Nurses Compass
Drug Guide
Adalimumab-aacf
Classification
Therapeutic: Immunosuppressant, Anti-inflammatory
Pharmacological: TNF-alpha inhibitor
FDA Approved Indications
- Rheumatoid arthritis
- Polyarticular juvenile idiopathic arthritis
- Ankylosing spondylitis
- Crohn's disease
- Ulcerative colitis
- Plaque psoriasis
- Hidradenitis suppurativa
- Juvenile idiopathic arthritis (JIA)
- Ankylosing spondylitis
Mechanism of Action
Adalimumab-aacf is a monoclonal antibody that binds to tumor necrosis factor-alpha (TNF-α), thereby inhibiting its interaction with p55 and p75 cell surface TNF receptors. This reduces inflammatory responses in autoimmune diseases.
Dosage and Administration
Adult: Dosed based on condition; typically 40 mg subcutaneously every other week. Adjustments depend on response and tolerability.
Pediatric: Dosing varies; typically weight-based. For example, for pediatric Crohn's disease, 20 mg or 40 mg every other week.
Geriatric: No specific dosage adjustment; use with caution due to potential increased risk of infections.
Renal Impairment: No specific adjustment recommended.
Hepatic Impairment: No specific adjustment recommended.
Pharmacokinetics
Absorption: Subcutaneous administration: peak levels in 5 days
Distribution: Widely distributed in tissues, limited crossing of blood-brain barrier
Metabolism: Metabolized via standard protein degradation pathways
Excretion: Eliminated via catabolism to peptides and amino acids
Half Life: Approximately 2 weeks (range 10-20 days)
Contraindications
- Hypersensitivity to adalimumab or its components
- Active infections, including tuberculosis
Precautions
- Screen for latent TB before initiation.
- Use with caution in patients with a history of demyelinating disease, infections, or heart failure.
- Monitor for signs of infection during therapy.
- Pregnancy category B; discontinue if pregnancy occurs. Lactation consider risk-benefit.
Adverse Reactions - Common
- Injection site reactions (Common)
- Infections (upper respiratory, urinary tract) (Common)
Adverse Reactions - Serious
- Serious infections (including sepsis, TB reactivation) (Less common)
- Hypersensitivity reactions (Rare)
- Hematologic reactions (cytoplasmia) (Rare)
- Lupus-like syndrome (Very rare)
Drug-Drug Interactions
- Other immunosuppressants, live vaccines
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for signs of infection, injection site reactions, and allergic responses. Baseline TB screening required.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Administer as prescribed, monitor response and adverse effects, ensure proper storage.
Evaluation: Assess for reduction in disease symptoms, monitor for adverse events.
Patient/Family Teaching
- Report signs of infection promptly.
- Notify provider of any allergic reactions.
- Do not administer live vaccines during therapy.
- Follow injection technique instructions carefully.
Special Considerations
Black Box Warnings:
- Serious infections, including tuberculosis and opportunistic infections
- Malignancies, including lymphoma and other cancers
Genetic Factors: Genetic variations may influence response or risk of adverse effects.
Lab Test Interference: May interfere with immune system markers; routine labs should be monitored.
Overdose Management
Signs/Symptoms: No specific overdose symptoms identified, but excessive immunosuppression may increase infection risk.
Treatment: Supportive care; no specific antidote. Discontinue drug and monitor patient closely.
Storage and Handling
Storage: Refrigerate at 2°C to 8°C (36°F to 46°F). Do not freeze.
Stability: Stable for up to 14 days at room temperature in the original carton, if necessary, but best stored refrigerated.