• Use adalimumab cautiously in patients
with recurrent infection or increased risk
of infection, patients who live in regions
where tuberculosis and mycoses are
endemic, and patients with a history of
CNS demyelinating disorders because they
occur, rarely, during adalimumab therapy.
WARNING If patient has evidence of an
active infection when drug is prescribed,
therapy shouldn’t start until infection has
been treated.Monitor all patients for
infection during therapy, especially those
receiving immunosuppressants. If a serious
infection develops, expect prescriber
to stop drug.
•Make sure patient has a tuberculin skin
test before therapy starts. If skin test is
positive, treatment of latent tuberculosis
will start before adalimumab, as prescribed.
• Be aware that the needle cover of the
syringe contains dry rubber. Don’t handle
if you’re allergic to latex.
• To activate the protection device on needles
of prefilled syringes delivered to institutions,
hold the syringe in one hand and,
with the other hand, slide outer protective
shield over exposed needle until it locks
WARNING Stop adalimumab immediately
and tell prescriber if patient has an allergic
reaction. Expect to provide supportive
•Watch closely for evidence of congestive
heart failure (sudden, unexplained weight
gain; dyspnea; crackles; anxiety), and notify
prescriber if they occur.
•Monitor patient’s CBC, as ordered,
because adalimumab may have adverse
hematologic effects. Notify prescriber
about persistent fever, bruising, bleeding,
• Be aware that adalimumab belongs to a
group of drugs called tumor necrosis factor
(TNF) blockers. Although rare, malignancies,
especially lymphomas and
leukemias, have occurred in patients receiving
TNF blockers, including children.
Patients with rheumatoid arthritis, especially
those with very active disease, are at
greatest risk.Monitor patients closely.
vInform patient that the first injection of
adalimumab must take place with a health
care professional present.
• Teach patient or caregiver how to give
adalimumab as a subcutaneous injection
at home, if applicable. Emphasize importance
of injecting the full amount in the
syringe (0.8 ml) to obtain the correct dose
of 40 mg.
• If patient is allergic to latex, explain that
the needle cover contains rubber.
• Caution patient against reusing needles
and syringes. Provide patient or caregiver
with a puncture resistant container for
disposal of needles and syringes at home.
• Instruct patient or caregiver to rotate
injection sites and to avoid injecting in any
area that’s tender, bruised, red, or hard.
• Inform patient that prefilled syringes must
be refrigerated (not frozen), protected
from light, and stored in the original container.
• Urge patient to check expiration dates and
not to use outdated drug.
• Review signs and symptoms of an allergic
reaction (rash, swollen face, difficulty
breathing), and tell patient to seek emergency
care immediately if these occur.
• Inform patient that injection site reactions
(such as redness, rash, swelling, itching,
and bruising) may occur but are usually
mild and transient. Instruct him to apply a
towel soaked with cold water on the injection
site if it hurts or remains swollen. If
reaction does not disappear or seems to
worsen, tell patient to call prescriber
• Inform patient that tuberculosis may
occur during adalimumab therapy.
Instruct him to report persistent cough,
wasting or weight loss, and low-grade
fever to prescriber.
• Teach patient to recognize evidence of
infection and bleeding disorders and to
tell prescriber if they occur; drug may
need to be stopped. Advise patient to
avoid people with infections and to have
all prescribed laboratory tests.
• Inform patient that the risk of certain
kinds of cancer, especially lymphomas, is
higher in patients taking adalimumab but
still rare. Emphasize the importance of
follow-up visits and reporting an unusual
or sudden onset of signs or symptoms.
• Caution patient against receiving livevirus
vaccines while taking adalimumab
because doing so may adversely effect the
• Inform patient that blood samples may be
needed periodically, but especially around
week 24 of therapy, to check for autoantibody
development. Explain that adalimumab
therapy will need to be stopped if
• Instruct patient to report lupus-like signs
and symptoms that, although rare, may
occur during therapy, such as chest pain
that doesn’t go away, shortness of breath,
joint pain, or a rash on cheeks or arms
that’s sensitive to the sun. Explain that
drug may be stopped if these occur.
• Advise patient to inform all health care
providers about adalimumab use and to
inform prescriber about any OTC medications
being taken, including herbal remedies
and vitamin and mineral supplements.