Messed Up Humira Injection? The 25 Correct Answer

Patients with inflammatory bowel disease taking the biologics Humira or Cimzia (certolizumab) are at significant risk of flare-ups if they delay refilling their prescriptions by more than two days in two weeks, a study has found.

The study, titled “Defining an Optimal Adherence Threshold for Patients Taking Subcutaneous Anti-TNFs for Inflammatory Bowel Diseases,” was published in the American Journal of Gastroenterology.

AbbVie’s Humira (adalimumab) and UCB’s Cimzia (certolizumab) inhibit tumor necrosis factor, a protein associated with intestinal inflammation.

The two help more than half of IBD patients, but about a third no longer benefit from them over time. One of the main reasons is that patients develop antibodies against them that block their effects or cause them to be eliminated from the body.

Scientists believe that intermittent use of the drugs – ie going on and off – leads to the antibodies. Gaps in taking the treatments can cause flare-ups that require steroid use and hospitalization.

Researchers wanted to determine the maximum time a patient can be weaned from their therapy without experiencing a flare-up. They defined lower adherence to a regimen — that is, taking it less conscientiously — as delays in filling prescriptions for it. Researchers used claims of steroids or hospitalization as evidence that relapses had occurred.

The team identified 6,048 IBD patients whose claims appeared in the Truven Health MarketScan Commercial Claims and Encounters database from 2009 to 2013. They only included information from the patients’ last treatment in their analysis.

Researchers said 5,325 patients took Humira and 723 Cimzia. The mean age of the patients was 41 years, and 54 percent were women. Humira patients maintained their treatment better than Cimzia patients.

The team calculated a drug ownership ratio for each patient. It reflects the number of days a medication is delivered out of the number of days between refills. “For example, if a patient is given a 28-day supply on January 1 and then another 28-day supply on February 1,” the ratio is 56/59, or 0.95,” the authors write.

The minimum ratio to prevent risk of relapse was 0.87 for Cimzia and 0.86 for Humira. This meant missing more than four days of medication put the patient at high risk of a flare-up, the team said.

A ratio of “0.87 or greater is associated with a significantly lower risk of hospitalization or a new steroid prescription for those starting certolizumab and an MPR [ratio] of 0.86 or greater for those starting adalimumab” , write. “These measures of compliance are equivalent to missing just four days of medication in a 28-day cycle.”

Researchers noted that doses are sometimes missed for reasons that cannot be remedied, such as: B. if a patient has a bacterial infection or is reacting to the injections.

“In conclusion, we found an association between subcutaneous biologics adherence and hospitalizations and steroid use,” the team wrote. “We show that adherence to therapy for these drugs should be maximized, ideally above an MPR of 0.87, to avoid poor outcomes. The compliance threshold of 0.87 allows for fewer than four days of missed medication per 28-day period.”

They added that future studies “should be conducted on the most effective interventions targeting high-risk patients who are on these drugs and fall below this compliance level.”

HUMIRA is injected just under the skin. Your doctor will decide how much HUMIRA you need and how often to inject. Inject only as directed by your doctor.

HUMIRA is available in either a single-use pre-filled syringe or a single-use pre-filled auto-injector pen, and both are pre-loaded with the exact dose of medication. Your doctor or nurse will be able to help and guide you through your first injection, and soon you will be able to give it yourself. If this is not possible, another healthcare professional or a family member or friend can give the injection after they have been trained.

Some people find it helpful to inject HUMIRA in the morning or at bedtime. However, once you find a time that suits you best, using the medicine at a consistent time can help you remember to take it. It’s also a good idea to mark your calendar with the dates of your treatment as this can help you remember when to use it. Always follow your doctor’s instructions about when to use HUMIRA and how often.

If you forget to use HUMIRA as directed, inject the next dose as soon as you remember. Then inject your next dose as you would have done on your originally scheduled day if you had not forgotten the dose. Don’t give yourself two injections to make up for the missed injection. If it is almost time for your next dose, skip the missed dose and take your next dose when it is due.

Understanding post-injection inflammation

After an injection, swelling and irritation (inflammation) may occur where the needle enters the skin. This is a reaction to the needle or the injected medicine. Or it can be a reaction to both. The reaction can be immediate. Or it may not start until hours after the injection. In most cases, the reaction is not severe and goes away on its own.

What causes post-injection inflammation?

The most common cause is the skin’s reaction to the needle or drug. Less common causes are an allergic reaction to the drug. Or you have an infection at the injection site.

Symptoms of post-injection inflammation

Symptoms at the injection site may include:

swelling

itching

Pains

redness

warmth

Drainage at the injection site

rash

Treatment of post-injection inflammation

Treatment depends on the cause and how severe the reaction is. Most post-injection inflammation is mild. It will go away on its own in hours to days. If treatment is needed, it may include:

cold packs. These help reduce swelling, itching, and pain.

Over-the-counter pain relievers. These help reduce pain and inflammation.

Prescription Medicines. These treat infections.

Possible complications of post-injection inflammation

Watch for a whole body reaction. This can cause symptoms such as a rash, severe itching, or raised, fluid-filled bumps called hives. This type of reaction can be serious, especially if it affects breathing. If you or your child develop symptoms away from the injection site, contact your doctor for further instructions.

Like most medications, Humira can cause mild or serious side effects. The following lists describe some of the more common side effects that Humira can cause. These lists do not include all possible side effects.

Remember that side effects of a drug can depend on:

your age

other health problems you have

other medications you may be taking

Your doctor or pharmacist can tell you more about the possible side effects of Humira. They can also suggest ways to reduce side effects.

Mild side effects

Here is a short list of some of the mild side effects that Humira can cause. To learn about other mild side effects, talk to your doctor or pharmacist, or read the Humira prescribing information.

Mild side effects of Humira that have been reported include:

headache

Upper respiratory tract infections such as B. a cold

rash

Injection site reaction*

Mild side effects of many medications can go away in a few days or a few weeks. But if they become bothersome, talk to your doctor or pharmacist.

* For more information on this side effect, see the Focus on Side Effects section below.

Serious side effects

Serious side effects with Humira can occur, but are not common. If you experience any serious side effects with Humira, contact your doctor immediately. But if you think you have a medical emergency, call 911 or your local emergency number.

Serious side effects of Humira that have been reported include:

* For more information on this side effect, see the Focus on Side Effects section below.

focus side effect

Learn about some of the side effects Humira can cause.

Boxed warnings

Humira has boxed warnings. A boxed warning is a serious warning from the Food and Drug Administration (FDA). Humira’s boxed warnings are described below.

Risk of serious infections. Taking Humira may increase your risk of getting a serious infection. These include tuberculosis, fungal infections, and other rare infections. It can also include bacterial sepsis (a life-threatening disease that can result from infection).

Symptoms of a severe infection vary, but they can include:

breathe fast

fast heart rate

being confused or disoriented

Fever

chills

rash

Cough

cancer risk. Some children and adolescents have developed certain types of cancer while taking Humira. Lymphoma, a type of cancer affecting the lymphatic system, has been reported in some children and adolescents taking the drug. Other types of cancer that can cause death have also been reported.

In addition, a rare type of lymphoma called hepatosplenic T-cell lymphoma has been reported in adolescents and children with inflammatory bowel disease taking Humira. (Hepatosplenic T-cell lymphoma is a rare cancer that affects cells in the liver and spleen.)

What could help

If you develop a serious infection or sepsis while taking Humira, your doctor will tell you to stop taking the drug. Call your doctor at once if you have symptoms of an infection while using this drug.

Your doctor will also check you for tuberculosis before you start using Humira. And while you are being treated with Humira, your doctor will monitor you for signs or symptoms of tuberculosis.

Before prescribing Humira, your doctor will consider the benefits and risks of using this medicine if you already have cancer. If you develop cancer while taking Humira, your doctor will also consider the benefits and risks of Humira treatment. Your doctor may recommend that you stop taking Humira. But don’t stop taking the drug without first talking to your doctor.

Injection site reactions

Injection site reactions are the most common side effect of Humira. These appear on your skin after you have had a Humira injection. If you have an injection site reaction, you may have:

Reddening or deepening of the skin color

itching

rash

bruises

bleeding

Pains

swelling

Most injection site reactions with Humira are mild.

What could help

Injection site reactions usually go away within a few days after you have received a Humira injection. However, if you experience severe pain, redness or discoloration, or swelling that doesn’t go away, call your doctor right away. They can recommend ways to treat your condition.

Sometimes changing injection techniques can help prevent injection site reactions. Talk to your doctor or pharmacist to make sure you inject Humira correctly.

Side effects after the first injection

You may have side effects from Humira after your first injection of the medicine. However, it is also possible to have similar side effects that last for several hours after each injection. And you may also have side effects for a few days after Humira injections.

These side effects are generally mild and include:

Pain at Humira injection sites

a hangover feeling

What could help

If you get any side effects after your first Humira injection or after more than one injection, talk to your doctor or pharmacist. They can recommend ways to reduce your side effects before considering any other treatment.

Sometimes using a lower dose of Humira can help reduce side effects. But do not change your Humira dose without first talking to your doctor.

Author: Michaela Wachal, clinical pharmacist

It’s perfectly normal to be nervous around needles. Many people become uncomfortable when their doctor starts talking about needles, needle sticks, and syringes. It’s important that this fear doesn’t stop you from getting the medical care you need, especially if you’re prescribed self-injection medication. Self-injections are a safe way for you to manage many medical conditions. If you’re taking self-injecting medication, here are 10 ways you can overcome your fear of self-injecting.

Inform your doctor

If you are uncomfortable injecting yourself, it is important for your doctor to know. He or she may be able to offer you an alternative or help you overcome your fears. Your Hy-Vee Pharmacy Solutions (HPS) pharmacist should also know if self-injecting makes you nervous. Fear of injections prevents some people from taking their medication, which can be a problem. Your HPS pharmacist wants to make sure you are comfortable taking your medication.

To breathe

Watch your breathing, especially if you are nervous about injecting yourself. When people get nervous, they tend to hold their breath or take shallow breaths. It’s important to take deep breaths while injecting yourself with your medication. Breathing can help you relax and stay calm while administering your medicine.

Move with confidence

Once you begin the process, be purposeful and confident. Moving slowly can be more painful and give your mind more time to deal with your fear. Don’t rush things, which can lead to mistakes, but don’t take too long and don’t overthink it. With time and practice, many people gain confidence in the self-injection process and overcome their fear.

listen to music

Some auto-injector pens make a clicking sound. This can cause some people to tense up when they associate it with the needle. Block it out by listening to music, a podcast, or other background noise.

Make yourself comfortable

When it comes time to self-inject your medication, it’s easier when you’re comfortable. Try to administer your medication in a stress-free environment. You may be more relaxed in a private, clean space. If possible, wear comfortable clothing that will facilitate access to the self-injection site. If your medication is stored in the refrigerator, take it out early to allow it to warm to room temperature. Injecting cold medicine can cause discomfort. Ask your HPS pharmacist if it may be beneficial to place ice at the injection site before injecting.

Keep practicing

Your doctor will teach you how to safely self-inject your medication and provide you with tools to practice at home. If you’re uncomfortable with self-injections, it can help to practice at home regularly. When it comes time to administer your medication, your HPS pharmacist can walk you through each step until you are comfortable with the self-injection process. With practice, you will gain confidence and self-injection will become easier.

Distract yourself

While it’s important to focus on correctly self-injecting your medication, there are ways you can safely distract yourself if needles are making you nervous. You could talk to a friend or have an episode of your favorite show playing in the background. Some people blow on a pinwheel while injecting their medicine, which helps them breathe and distracts them with spinning colors. If self-injections are stressful, consider self-medicating afterwards. Sometimes a fun, colorful patch after the injection is enough to improve the process.

Build a support team

Your medication may be prescribed to inject yourself, but sometimes a caregiver can teach you how to give the injection. Ask your doctor if they can train a friend, family member, or other caregiver to inject your medication. In some cases, a nurse can administer the medicine for you. He or she can also offer you support while you self-inject your medication.

Ask for a sign

Some medicines have a shield that hides the needle during the injection. If self-injecting makes you nervous, it may be easier if you don’t have to see the needle when you administer your medication. Many auto-injector pens have a guard that also helps prevent accidental needle sticks. Ask your HPS pharmacist or doctor if a shield is an option for your self-injectable medication.

Remember why you are doing this

If you’re afraid to inject your medication, stop and remind yourself why you’re taking it. Your health is important. The medicine you inject helps keep your body healthy and strong. Even if you’re uncomfortable injecting yourself, it’s worth it.

Hy-Vee Pharmacy Solutions (HPS) is available 24 hours a day, 7 days a week to help you manage your self-injection medication. Our clinical team and certified case manager can guide you through the self-injection process and help you gain confidence in the successful completion of your treatment.

Drinking alcohol in moderation may be safe for some people while using Humira (adalimumab), although specific studies by the manufacturer are not available.

Specific drug-drug interactions between alcohol and Humira aren’t listed in the package insert, but a reaction may still be possible depending on your medical condition, risk factors, and other medications you’re taking.

Potential alcohol-drug interactions can occur with other drugs that can be used with Humira, including methotrexate, NSAIDs, and corticosteroids such as prednisone.

Ask your doctor if it’s safe to combine alcohol with Humira

According to CDC diet guidelines, moderate drinking is defined as up to 1 drink per day for women and up to 2 drinks per day for men, or no alcohol consumption at all.

Some conditions treated with Humira, such as Crohn’s disease and ulcerative colitis, can be made worse by alcohol consumption. Certain foods and drinks can make these gut conditions worse, especially during a flare-up. It’s best to avoid alcohol if it’s making your symptoms worse.

Humira is commonly used to treat rheumatoid arthritis. Many patients using Humira also use methotrexate to control their symptoms. Methotrexate is broken down (metabolized) in the liver. In general, long-term use of methotrexate can also lead to liver toxicity. Most healthcare providers recommend that patients avoid or limit alcohol consumption when using methotrexate.

Can alcohol make liver damage worse with Humira?

Humira is listed on the product label as a possible cause of severe liver damage, including acute liver failure. Alcohol in large amounts can also lead to long-term liver damage. The combination of these two active substances can make your liver function worse.

In addition, elevations in liver enzymes, which may indicate the onset of liver damage, have been reported with Humira, although patients were also taking other medicines that may have affected their liver function.

What are the signs of liver damage?

Signs and symptoms of liver damage may include:

Fever

chills

joint pain or swelling

unusual bleeding or bruising

skin rash

itching

loss of appetite

fatigue

nausea

Vomit

stomach pain

dark urine

bright chairs

yellowing of the skin or eyes

Call your doctor right away if you notice any of these symptoms.

Always tell your doctor and pharmacist about all medications you are taking, including over-the-counter (OTC) drugs, vitamins, dietary supplements, and herbal products.

Don’t stop taking any medication without first talking to your doctor.

bottom line

Drinking alcohol in moderation while using Humira may be safe for some people, although studies by the manufacturer are not available.

Alcohol may not be safe to consume in patients at risk of liver disease or who have liver disease. Humira itself is noted on the product label as a possible cause of severe liver damage.

Some gut conditions treated with Humira, such as Crohn’s disease and ulcerative colitis, can be made worse by alcohol consumption and lead to flare-ups.

It’s always best to speak to your doctor about drinking alcohol with any medication, including Humira.

See also: Humira: One Drug, Nine Uses, Billions of Dollars

This is not all the information you need to know about Humira (adalimumab) for safe and effective use. Read the full Humira information here and discuss this information with your doctor or other healthcare provider.

Does Methotrexate, Humira, Enbrel cause broken teeth?

Dear pharmacist,

I have tried a number of medications for my rheumatoid arthritis including Methotrexate, Humira and Enbrel. Suddenly I was having a horrible time with broken teeth that resulted in an extraction. Are these drugs affecting your dental health?

dear tooth fairy,

Drugs like these can raise serious concerns, but more often than not, the benefits outweigh the risks. In particular, Humira and Enbrel should be closely monitored by your doctor and pharmacist. Our pharmacy has a pharmacist dedicated ONLY to patients taking medications such as Humira, Enbrel, Orencia and Harvoni to name a few. Although rare, Humira and methotrexate can destroy bone tissue, especially in the jaw and teeth. In the Humira prescribing information, there is a section called: Other rare serious side effects occurring in less than 5% of patients treated with Humira; including bone disease, fractures and bone necrosis (death of bone tissue). However, please remember that these were so rare that they didn’t even appear in the Warnings and Precautions or Side Effects sections of the material. Methotrexate has also been reported at a frequency that is undefined to possibly cause osteonecrosis (bone death) with radiation therapy, as well as bone fractures. If you are still taking any of these medications, you should consult your doctor to determine if there is a chance that these agents are causing your dental problems. Please do not stop taking your medication without first talking to your doctor. Keep in mind that even these types of medications can pose an increased risk, but they often offer greater benefits.

For some people with rheumatoid arthritis (RA), chronic fatigue can be just as debilitating as joint pain. A person can sleep 8 hours and wake up feeling like they never slept. This exhaustion can affect mental focus and cause a person to feel frustrated and helpless.

Unfortunately, there is no quick fix to get rid of chronic fatigue. Managing fatigue often requires a multi-pronged approach that includes both medical treatment and lifestyle changes.

See Rheumatoid Arthritis and Fatigue

Talking to a healthcare provider about fatigue

The first step in combating fatigue is to speak to a doctor or rheumatologist. Patients are advised to describe when and for how long the fatigue lasts, whether it affects concentration, and whether it is accompanied by feelings of anxiety or depression. Patients may also report symptoms such as daytime sleepiness, nocturnal insomnia, sleep quality, and observations from a caregiver (e.g., restless sleep, snoring).

See Recognizing Fatigue in Rheumatoid Arthritis (RA) and Diagnosing Depression in People with Chronic Pain

A doctor can make specific suggestions tailored to the person. Most suggestions for dealing with fatigue fall into one of these categories:

adjust medication

Investigation and treatment of underlying medical problems

I am seeking therapy and emotional support

change diet and exercise

Prioritize and simplify tasks

See Chronic Fatigue Syndrome and Myofascial Pain Syndrome vs. Fibromyalgia

Learn about lifestyle factors and fatigue associated with RA.

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Medication modifications to reduce fatigue in rheumatoid arthritis

Medications can affect fatigue in two ways.

Medications can reduce the symptoms and pain of rheumatoid arthritis, thereby improving sleep quality and reducing fatigue.

Side effects or side effects of medications can cause fatigue and weakness.

Sometimes a drug can both alleviate the fatigue associated with disease activity and induce fatigue. For example, methotrexate (Rheumatrex, Trexall, Otrexup) is used to bring active RA under control, resulting in a reduction in disease-related fatigue. However, this drug can also induce fatigue by interfering with the body’s normal metabolism.

See Managing Chronic Pain and Insomnia

Other drugs like etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) have been reported to reduce fatigue, but some experts suggest the reduction may be limited and not permanent.

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There is no one-size-fits-all recipe

Everyone is unique and may react differently to medication. Side effects and side effects can sometimes appear days or weeks after starting a new medication. In addition, different patients may have different treatment goals. For example, some people are willing to tolerate moderate fatigue as long as pain and inflammation are manageable. In some cases, the body develops a tolerance to the side effects of a drug.

See Treatment of Rheumatoid Arthritis (RA).

A person with rheumatoid arthritis needs to work with their doctor to find the right combination of medications and/or dosages that will give them optimal results.

Review of RA Drugs and Chronic Fatigue

Patients suffering from fatigue can ask their doctor to review their full list of medications and supplements. Patients are advised to report all medications and dietary supplements, noting the following:

Many over-the-counter cold and allergy medicines (especially combination products) can cause drowsiness or dizziness.

Certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can cause drowsiness or dizziness. ,

Many drugs used to treat other conditions, such as depression, allergies, high blood pressure, and diabetes, can also cause fatigue.

Information about the patient’s chronic fatigue syndrome, RA, and medication prescriptions should be shared with all healthcare team members, such as: B. medical specialists, nurses, medical assistants, psychologists, consultants and pharmacists.

Other Measures

A 90° angle between the cannula and the skin causes less pain because fewer pain receptors in the dermis are hit by the needle (4, 16). Pinching, pressing or stretching the skin to be injected can also reduce the sensation of pain, possibly because the nerve impulses triggered by this “close” the gate for pain impulses (4, 17).

Cooling the area to be numbed with ice cubes for 2-5 minutes will relieve the pain of the injection. Leff et al. randomized 100 patients in whom an inguinal hernia was to be operated on under local anesthesia (18). Half of them held a bag of 4°C warm ice cubes to the site to be operated on for five minutes before being anesthetized. This reduced the mean pain score for lidocaine injection from 6/10 to 2/10. Exactly how cooling reduces this pain is unclear, but it has been suggested that vasoconstriction and reduced nerve conduction may play an important role (4, 17, 18).

The application of Emla cream (a combination of lidocaine and prilocaine) makes sense before dermatological interventions and venipuncture (4). However, after 60 minutes, the anesthetic only reaches 3 mm into the tissue. Therefore, it is usually not practical to use Emla Cream before infiltration anesthesia. In one study, 20 patients were injected with 0.1 mL of lidocaine with epinephrine via a 30-gauge needle after the injection site had been treated with either Emla cream for 52 minutes or ice for 1–2 minutes (17). Both measures significantly reduced injection pain compared to injecting into an untreated area, but Emla cream was only slightly more effective than ice cooling.

There are a number of published reviews on how to reduce injection pain. One is by Strazar and collaborators from a unit with very extensive use of local anesthesia (4). They perform around 95% of all hand surgeries, including major surgeries like tendon transpositions, under local anesthesia and routinely use buffered lidocaine with epinephrine. The addition of adrenaline is safe, even in fingers and toes (19). You have described what must be considered the gold standard in lidocaine anesthesia. Overall, 75% of their patients only feel the first puncture of the needle through the skin (4).

They use 30-gauge cannulas for the face and 27-gauge cannulas for other areas. The skin is punctured at a 90° angle and the needle tip is inserted into the subcutaneous fat layer. Here 0.2 – 0.5ml is injected and the needle is held in place until it is no longer felt by the patient when 2ml is injected. Only after that do they splash to the sides. The injection is given slowly while the needle is pushed under the skin. There should always be a 5-10mm zone of skin in front of the needle tip, hardened by the injected fluid and bleached by the adrenaline. When larger areas need to be injected, new skin penetrations should always be at least 10mm within the hardened and bleached, and thus anesthetized, area. In the case of open wounds, the injection is made into the wound itself and not through the skin.

People with autoimmune diseases like rheumatoid arthritis (RA) and lupus may experience hair loss as a troubling symptom of their disease. However, in other cases, the cause of hair loss could be the medications used to treat the condition.

Fortunately, hair loss from arthritis medication is not a common complication. However, if your hair is an important part of your identity, then it is no small thing for you.

What drugs cause hair loss?

Methotrexate: The most commonly prescribed disease-modifying anti-inflammatory drug (DMARD) for rheumatoid arthritis, methotrexate is responsible for hair loss in about 1% to 3% of people. The hair loss occurs because methotrexate is doing what it’s supposed to do – stop cell growth. This includes cells that cause inflammation and, unfortunately, hair follicles.

Folic acid is often prescribed along with methotrexate to reduce some of the side effects. Taking this synthetic form of folate, a B-complex vitamin, may help keep your hair healthy, but it has not been shown to promote hair growth.

Leflunomide (Arava): Another widely used DMARD for RA with the potential for hair loss is leflunomide. It is often prescribed in combination with methotrexate and causes hair loss similar to methotrexate in about 10% of users.

Biologics: In rare cases, biologics like etanercept (Enbrel) or adalimumab (Humira) have side effects for hair loss. It’s not known exactly why these drugs affect hair growth, but it’s thought that they alter the balance of messenger molecules known as “cytokines” in the body.

What to expect from the side effects of hair loss

In general, hair loss as a side effect of medication is not drastic and hair does not fall out in patches. And it usually grows back after you stop taking the drug.

But if you’ve inherited male or female pattern baldness, arthritis medication can trigger or accelerate such permanent hair loss. The most common form of hair loss, male pattern baldness, affects up to 80 million Americans and usually presents as a receding hairline or balding on top. Women tend to thin out at the front and top of the scalp.

While your instinct may be to drop the medication at the first sight of hair loss, you should weigh the benefits of the medication for your arthritis against the cost of the hair loss.

When to talk to your doctor

If drug-induced hair loss is significantly affecting your appearance and self-esteem, reducing your dose may be a potential solution. Your rheumatologist may also recommend switching to a different medication.

If changing your medication schedule isn’t an option, you may be referred to a dermatologist for hair loss lotions or other regrowth treatments.

Talk to your rheumatologist right away if you have sudden or patchy hair loss, or if you see excessive hair falling out when washing or combing your hair, if you regularly find hair in your food, or see a lot of hair on your pillow. You could have a serious underlying condition that needs attention.

This report shows the potential drug interactions for the following 2 drugs:

Edit list (add/remove drugs)

No interactions have been found between Humira and ibuprofen. However, this does not necessarily mean that there are no interactions. Always consult your doctor.

Humira

A total of 421 drugs are known to interact with Humira.

ibuprofen

A total of 367 drugs are known to interact with ibuprofen.

Drug and food interactions

No interactions between alcohol and food were found. However, this does not necessarily mean that there are no interactions. Always consult your doctor.

IMPORTANT SAFETY INFORMATION for HUMIRA (adalimumab)1

SERIOUS INFECTIONS

Patients treated with HUMIRA are at an increased risk of developing serious infections that can lead to hospitalization or death. Most patients who developed these infections were also taking immunosuppressive drugs such as methotrexate or corticosteroids.

Discontinue HUMIRA if a patient develops a severe infection or sepsis.

Reported infections include:

Active tuberculosis (TB), including reactivation of latent TB. Patients with TB often have disseminated or extrapulmonary disease. Test patients for latent TB before using HUMIRA and during therapy. Start treatment for latent TB before using HUMIRA.

Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may have disseminated rather than localized disease. Antigen and antibody tests for histoplasmosis may be negative in some patients with active infection. Consider empiric antifungal therapy in patients at risk for invasive fungal infections who develop severe systemic disease.

Bacterial, viral, and other infections caused by opportunistic pathogens, including Legionella and Listeria.

Carefully consider the risks and benefits of treatment with HUMIRA before initiating therapy in patients: 1. with chronic or recurrent infection, 2. who have been exposed to TB, 3. with a history of opportunistic infection, 4. who are Have lived in or traveled to areas where mycoses are endemic, 5. with underlying medical conditions that may predispose them to infection. Monitor patients closely during and after treatment with HUMIRA for the development of signs and symptoms of infection, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.

Do not start HUMIRA during an active infection, including localized infections.

Patients older than 65 years, patients with comorbidities and/or patients taking concomitant immunosuppressive medicinal products may be at higher risk of infection.

If infection develops, monitor carefully and initiate appropriate therapy.

Drug interactions with biological products: A higher rate of serious infections has been observed in rituximab-treated RA patients who received subsequent treatment with a TNF blocker. An increased risk of serious infections was observed when TNF blockers were combined with anakinra or abatacept, without demonstrating an added benefit in patients with RA. Co-administration of HUMIRA with other biologic DMARDs (eg, anakinra or abatacept) or other TNF blockers is not recommended due to the possible increased risk of infection and other potential pharmacologic interactions.

MALIGNANCY

Lymphoma and other malignancies, some with fatal outcomes, have been reported in children and adolescents treated with TNF-blockers, including HUMIRA. Post-marketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with anti-TNF agents, including HUMIRA. These cases had a very aggressive disease course and were fatal. The majority of reported cases of TNF blockers have been in patients with Crohn’s disease or ulcerative colitis, and the majority have been in adolescent and young adult males. Almost all of these patients had been receiving treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or before diagnosis. It is uncertain whether the occurrence of HSTCL is related to the use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants.

Before initiating or continuing therapy in a patient with a known malignancy, consider the risks and benefits of treatment with HUMIRA.

In clinical trials, more cases of malignancy were observed in HUMIRA-treated patients than in control patients.

Non-melanoma skin cancer (NMSC) has been reported during clinical trials in patients treated with HUMIRA. Before and during treatment with HUMIRA, evaluate all patients for the presence of NMSC, particularly those with a history of prolonged immunosuppressant or PUVA therapy.

In clinical trials of HUMIRA, there was an approximately 3-fold higher than expected rate of lymphoma in the US general population. Patients with chronic inflammatory diseases, particularly those with highly active disease and/or chronic exposure to immunosuppressive therapies, may be at higher risk of lymphoma than the general population, even without TNF blockers.

Post-marketing cases of acute and chronic leukemia have been reported with the use of TNF blockers. Approximately half of post-marketing malignancies in children, adolescents and young adults who received TNF-blockers were lymphomas; other cases included rare malignancies associated with immunosuppression and malignancies not usually observed in children and adolescents.

OVERSENSITIVITY

Anaphylaxis and angioneurotic edema have been reported following administration of HUMIRA. If a severe allergic reaction occurs, discontinue HUMIRA and institute appropriate therapy.

HEPATITIS B VIRUS REACTIVATION

Use of TNF blockers, including HUMIRA, may increase the risk of hepatitis B virus (HBV) reactivation in patients who are chronic carriers. Some cases have been fatal.

Assess patients at risk for HBV infection for prior signs of HBV infection before initiating TNF-blocking therapy.

Exercise caution in patients who are carriers of HBV and monitor them during and after treatment with HUMIRA.

Discontinue HUMIRA and initiate antiviral therapy in patients who develop HBV reactivation. Exercise caution when restarting HUMIRA after HBV treatment.

NEUROLOGICAL REACTIONS

TNF blockers, including HUMIRA, have been associated with rare cases of new onset or worsening of central nervous system disorders and peripheral demyelination, including multiple sclerosis, optic neuritis and Guillain-Barre syndrome.

Use caution when considering HUMIRA for patients with these conditions; Discontinuation of HUMIRA should be considered if any of these conditions develop.

There is a known association between intermediate uveitis and central demyelinating diseases.

HEMATOLOGICAL REACTIONS

Pancytopenia, including aplastic anemia, has been reported rarely with TNF blockers. Medically significant cytopenia has been reported rarely with HUMIRA.

Consider discontinuing HUMIRA if significant haematological abnormalities develop.

CONGESTION HEART FAILURE

Worsening and recurrence of congestive heart failure (CHF) has been reported with TNF blockers. Cases of CHF worsening have been observed with HUMIRA; Be careful and monitor carefully.

AUTOIMMUNITY

Treatment with HUMIRA can lead to the formation of autoantibodies and rarely to the development of a lupus-like syndrome. Discontinue treatment if symptoms of lupus-like syndrome develop.

IMMUNIZATIONS

Patients on HUMIRA should not receive live vaccines.

Pediatric patients should be up to date with all immunizations prior to initiating HUMIRA therapy whenever possible.

Adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect the immune response in intrauterine exposed infants. The safety of administering live or live attenuated vaccines to infants who have been exposed to HUMIRA in utero is unknown. Risks and benefits should be weighed before vaccination (live or live-attenuated) of exposed infants.

SIDE EFFECTS

The most common adverse reactions in clinical studies with HUMIRA (>10%) were: infections (e.g. upper respiratory tract, sinusitis), injection site reactions, headache and rash.

INDICATIONS1

Rheumatoid arthritis: HUMIRA, alone or in combination with methotrexate or other nonbiologic DMARDs, is indicated for reducing signs and symptoms, inducing a strong clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderate to severe Activity rheumatoid arthritis.

HUMIRA, alone or in combination with methotrexate or other non-biologic DMARDs, is indicated for reducing signs and symptoms, inducing a strong clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis Arthritis. Juvenile Idiopathic Arthritis: HUMIRA alone or in combination with methotrexate is indicated for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older.

HUMIRA alone or in combination with methotrexate is indicated for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. Psoriatic arthritis: HUMIRA alone or in combination with nonbiologic DMARDs is indicated for reducing signs and symptoms, halting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis.

HUMIRA, alone or in combination with nonbiologic DMARDs, is indicated for reducing signs and symptoms, halting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. Ankylosing spondylitis: HUMIRA is indicated for the relief of signs and symptoms in adult patients with active ankylosing spondylitis.

HUMIRA is indicated for the relief of signs and symptoms in adult patients with active ankylosing spondylitis. Crohn’s disease: HUMIRA is indicated for the treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older.

HUMIRA is indicated for the treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older. Ulcerative colitis: HUMIRA is indicated for the treatment of moderately to severely active ulcerative colitis in adults and children 5 years and older.

Usage Restrictions:

The effectiveness of HUMIRA in patients who have failed to respond to or are intolerant to anti-TNF therapy has not been established.

HUMIRA is indicated for the treatment of moderately to severely active ulcerative colitis in adults and pediatric patients 5 years of age and older. : The efficacy of HUMIRA in patients who have failed to respond to or are intolerant to anti-TNF therapy has not been established. Plaque psoriasis: HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy and when other systemic therapies are medically unsuitable. HUMIRA should only be given to patients who are closely monitored and regularly followed up by a doctor.

HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy and when other systemic therapies are medically less appropriate. HUMIRA should only be given to patients who are closely monitored and regularly followed up by a doctor. Hidradenitis suppurativa: HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.

HUMIRA is indicated for the treatment of moderate to severe suppurative hidradenitis in patients 12 years of age and older. Uveitis: HUMIRA is indicated for the treatment of non-infectious intermediate, posterior and panuveitis in adults and children 2 years of age and older.

Please read full Prescribing Information.

US-HUM-210183