Nurses Compass
Drug Guide
Adalimumab
Classification
Therapeutic: Immunosuppressant, Monoclonal Antibody
Pharmacological: Tumor Necrosis Factor (TNF) inhibitor
FDA Approved Indications
- Rheumatoid arthritis
- Crohn's disease
- Ulcerative colitis
- Plaque psoriasis
- Ankylosing spondylitis
- Juvenile idiopathic arthritis
- Hidradenitis suppurativa
- Uveitis
Mechanism of Action
Adalimumab is a recombinant human IgG1 monoclonal antibody that binds specifically to tumor necrosis factor-alpha (TNF-α), thereby inhibiting its interaction with p55 and p75 cell surface TNF receptors, resulting in downregulation of inflammatory processes.
Dosage and Administration
Adult: Dosage varies based on condition; typically 40 mg subcutaneously every other week. Sometimes initial doses are higher or more frequent, depending on the condition.
Pediatric: Dosing varies; usually 20 mg or 40 mg every other week subcutaneously, adjusted for weight and condition.
Geriatric: No specific dosage adjustment necessary, but caution advised due to comorbidities.
Renal Impairment: No specific adjustments needed.
Hepatic Impairment: No specific adjustments needed.
Pharmacokinetics
Absorption: Slowly absorbed after subcutaneous administration, with peak serum concentrations in 131 hours.
Distribution: Limited to the vascular and extravascular spaces; approximately 9-13 days half-life.
Metabolism: Metabolized via proteolytic enzymes into small peptides and amino acids.
Excretion: Eliminated via catabolism in reticuloendothelial system.
Half Life: Approximately 2 weeks (around 10-20 days).
Contraindications
- Hypersensitivity to adalimumab or any of its components.
- Active infections, including tuberculosis
Precautions
- Screen for latent TB before initiation.
- Monitor for signs of infection during therapy.
- Use with caution in patients with heart failure.
- Potential for demyelinating disorders, lymphoma, or other malignancies.
Adverse Reactions - Common
- Injection site reaction (Frequent)
- Upper respiratory infection (Common)
- Headache (Common)
Adverse Reactions - Serious
- Serious infection (e.g., sepsis, tuberculosis reactivation) (Rare)
- Lymphoma and other malignancies (Rare)
- Demyelinating disease (Very rare)
Drug-Drug Interactions
- Live vaccines (avoid concomitant use)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of infection, injection site reactions, and allergic responses. Regular screening for TB prior to therapy.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Administer subcutaneously as directed. Educate patient about infection signs; maintain aseptic technique.
Evaluation: Assess for reduction in disease activity and monitor for adverse effects.
Patient/Family Teaching
- Keep appointments for routine screening and injections.
- Report signs of infection immediately.
- Do not receive live vaccines during therapy.
- Warn about possible injection site reactions and how to manage them.
Special Considerations
Black Box Warnings:
- Serious infections and malignancies, including lymphoma.
- TB reactivation.
Genetic Factors: No specific genetic testing required.
Lab Test Interference: May cause false-positive tests for tuberculosis via skin test (use interferon-gamma release assays for better accuracy).
Overdose Management
Signs/Symptoms: No specific overdose reports; potential for exaggerated immunosuppression leading to severe infection.
Treatment: Supportive care, monitoring, and infection management.
Storage and Handling
Storage: Store in a refrigerator (2°C to 8°C). Do not freeze.
Stability: Stable until the expiration date printed on the vial if unopened. Once opened, use promptly.