimumab) :
  • cough that does not go away
  • low grade fever
  • weight loss
  • loss of body fat and muscle (wasting)
• Hepatitis B infection in people who carry the virus in their blood.
  If you are a carrier of the hepatitis B virus (a virus that affects the liver), the virus can become active while you use HUMIRA (adalimumab) . Your doctor may do blood tests before you start treatment with HUMIRA (adalimumab) and while you are using HUMIRA (adalimumab) . Tell your doctor if you have any of the following symptoms of a possible hepatitis B infection:

• Allergic reactions. Allergic reactions can happen in people who use HUMIRA (adalimumab) . Call your doctor or get medical help right away if you have any of these symptoms of a serious allergic reaction:
  • hives
  • swelling of your face, eyes, lips or mouth
  • trouble breathing
• Nervous system problems. Signs and symptoms of a nervous system problem include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
• Blood problems. Your body may not make enough of the blood cells that help fight infections or help to stop bleeding. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
• New heart failure or worsening of heart failure you already have. Call your doctor right away if you get new worsening symptoms of heart failure while taking HUMIRA (adalimumab) , including:
  • shortness of breath
  • swelling of your ankles or feet
  • sudden weight gain.
• Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or a rash on your cheeks or arms that gets worse in the sun. Symptoms may improve when you stop HUMIRA (adalimumab) .
• Liver Problems. Liver problems can happen in people who use TNF-blocker medicines. These problems can lead to liver failure and death. Call your doctor right away if you have any of these symptoms:
  • feel very tired
  • skin or eyes look yellow
  • poor appetite or vomiting
  • pain on the right side of your stomach (abdomen)
• Psoriasis. Some people using HUMIRA (adalimumab) had new psoriasis or worsening of psoriasis they already had. Tell your doctor if you develop red scaly patches or raised bumps that are filled with pus. Your doctor may decide to stop your treatment with HUMIRA (adalimumab) .

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA (adalimumab) may be stopped.

Common side effects with HUMIRA (adalimumab) include:

• injection site reactions: redness, rash, swelling, itching, or bruising. These symptoms usually will go away within a few days. Call your doctor right away if you have pain, redness or swelling around the injection site that does not go away within a few days or gets worse.
• upper respiratory infections (including sinus infections)
• headaches
• rash
• nausea

These are not all the possible side effects with HUMIRA (adalimumab) . Tell your doctor if you have any side effect that bothers you or that does not go away. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

How should I store HUMIRA (adalimumab) ?

• Store HUMIRA (adalimumab) in a refrigerator at 36°F to 46°F (2°C to 8°C) in the original container until it is used. Protect from light.
• When traveling, HUMIRA (adalimumab) should be stored in a cool carrier with an ice pack.
• Do not freeze HUMIRA (adalimumab) . Do not use HUMIRA (adalimumab) if frozen, even if it has been thawed.
• Refrigerated HUMIRA (adalimumab) may be used until the expiration date printed on the HUMIRA (adalimumab) carton, dose tray, Pen or prefilled syringe.
• Do not use a Pen or prefilled syringe if the liquid is cloudy, discolored, or has flakes or particles in it.
• Do not drop or crush HUMIRA (adalimumab) . The prefilled syringe is glass.
• Keep HUMIRA (adalimumab) , injection supplies, and all other medicines out of the reach of children.

General information about HUMIRA (adalimumab)

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use HUMIRA (adalimumab) for a condition for which it was not prescribed. Do not give HUMIRA (adalimumab) to other people, even if they have the same condition. It may harm them.

This Medication Guide summarizes the most important information about HUMIRA (adalimumab) . If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about HUMIRA (adalimumab) that was written for healthcare professionals.

For more information go to www.HUMIRA (adalimumab) .com or you can enroll in a patient support program by calling 1-800-4HUMIRA (adalimumab) (1-800-448-6472).

What are the ingredients in HUMIRA?

Active ingredient: adalimumab

Inactive ingredients: sodium chloride, monobasic sodium phosphate dihydrate, dibasic sodium phosphate dihydrate, sodium citrate, citric acid monohydrate, mannitol, polysorbate 80, and Water for Injection. Sodium hydroxide is added as necessary to adjust pH.

PATIENT INSTRUCTIONS

HUMIRA®
(Hu-MARE-ah)
(adalimumab)

SINGLE-USE PEN

Do not try to inject HUMIRA (adalimumab) yourself until you have been shown the right way to give the injections. If your doctor decides that you or a caregiver may be able to give your injections of HUMIRA (adalimumab) at home, you should receive training on the right way to prepare and inject HUMIRA (adalimumab) . It is important that you read, understand, and follow these instructions so that you inject HUMIRA (adalimumab) the right way. Call your healthcare provider if you or your caregiver has any questions about the right way to inject HUMIRA (adalimumab) .

IMPORTANT:

• Do not use HUMIRA (adalimumab) if frozen, even if it has been thawed.
• The HUMIRA (adalimumab) Pen contains glass. Do not drop or crush the Pen because the glass inside may break.
• Do not remove the gray cap or the plum-colored cap until right before your injection.
• When the plum-colored button on the HUMIRA (adalimumab) Pen is pressed to give your dose of HUMIRA (adalimumab) , you will hear a loud “click” sound.
  • You must practice injecting HUMIRA (adalimumab) with your doctor or nurse so that you are not startled by this click when you start giving yourself the injections at home.
  • The loud click sound means the start of the injection.
  • You will know that the injection has finished when the yellow marker appears fully in the window view and stops moving.

See the section below called “Prepare the HUMIRA (adalimumab) Pen”.

How should I store HUMIRA (adalimumab) ?

• Store HUMIRA (adalimumab) in a refrigerator at 36°F to 46°F (2°C to 8°C) in the original container until it is used. Protect from light.
• When traveling, HUMIRA (adalimumab) should be stored in a cool carrier with an ice pack.
• Do not freeze HUMIRA (adalimumab) . Do not use HUMIRA (adalimumab) if frozen, even if it has been thawed.
• Refrigerated HUMIRA (adalimumab) may be used until the expiration date printed on the HUMIRA (adalimumab) carton, dose tray, and Pen.
• Do not use a Pen if the liquid is cloudy, discolored, or has flakes or particles in it.
• Do not drop or crush HUMIRA (adalimumab) .
• Keep HUMIRA (adalimumab) , injection supplies, and all other medicines out of the reach of children.

Gather the Supplies for Your Injection

• You will need the following supplies for your injection of HUMIRA (adalimumab) . Find a clean, flat surface to place the supplies on.
  • 1 alcohol swab
  • 1 cotton ball or gauze pad (not included in your HUMIRA (adalimumab) carton)
  • 1 HUMIRA (adalimumab) Pen (See Figure A)
  • 1 puncture-proof sharps container for HUMIRA (adalimumab) Pen disposal (not included in your HUMIRA (adalimumab) carton)

If you do not have all of the supplies you need to give yourself an injection, go to a pharmacy or call your pharmacist. The diagram below shows what the HUMIRA (adalimumab) Pen looks like. See Figure A.

Figure A

Check the carton, dose tray, and HUMIRA (adalimumab) Pen.

1. Make sure the name HUMIRA (adalimumab) appears on the carton, dose tray, and HUMIRA (adalimumab) Pen label.

2. Do not use and call your doctor or pharmacist if:

• you drop or crush your HUMIRA (adalimumab) Pen.
• the seals on the top or bottom of the carton are broken or missing.
• the expiration date on the carton, dose tray, and Pen has passed.
• the HUMIRA (adalimumab) Pen has been frozen or left in direct sunlight. See the section: “How should I store HUMIRA (adalimumab) ?” at the beginning of these Instructions For Use.

3. Hold the Pen with the gray cap (Cap # 1) pointed down.

4. Make sure the amount of liquid in the Pen is at the fill line or close to the fill line seen through the window. This is the full dose of HUMIRA (adalimumab) that you will inject. See Figure B.

5. If the Pen does not have the full amount of liquid, do not use that Pen. Call your pharmacist.

Figure B

6. Turn the Pen over and hold the Pen with the gray cap (Cap # 1) pointed up. See Figure C.

7. Check the solution through the windows on the side of the Pen to make sure the liquid is clear and colorless. Do not use your HUMIRA (adalimumab) Pen if the liquid is cloudy, discolored, or if it has flakes or particles in it. Call your pharmacist. It is normal to see one or more bubbles in the window.

Figure C

Choose the Injection Site

8. Wash and dry your hands well.

9. Choose an injection site on:

• the front of your thighs or
• your lower abdomen (belly). If you choose your abdomen, do not use the area 2 inches around your belly button (navel). See Figure D.

Figure D

• Choose a different site each time you give yourself an injection. Each new injection should be given at least one inch from a site you used before.
• Do not inject HUMIRA (adalimumab) into skin that is:
  • sore (tender)
  • bruised
  • red
  • hard
  • scarred or where you have stretch marks
• If you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin.
• Do not inject through your clothes.

Prepare the Injection Site

10. Wipe the injection site with an alcohol prep (swab) using a circular motion.

• Do not touch this area again before giving the injection. Allow the skin to dry before injecting. Do not fan or blow on the clean area.

Preparing the HUMIRA (adalimumab) Pen

11. Do not remove the gray cap (Cap # 1) or the plum-colored cap (Cap # 2) until right before your injection.

12. Hold the middle of the Pen (gray body) with one hand so that you are not touching the gray cap (Cap # 1) or the plum-colored cap (Cap # 2). Turn the Pen so that the gray cap (Cap # 1) is pointing up. See Figure E.

Figure E

13. With your other hand, pull the gray cap (Cap # 1) straight off (do not twist the cap). Make sure the small gray needle cover of the syringe has come off with the gray cap (Cap # 1). See Figure F.

14. Throw away the gray cap (Cap # 1).

Figure F

• Do not put the gray cap (Cap # 1) back on the Pen. Putting the gray cap (Cap # 1) back on may damage the needle.
• The white needle sleeve, which covers the needle, can now be seen.
• Do not touch the needle with your fingers or let the needle touch anything.
• You may see a few drops of liquid come out of the needle. This is normal.

15. Remove the plum-colored cap (Cap # 2) from the bottom of the Pen by pulling it straight off (do not twist the cap). The Pen is now activated. Throw away the plum-colored cap.

• Do not put the plum-colored cap (Cap # 2) back on the Pen because it could cause medicine to come out of the syringe.

The plum-colored activator button:

• Turn the Pen so the plum-colored activator button is pointed up. See Figure G.

Figure G

• Do not press the plum-colored activator button until you are ready to inject HUMIRA (adalimumab) . Pressing the plum-colored activator button will release the medicine from the Pen.
• Hold the Pen so that you can see the window. See Figure H. It is normal to see one or more bubbles in the window.

Figure H

Position the Pen and Inject HUMIRA (adalimumab)

16. Position the Pen:

Gently squeeze the area of the cleaned skin and hold it firmly. See Figure I. You will inject into this raised area of skin.

Figure I

17. Place the white end of the Pen straight (at a 90° angle) and flat against the raised area of your skin that you are squeezing. Place the Pen so that it will not inject the needle into your fingers that are holding the raised skin. See Figure J.

Figure J

18. Inject HUMIRA (adalimumab)

• With your index finger or your thumb, press the plum-colored activator button to begin the injection. Try not to cover the window. See Figure K.

Figure K

• You will hear a loud “click” when you press the plum-colored activator button. The loud click means the start of the injection.
• Keep pressing the plum-colored activator button and continue to hold the Pen against your squeezed, raised skin until all of the medicine is injected. This can take up to 10 seconds, so count slowly to ten. Keep holding the Pen against the squeezed, raised skin of your injection site for the whole time so you get the full dose of medicine.
• You will know that the injection has finished when the yellow marker fully appears in the window view and stops moving. See Figure L.

Figure L

19. When the injection is finished, slowly pull the Pen from your skin. The white needle sleeve will move to cover the needle tip. See Figure M.

• Do not touch the needle. The white needle sleeve is there to prevent you from touching the needle.

Figure M

• Press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. Do not rub the injection site. You may have slight bleeding. This is normal.

20. Dispose of your used HUMIRA (adalimumab) Pen. See the section “How should I dispose of the used HUMIRA (adalimumab) Pen?”

21. Keep a record of the dates and location of your injection sites. To help you remember when to take HUMIRA (adalimumab) , you can mark your calendar ahead of time.

How should I dispose of the used HUMIRA (adalimumab) Pen?

• Do not throw the Pen in the household trash. Do not recycle.
• Do not try to touch the needle. The white needle sleeve is there to prevent you from touching the needle.
• Place the used HUMIRA (adalimumab) Pen in a puncture-proof sharps container right away. You may use a sharps container (such as a red biohazard container), a hard plastic container (such as a detergent bottle), or a metal container (such as an empty coffee can). Do not use glass or clear plastic containers. See Figure N.

Figure N

• You should follow any special state or local laws regarding the disposal of needles and syringes.
• For the safety and health of you and others, never re-use your HUMIRA (adalimumab) Pens.
• Always keep the sharps container out of the reach of children.
• The used alcohol pads, cotton balls, dose trays and packaging may be placed in your household trash.
• When the sharps container is about two-thirds full, tape the cap or lid down so it does not come off and dispose of it as instructed by your doctor, nurse, or pharmacist. Do not throw the container in the household trash. Do not recycle.

PATIENT INSTRUCTIONS FOR USE

HUMIRA®
(Hu-MARE-ah)
(adalimumab)

SINGLE-USE PREFILLED SYRINGE

Do not try to inject HUMIRA (adalimumab) yourself until you have been shown the right way to give the injections. If your doctor decides that you or a caregiver may be able to give your injections of HUMIRA (adalimumab) at home, you should receive training on the right way to prepare and inject HUMIRA (adalimumab) . It is important that you read, understand, and follow these instructions so that you inject HUMIRA (adalimumab) the right way. Call your healthcare provider if you or your caregiver has any questions about the right way to inject HUMIRA (adalimumab) .

How should I store HUMIRA (adalimumab) ?

• Store HUMIRA (adalimumab) in a refrigerator at 36°F to 46°F (2°C to 8°C) in the original container until it is used. Protect from light.
• When traveling, HUMIRA (adalimumab) should be stored in a cool carrier with an ice pack.
• Do not freeze HUMIRA (adalimumab) . Do not use HUMIRA (adalimumab) if frozen, even if it has been thawed.
• Refrigerated HUMIRA (adalimumab) may be used until the expiration date printed on the HUMIRA (adalimumab) carton, dose tray and prefilled syringe.
• Do not use a prefilled syringe if the liquid is cloudy, discolored, or has flakes or particles in it.
• Do not drop or crush HUMIRA (adalimumab) . The prefilled syringe is glass.
• Keep HUMIRA (adalimumab) , injection supplies, and all other medicines out of the reach of children.

Gather the Supplies for Your Injection

• You will need the following supplies for your injection of HUMIRA (adalimumab) . Find a clean, flat surface to place the supplies on.
  • 1 alcohol swab
  • 1 cotton ball or gauze pad (not included in your HUMIRA (adalimumab) carton)
  • 1 HUMIRA (adalimumab) prefilled syringe (See Figure A)
  • 1 puncture-proof sharps container for HUMIRA (adalimumab) prefilled syringe disposal (not included in your HUMIRA (adalimumab) carton)

If you do not have all of the supplies you need to give yourself an injection, go to a pharmacy or call your pharmacist.

The diagram below shows what a prefilled syringe looks like. See Figure A.

Figure A

Check the carton, dose tray, and prefilled syringe

1. Make sure the name HUMIRA (adalimumab) appears on the dose tray and prefilled syringe label.

2. Do not use and call your doctor or pharmacist if:

• the seals on top and bottom of the carton are broken or missing.
• the HUMIRA (adalimumab) labeling has an expired date. Check the expiration date on your HUMIRA (adalimumab) carton and do not use if the date has passed.
• the prefilled syringe that has been frozen or left in direct sunlight. See the section: “How should I store HUMIRA (adalimumab) ?” at the beginning of these Instructions for Use.
• the liquid in the prefilled syringe is cloudy, discolored or has flakes or particles in it. Make sure the liquid is clear and colorless.

Choose the Injection Site

3. Wash and dry your hands well.

4. Choose an injection site on:

• the front of your thighs or
• your lower abdomen (belly). If you choose your abdomen, do not use the area 2 inches around your belly button (navel). See Figure B.

Figure B

• Choose a different site each time you give yourself an injection. Each new injection should be given at least one inch from a site you used before.
• Do not inject into skin that is:
  • sore (tender)
  • bruised
  • red
  • hard
  • scarred or where you have stretch marks
• If you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin.
• Do not inject through your clothes.

Prepare the Injection Site

5. Wipe the injection site with an alcohol prep (swab) using a circular motion.

6. Do not touch this area again before giving the injection. Allow the skin to dry before injecting. Do not fan or blow on the clean area.

Prepare the Syringe and Needle

7. Check the fluid level in the syringe:

• Always hold the prefilled syringe by the body of the syringe. Hold the syringe with the covered needle pointing down. See Figure C.

Figure C

• Hold the syringe at eye level. Look closely to make sure that the amount of liquid in the syringe is the same or close to the:
  • 0.8 mL line for the 40 mg prefilled syringe
  • 0.4 mL line for the 20 mg pediatric prefilled syringe. See Figure D.

Figure D

8. The top of the liquid may be curved. If the syringe does not have the correct amount of liquid, do not use that syringe. Call your pharmacist.

9. Remove the needle cover:

• Hold the syringe in one hand. With the other hand gently remove the needle cover. See Figure E.
• Throw away the needle cover.

Figure E

• Do not touch the needle with your fingers or let the needle touch anything.

10. Turn the syringe so the needle is facing up and hold the syringe at eye level with one hand so you can see the air in the syringe. Using your other hand, slowly push the plunger in to push the air out through the needle. See Figure F.

Figure F

• You may see a drop of liquid at the end of the needle. This is normal.

Position the Prefilled Syringe and Inject HUMIRA (adalimumab)

Position the Syringe

11. Hold the body of the prefilled syringe in one hand between the thumb and index fingers. Hold the syringe in your hand like a pencil. See Figure G.

Figure G

• Do not pull back on the plunger at any time.
• With your other hand, gently squeeze the area of the cleaned skin and hold it firmly. See Figure H.

Figure H

Inject HUMIRA (adalimumab)

12. Using a quick, dart-like motion, insert the needle into the squeezed skin at about a 45-degree angle. See Figure I.

Figure I

• After the needle is in, let go of the skin. Pull back gently on the plunger.

If blood appears in the syringe:

• It means that you have entered a blood vessel.
• Do not inject HUMIRA (adalimumab) .
• Pull the needle out of the skin while keeping the syringe at the same angle.
• Press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. See Figure J.

Figure J

• Do not use the same syringe and needle again. Throw away the needle and syringe in your special sharps container.
• Do not rub the injection site. You may have slight bleeding. This is normal.
• Repeat Steps 1 through 12 with a new prefilled syringe.

If no blood appears in the syringe:

• Slowly push the plunger all the way in until all of the liquid is injected and the syringe is empty.
• Pull the needle out of the skin while keeping the syringe at the same angle.
• Press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. Do not rub the injection site. You may have slight bleeding. This is normal.

13. Throw away the used prefilled syringe and needle. See “How should I dispose of used prefilled syringes and needles?”

14. Keep a record of the dates and location of your injection sites. To help you remember when to take HUMIRA (adalimumab) , you can mark your calendar ahead of time.

How should I dispose of used prefilled syringes and needles?

• Do not throw the needle, or syringe, in the household trash. Do not recycle.
• Do not try to touch the needle.
• Place the used prefilled syringe and needle in a special puncture-proof sharps container. You may use a sharps container (such as a red biohazard container), a hard plastic container (such as a detergent bottle), or a metal container (such as an empty coffee can). Do not use glass or clear plastic containers. See Figure K.

Figure K

• You should follow any special state or local laws regarding the disposal of needles and syringes.
• For the safety and health of you and others, needles and used syringes must never be re-used.
• Always keep the sharps container out of the reach of children.
• The used alcohol pads, cotton balls, dose trays and packaging may be placed in your household trash.
• When the sharps container is about two-thirds full, tape the cap or lid down so it does not come off and dispose of it as instructed by your doctor, nurse or pharmacist. Do not throw the container in the household trash. Do not recycle.

Last reviewed on RxList: 4/15/2011
This monograph has been modified to include the generic and brand name in many instances.