Active ingredient: adalimumab
The text below is about the active substance adalimumab .
- Adalimumab suppresses body defenses and inhibits inflammation.
- For joint infections (rheumatism, Bechterew’s disease), intestinal infections (Crohn’s disease, ulcerative colitis), the skin diseases psoriasis and hidradenitis. Also with the eye disease uveitis and sometimes with sarcoidosis (Besnier-Boeck disease).
- You will usually notice that the disease is calming down within a few weeks. Have you not noticed an effect within 2 to 4 months? Then your doctor will find another medicine for you.
- You can administer the drug yourself. The doctor or nurse will explain how to do this.
- Usually you use an injection once every two weeks; sometimes once a week
- You may experience redness, itching, pain and swelling at the injection site. Usually this will pass on its own within a few days. Therefore always give the injection in a different place.
- Other side effects: respiratory or other infections, gastrointestinal complaints and headaches. Blood abnormalities can develop after a few weeks to months. The doctor will therefore check your blood regularly. Do you get a sore throat, fever or bruises easily? Then notify your doctor.
- Adalimumab suppresses the body’s immune responses. It belongs to the group of TNF-alpha inhibitors . Adalimumab is a so-called biological . This means that it is made by living cells in cell cultures.
- Doctors prescribe it for rheumatoid arthritis , Bechterew’s disease , juvenile idiopathic arthritis ( juvenile rheumatism ), the chronic intestinal diseases Crohn’s disease and ulcerative colitis , for eye infections (uveitis) and for the skin disorders psoriasis and hidradenitis . Doctors sometimes prescribe it for sarcoidosis (Besnier-Boeck disease).
- Rheumatoid arthritis (RA) is inflammation of the joints. It causes pain, stiffness and swelling in the joints of, for example, hands, wrists, ankles or feet. Usually the symptoms are present in the same joints on the left and right. The inflammation makes the joint thick and tender, sometimes warm. Over time, the joints get damaged.
- Rheumatoid arthritis is an autoimmune disease. This means that the body makes antibodies against its own cells, in this case the joints. This creates inflammation that further damages the joint. It is unknown why the body turns against its own cells.
- Adalimumab inhibits the body’s protein tumor necrosis factor TNF-alpha , which is caused by inflammation such as rheumatoid arthritis. This reduces inflammation and slows down rheumatoid arthritis.
- Adalimumab is a DMARD : a so-called Disease Modifying Antirheumatic Drug. These are medicines that can slow down the damage to the joints caused by rheumatism. They do not have a rapid effect on the pain, but they can suppress the inflammation symptoms.
- Physicians prescribe adalimumab when other DMARDs, such as methotrexate, have insufficient effect. It is often added to methotrexate treatment. Even if the disease comes on very quickly and is very active, the doctor may prescribe adalimumab.
- Like the other DMARDs, adalimumab does not work immediately. The effect is usually noticeable within a few weeks.
- In Bechterew’s disease, also called ankylosing spondylitis or spondyloarthritis (SA), the joints between the vertebrae and between the spine and pelvis are inflamed. The result is a painful, stiff back that causes problems, especially in the morning after getting up. By moving, the pain and stiffness gradually disappear. In an advanced stage of the disease, the vertebrae can become fused with each other, causing a crooked spine.
- In addition to the vertebral joints, knees, hips and shoulders can also be inflamed. Furthermore, tendons, such as the Achilles tendon in the heel, can become inflamed. The fingers and feet will hurt because of this. Finally, some Bechterew patients have regular eye infections or skin or intestinal diseases.
- The cause of Bechterew’s disease is still unknown. The disease is considered a rheumatic disease, but it is not the same as rheumatoid arthritis. The disease is more common in certain families.
- aims to inhibit the pain and inflammation and to prevent curling. The doctor will initially prescribe pain-relieving anti-inflammatories such as ibuprofen, diclofenac or naproxen. In addition, exercise therapy is important to keep the spine flexible. If this does not work sufficiently, the doctor can prescribe a DMARD, a so-called Disease Modifying Antirheumatic Drug. These are drugs that can slow down joint damage caused by inflammation. Adalimumab is one of the DMARDs.
Mode of action and effect
- Adalimumab inhibits the protein tumor necrosis factor TNF-alpha in the body, which is caused by inflammation such as in Bechterew’s disease. This reduces inflammation and slows Bechterew’s disease. Like the other DMARDs, adalimumab does not work right away. The complaints such as pain and stiffness usually subside within a few weeks.
- Doctors sometimes prescribe adalimumab in children with joint inflammation, such as juvenile idiopathic arthritis (juvenile rheumatism).
- In juvenile rheumatism, certain joints are inflamed. It causes pain, stiffness and swelling in the joints of, for example, hands, wrists, ankles or feet. The inflammation makes the joint thick and tender, sometimes warm. Over time, the joints can be damaged or growth retardation can occur.
Mode of action and effect
- Adalimumab inhibits the protein tumor necrosis factor TNF-alpha in the body, which is caused by inflammation such as juvenile rheumatism. This reduces inflammation and slows down juvenile rheumatism.
- Adalimumab is a DMARD : a so-called Disease Modifying Antirheumatic Drug. These are medicines that can slow down the damage to the joints caused by rheumatism. They do not have a rapid effect on the pain, but they can suppress the inflammation symptoms. The complaints such as pain and stiffness usually subside after a few weeks.
Physicians prescribe adalimumab when other DMARDs, such as sulfasalazine or methotrexate, are ineffective.
- In Crohn’s disease, parts of the intestine are inflamed. The inflammation causes abdominal pain, fever, diarrhea, fatigue and weight loss. Periods with few complaints are alternated with periods in which the disease flares up.
- The exact cause of Crohn’s disease is unknown. Probably the immune system is confused and attacks these good bacteria in the gut. This creates inflammation that further damages the intestines.
- The inflammation penetrates deep into the muscle layers of the intestines. Usually the last part of the small intestine and the first part of the colon are affected.
- The chronic inflammation causes thickening in the intestine, which makes it difficult for stool to pass. Connecting tubes (fistulas) also develop from the intestine to other organs, such as the bladder, the vagina and between parts of the intestine.
- aims to inhibit pain and inflammation and to prevent thickening and fistulas in the intestines. The doctor will usually prescribe adrenal corticosteroids (corticosteroids) initially, in enemas or as tablets to take. If these drugs do not help enough or if you cannot or should not use these drugs, the doctor may prescribe adalimumab.
- Doctors also prescribe adalimumab in children over 6 years of age with severe bowel disease.
Mode of action and effect
- Adalimumab inhibits the protein tumor necrosis factor TNF-alpha in the body, which is caused by inflammation such as in Crohn’s disease. This reduces inflammation and slows down Crohn’s disease. Your complaints, such as stomach pain and diarrhea will then decrease. It may take a few weeks before you notice the effect.
- Ulcerative colitis is a chronic inflammation of the lining of the colon. This gives you frequent and severe diarrhea, often with blood and mucus. Other complaints are abdominal pain, fever, dehydration symptoms, anemia and weight loss. Periods with few complaints are alternated with periods in which the disease flares up.
- Ulcerative colitis is an autoimmune disease. This means that the immune system attacks its own cells, in this case the colon. This creates inflammation that further damages the intestine. Usually only the last part of the intestine is affected. Over time, the disease can spread to the rest of the colon.
- Ulcerative colitis is initially treated with 5-ASA drugs, such as mesalazine, with adrenal cortex hormones (corticosteroids), azathioprine or mercaptopurine. If this has insufficient effect or if you cannot or should not use these medicines, the doctor may prescribe adalimumab.
Mode of action and effect
- Adalimumab inhibits the protein tumor necrosis factor TNF-alpha in the body, which is caused by inflammation such as ulcerative colitis. This reduces inflammation and slows down the disease. Your complaints, such as diarrhea and stomach pain, will then decrease. It may take a few weeks before you notice the effect.
- Adalimumab is used in uveitis. Uveitis is a collective term for inflammation within the eye.
- Uveitis is usually treated with anti-inflammatory eye drops. If this doesn’t work or can’t be used, your doctor may prescribe adalimumab.
- In psoriasis the skin is inflamed and scaly. The skin also often itches. The complaints vary widely; there are periods with few complaints, alternated with periods with severe symptoms. The severity of the condition ranges from 1 to 2 small spots to extensive peeling of the skin. Often the nails are also affected.
- About 1 in 20 psoriasis patients also develop joint inflammation. This form of psoriasis is called psoriatic arthritis. The joints are then painful, warm and swollen.
- It is unknown what causes psoriasis. Psoriasis is thought to be an autoimmune disease. This means that the immune system attacks its own cells, in this case the skin and joints.
Treatment of psoriasis In the case of psoriasis,
- doctors initially prescribe skin remedies that counteract inflammation and scaling, such as adrenal corticosteroids (corticosteroids) or calcitriol. If these do not help enough, the doctor will prescribe light therapy (PUVA), cyclosporine or methotrexate. If these drugs do not help either and if the psoriasis is severe, the doctor may prescribe adalimumab.
Treatment of psoriatic arthritis
- In psoriatic arthritis, the doctor initially prescribes painkillers and anti-inflammatory drugs of the NSAID type, such as diclofenac or naproxen. If this doesn’t work, the doctor will prescribe a DMARD. DMARD stands for Disease Modifying Antirheumatic Drug. These are drugs that can slow down joint damage caused by inflammation.
Adalimumab is usually only eligible if other DMARDs have insufficient effect or are not tolerated.
- Doctors also prescribe adalimumab in children over 4 years of age with severe psoriasis.
Mode of action and effect
- Adalimumab inhibits in the body the protein tumor necrosis factor TNF-alpha , which is caused by inflammation such as in psoriasis. This reduces inflammation and slows down psoriasis.
Like the other DMARDs, adalimumab does not work right away. The complaints such as scaling, itching, inflamed skin and painful joints usually subside within a few weeks.
- Other names for hidradenitis are sweat gland inflammation, hidradenitis suppurativa, acne inversa, or acne ectopica.
- Although the condition is also called acne inversa or acne ectopia, it is not the same as acne (pimples). The swellings resemble a pustule or may be slightly elongated. They can become filled with pus and burst. The condition mainly occurs in the folds of the body, such as in the armpits and groin. Furthermore, the infections can be in the buttocks and pubic area, under or between the breasts, behind the ears or in the neck. In many cases, the infections keep coming back. This causes subcutaneous swellings, cavities and corridors and later scars. It can have an unpleasant odor.
- With hidradenitis, hair follicles, sebaceous glands and sweat glands are inflamed. The symptoms worsen when the inflammation bursts and becomes infected with bacteria. The inflammation appears to be more likely in people who smoke, with diabetes or who are overweight. In addition, it is more common in women and in some families. The inflammation can worsen with stress, sweating a lot and wearing tight-fitting clothes.
- You can use paracetamol against the pain. If the inflammation often returns, doctors usually prescribe a lotion with an antibiotic, such as clindamycin. You must then use this for 3 months. If this does not help enough, the doctor can also prescribe an antibiotic to take. Only when this does not help and the symptoms are severe can the doctor prescribe adalimumab.
- Adalimumab inhibits the so-called tumor necrosis factor TNF-alpha , a protein that plays a role in inflammation. This reduces inflammation and with it the number of cysts and swelling and pain.
- Adalimumab does not work immediately. The effect is usually noticeable within a few weeks.
In sarcoidosis (Besnier-Boeck disease), inflammation occurs spontaneously in various organs and tissues in the body, for example in the lungs, lymph nodes, skin, eyes and joints. So you can have very different complaints with this condition. The disease has quiet periods with few complaints that alternate with periods in which the disease flares up. Sometimes people suffer from scar tissue as a result of the inflammation.
- The cause of sarcoidosis is still unknown. It is suspected that the immune system attacks its own cells. It also seems to run more often in certain families, so there may be a hereditary predisposition.
- Usually the complaints disappear by themselves in the long run.
If there are severe complaints, the doctor prescribes adrenal cortex hormones, such as prednisolone. This suppresses inflammation. The doctor can also prescribe anti-inflammatory painkillers (NSAIDs). If these medicines are not effective enough or have too many side effects, the doctor may try a medicine that inhibits the immune response, such as adalimumab.
In addition to the desired effect, this can cause drug side effects.
The main side effects are the following.
Sometimes (affects 10 to 30 in 100 people)
- Redness , itching, pain and swelling at the injection site. This usually disappears on its own after a few days.
- Gastrointestinal complaints , such as nausea, vomiting and stomach pain. Rarely bloating, heartburn, belching or bleeding in the stomach or intestines.
- Fewer red and white blood cells and fewer platelets . This makes you more likely to get infections , anemia and bleeding .
Call the doctor if you have a sore throat, fever, blisters in the mouth, bruises, nosebleeds, pale skin, severe tiredness, shortness of breath, persistent cough or blood in the urine. Also if you have an infection such as boil, shingles, fungal infections or cystitis.
In rare cases tuberculosis can develop. Before, during and up to 6 months after the last injection, your doctor will have your lungs checked for tuberculosis, among other things.
- Headaches , rarely migraines. In rare cases, headaches are the result of meningitis (neck spasm, meningitis). Consult your doctor for headaches that last longer than a day.
- Muscle pain or muscle cramps . Usually the muscle pain is harmless, but in very rare cases a serious side effect on the muscles can develop. The signs of this serious side effect are muscle pain, muscle weakness, feeling generally ill, fever, nausea and vomiting. The muscle pain is usually in the calves or lower back, but the whole body can also hurt. If you experience these symptoms, you should see your doctor as soon as possible.
- Too much cholesterol and other fats in the blood. Your doctor will regularly check your blood for this.
- Dry skin , rash , itching, hives, inflammation of the skin, sweating and breaking of the nails. Skin rash may result from hypersensitivity (see Rare ). In case of a rash, consult the doctor.
Rare (affects 1 to 10 in 100 people)
- Psychological complaints , such as anxiety, depression, mood swings and insomnia.
- Feeling dizzy . Very rarely ringing in the ears, deafness.
- Nerve abnormalities . Notify your doctor if you notice numbness or tingling in the arms or legs. In people with multiple sclerosis (MS) or optic nerve abnormalities, the symptoms can worsen.
- Eye complaints , such as painful eyes and inflamed eyes. Very rarely double vision and inflammation of the eyelids. It can also reduce vision. Then notify your doctor.
- Dry mucous membranes . You will notice this especially in dry eyes and dry mouth.
- Flushing and dizziness of . These side effects are due to the widening of the blood vessels.
- Increased blood pressure, increased heart rate, chest pain and palpitations. Very rarely, a heart attack or stroke can develop. In people with high blood pressure , the doctor will check the blood pressure regularly.
- Hypersensitivity . You may notice this by a rash, hives and itching. Severe hypersensitivity can be noticed by breathlessness or a swollen face, lips, mouth, tongue or throat. You can get very short of breath.
Very rarely, a severe hypersensitivity reaction with red spots and blisters on the skin develops. In these cases, you should immediately see a doctor or go to the emergency room. If you are hypersensitive you should stop taking adalimumab. Therefore, pass this on to the pharmacist. The pharmacy team can then ensure that you do not receive this medicine again.
Very rare (affects less than 1 in 100 people)
- Heart failure, due to a reduced function of the heart muscle. You will notice this from shortness of breath, breathlessness or fluid retention (swollen ankles and feet). Consult your doctor for these symptoms.
- Disorders of the liver , pancreas , gallbladder, or spleen . Notify your doctor immediately if you have fever, night sweats, weight loss, upper abdominal pain, abdominal swelling, yellow skin and whites of the eyes, nausea and dark urine. People who have previously had hepatitis B can get it again.
- Lung disorders . You may notice this by shortness of breath, cough or fever. In some cases, severe pneumonia can develop. Consult your doctor if these complaints occur.
- Increased risk of chronic diseases , such as lupus erythematosus (LE), blood vessel inflammation (vasculitis), organ inflammation (sarcoidosis), intestinal inflammation.
- More likely to develop certain types of cancer , such as lymphoma , blood cancer (leukemia), skin cancer, breast cancer, cervical cancer or lung cancer.
Consult your doctor if you experience too much of any of the above side effects or if you experience any other side effects that worry you.
- Regular : affects more than 30 in 100 people
- Uncommon : affects 10 to 30 in 100 people
- Rare : affects 1 to 10 in 100 people
- Very rare : affects less than 1 in 100 people
Always check the pharmacy label for the correct dosage.
If you are going to administer the medicine yourself, you will be instructed by the doctor or nurse. Adalimumab must be injected just under the skin of the abdomen or thigh. Always choose a different injection site. Make sure the area where you are going to inject is not damaged, red, hardened, or bruised.
Usually you use an injection once every 2 weeks. In some cases you will use an injection once a week. It is best to choose a fixed day, so that you are less likely to forget a dose.
Within a few weeks it should be clearly noticeable that the medicine is working. Usually 3 to 4 months is used for this. In some cases, such as in ulcerative colitis, it is more likely that the medicine is working. If it does not work, further administration is of no use. If the drug does work, you can use it for a long time.
- You usually use this medicine once every 2 weeks. In some cases you will use this medicine once a week: take the missed dose as soon as you remember. Take the next dose on the normal day of the dosing schedule.
driving a car?
- Dizziness, blurred vision and double vision are very uncommon with this drug. Then do not participate in traffic.
drink alcohol and eat everything?
- There are no restrictions for this with this medication.
This drug interacts with other drugs. The text below only lists the active ingredients of these drugs, not the brand names. You can check whether your medicine contains one of these active substances in your package leaflet under the heading ‘composition’.
The drugs with which the main interactions occur are the following.
- Vaccines . Talk to your doctor if you are going to be vaccinated. You should not use certain vaccines. Adalimumab decreases the effectiveness of these vaccines and increases the risk of side effects. This includes measles-mumps-rubella vaccine (MMR), yellow fever vaccine, rotavirus vaccine and BCG vaccine.
With other vaccines, you may need to get an extra vaccination or have your blood tested to see if the vaccine has worked properly. This includes influenza vaccine, tetanus vaccine and vaccine against cervical cancer.
- Abatacept and anakinra , anti-rheumatism. These drugs reduce your resistance, just like adalimumab. This can make you more likely to get infections. Consult your doctor if you have been prescribed this combination.
- Some cancer drugs . Ask your pharmacist which medicines this concerns. The effects or side effects of these drugs may change. Discuss this with your doctor.
Are you unsure whether any of the above interactions are of interest to you? Please contact your pharmacist or doctor.
- Report it to your doctor and pharmacist as soon as you are pregnant or plan to become pregnant soon. Together you can discuss the possible options.
- If you want to breast-feed, talk to your doctor. This is because this medicine passes into breast milk in small amounts. No side effects have been reported in the child so far.
- Are you on prescription or over-the-counter medications? Would you like to help increase knowledge about medication use during pregnancy and breastfeeding? Then report your experience to pREGnant .
If you stop taking this medicine, the symptoms may return. If you want to stop, talk to your doctor.
Adalimumab has been marketed internationally since 2003. It is available by prescription under the brand names Humira, Hulio, Hyrimoz, Idacio, Imraldi and Amgevita in injection solution.