Home Drug Guide Adalimumab-afzb

Drug Guide

Generic Name

Adalimumab-afzb

Brand Names Abrilada

Classification

Therapeutic: Antirheumatic, Immunosuppressant

Pharmacological: Tumor Necrosis Factor (TNF) Inhibitor

FDA Approved Indications

  • Rheumatoid arthritis (moderate to severe)
  • Juvenile idiopathic arthritis
  • Ankylosing spondylitis
  • Crohn's disease
  • Ulcerative colitis
  • Psoriasis psoriasis vulgaris
  • Hidradenitis suppurativa
  • Uveitis

Mechanism of Action

Adalimumab binds to tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine, neutralizing its activity and thereby reducing inflammation.

Dosage and Administration

Adult: Initial dose varies by condition; typically 40 mg subcutaneously every other week. Dose adjustments depend on the specific disease and response.

Pediatric: Dosing varies based on weight and condition; generally, 20 mg every other week for children ≥2 years old with juvenile idiopathic arthritis.

Geriatric: Dosing generally similar to adults; monitor for increased risk of infections.

Renal Impairment: Adjustments not specifically required, but caution advised.

Hepatic Impairment: No specific adjustments; use with caution especially in moderate to severe impairment.

Pharmacokinetics

Absorption: Subcutaneous administration with bioavailability approximately 64%.

Distribution: Widely distributed; volume of distribution roughly 5.5 L.

Metabolism: Metabolized via proteolytic degradation into small peptides and amino acids.

Excretion: Excreted mainly via catabolism; no specific renal elimination data.

Half Life: Approximately 2 weeks, allowing for biweekly dosing.

Contraindications

  • Hypersensitivity to adalimumab or excipients
  • Active serious infections

Precautions

  • Screen for latent tuberculosis before initiation.
  • Monitor for signs of infection.
  • Use with caution in patients with comorbid conditions that predispose to infections.
  • Avoid live vaccines during treatment.

Adverse Reactions - Common

  • Injection site reactions (Common)
  • Upper respiratory infections (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Serious infections (e.g., TB, invasive fungal infections) (Serious)
  • Hypersensitivity reactions (Serious)
  • Demyelinating disease (Serious)
  • Heart failure exacerbation (Serious)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, TB screening prior to initiation, and monitor injection sites.

Diagnoses:

  • Risk of infection
  • Impaired skin integrity

Implementation: Administer as prescribed, observe injection sites, educate patients on infection risks.

Evaluation: Assess for signs of response in the specific condition, monitor for adverse effects.

Patient/Family Teaching

  • Report signs of infection promptly.
  • Follow injection techniques as instructed.
  • Do not administer live vaccines during treatment.
  • Keep regular follow-up appointments.

Special Considerations

Black Box Warnings:

  • Increased risk of serious infections, including TB and invasive fungal infections.
  • Malignancies, including lymphoma.
  • Demyelinating neurological diseases.

Genetic Factors: Genetic polymorphisms in immune response genes may influence efficacy and risk.

Lab Test Interference: Can alter TB test results; screen for latent TB before therapy.

Overdose Management

Signs/Symptoms: Potential increased risk of infections, allergic reactions.

Treatment: Supportive care; no specific antidote. Consider discontinuation and medical management of adverse effects.

Storage and Handling

Storage: Refrigerate at 2°C to 8°C (36°F to 46°F); protect from light.

Stability: Stable until the expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.