Humira

What is HUMIRA?

HUMIRA is a medicine called a Tumor Necrosis Factor (TNF) blocker which is used to Reduce the signs and symptoms of:

• moderate to severe rheumatoid arthritis (RA) in adults. HUMIRA can be used alone, with methotrexate, or with certain other medicines.
• moderate to severe polyarticular juvenile idiopathic arthritis (JIA) in children 4 years and older. HUMIRA can be used alone, with methotrexate, or with certain other medicines.
• psoriatic arthritis (PsA) in adults. HUMIRA can be used alone or with certain other medicines.
• ankylosing spondylitis (AS) in adults.
• moderate to severe Crohn’s disease (CD) in adults when other treatments have not worked well enough.
• Treat moderate to severe chronic (lasting a long time) plaque psoriasis (Ps) in adults who have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

What are the possible side effects of HUMIRA?

1. Serious Infections

• .Your doctor will examine you for TB and perform a test to see if you have TB.
• If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA.
• Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA.
• People who had a negative TB skin test before receiving HUMIRA have developed active TB.

Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA:

• cough that does not go away
• low grade fever
• weight loss
• loss of body fat and muscle (wasting)

2. Hepatitis B infection in people who carry the virus in their blood.

•  If you are a carrier of the hepatitis B virus (a virus that affects the liver), the virus can become active while you use HUMIRA.
• Your doctor may do blood tests before you start treatment with HUMIRA and while you are using HUMIRA.

Tell your doctor if you have any of the following symptoms of a possible hepatitis B infection:
• muscle aches
• clay-colored bowel movements
• feel very tired
• fever
• dark urine
• chills
• skin or eyes look yellow
• stomach discomfort
• little or no appetite
• skin rash
• vomiting
3. Allergic reactions.

• Allergic reactions can happen in people who use HUMIRA.

Call your doctor or get medical help right away if you have any of these symptoms of a serious allergic reaction:

• hives
• swelling of your face, eyes, lips or mouth
• trouble breathing

4. Nervous system problems.
Signs and symptoms of a nervous system problem include:

• numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.

5. Blood problems.

•  Your body may not make enough of the blood cells that help fight infections or help to stop bleeding. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
• New heart failure or worsening of heart failure you already have.

Call your doctor right away if you get new worsening symptoms of heart failure while taking HUMIRA, including:

• shortness of breath
• swelling of your ankles or feet
• sudden weight gain.

6. Immune reactions including a lupus-like syndrome.

• Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or a rash on your cheeks or arms that gets worse in the sun.
• Symptoms may improve when you stop HUMIRA.

7. Liver Problems.

• Liver problems can happen in people who use TNF-blocker medicines. These problems can lead to liver failure and death.

Call your doctor right away if you have any of these symptoms:

• feel very tired
• skin or eyes look yellow
• poor appetite or vomiting
• pain on the right side of your stomach (abdomen)

8. Psoriasis.

• Some people using HUMIRA had new psoriasis or worsening of psoriasis they already had.
• Tell your doctor if you develop red scaly patches or raised bumps that are filled with pus.
• Your doctor may decide to stop your treatment with HUMIRA.

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped. Common side effects with HUMIRA include:

• injection site reactions: redness, rash, swelling, itching, or bruising. These symptoms usually will go away within a few days. Call your doctor right away if you have pain, redness or swelling around the injection site that does not go away within a few days or gets worse.
• upper respiratory infections (including sinus infections)
• headaches
• rash
• nausea

Before starting HUMIRA, tell your doctor if you:

• think you have an infection or have symptoms of infection such as: fever, sweats, or chills
• warm, red, or painful skin or sores on your body
• muscle aches
• diarrhea or stomach pain
• cough
• burning when you urinate or urinate more often than normal
• shortness of breath
• feel very tired
• blood in phlegm
• weight loss
• are being treated for an infection
• get a lot of infections or have infections that keep coming back
• have diabetes
• have TB, or have been in close contact with someone with TB
• were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure.
• live or have lived in certain parts of the country (such as the Ohio and Mississippi River valleys) where there is an increased risk for getting certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, or blastomycosis). These infections may happen or become more severe if you use HUMIRA. Ask your doctor if you do not know if you have lived in an area where these infections are common.
• have or have had hepatitis B
• use the medicine ORENCIA (abatacept), KINERET (anakinra), RITUXAN (rituximab), IMURAN (azathioprine), or PURINETHOL (mercaptopurine, 6-MP).
• are scheduled to have major surgery

After starting HUMIRA, call your doctor right away if you have an infection, or any sign of an infection.

• HUMIRA can make you more likely to get infections or make any infection that you may have worse.

Cancer

• For children and adults taking TNF-blockers, including HUMIRA, the chances of getting cancer may increase.
• There have been cases of unusual cancers in children, teenagers, and young adults using TNF-blockers.
• People with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma.
• If you use TNF blockers including HUMIRA your chance of getting two types of skin cancer may increase (basal cell cancer and squamous cell cancer of the skin). These types of cancer are generally not life-threatening if treated. Tell your doctor if you have a bump or open sore that doesn’t heal.
• Some people receiving TNF blockers including HUMIRA developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. Most of these people were male teenagers or young men. Also, most people were being treated for Crohn’s disease or ulcerative colitis with another medicine called IMURAN® (azathioprine) or PURINETHOL® (6-mercaptopurine).

What should I tell my doctor before taking HUMIRA?

HUMIRA may not be right for you. Before starting HUMIRA, tell your doctor about all of your health conditions, including if you:

• have an infection.
• have or have had cancer.
• have any numbness or tingling or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome.
• have or had heart failure.
• have recently received or are scheduled to receive a vaccine. You may receive vaccines, except for live vaccines while using HUMIRA.
• Children with juvenile idiopathic arthritis should be brought up to date with all vaccines before starting HUMIRA.
• are allergic to rubber or latex. The needle cover on the prefilled syringe contains dry natural rubber. Tell your doctor if you have any 
• allergies to rubber or latex.
• are allergic to HUMIRA or to any of its ingredients. See the end of this Medication Guide for a list of ingredients in HUMIRA.
• are pregnant or planning to become pregnant. It is not known if HUMIRA will harm your unborn baby. HUMIRA should only be used during a pregnancy if needed. 

Especially tell your doctor if you use:

• ORENCIA (abatacept), 
• KINERET 
• (anakinra), 
• REMICADE (infliximab), 
• ENBREL (etanercept),
• CIMZIA (certolizumab pegol) or SIMPONI
• (golimumab), because you should not use HUMIRA while you are also taking one of these medicines.
• RITUXAN (rituximab). Your doctor may not want to give you HUMIRA if you have received RITUXAN (rituximab) recently.
• IMURAN (azathioprine) or PURINETHOL (mercaptopurine, 6-MP).

How should I take HUMIRA?

• HUMIRA is given by an injection under the skin. Your doctor will tell you how often to
• take an injection of HUMIRA. This is based on your condition to be treated. Do not inject HUMIRA more often than you were prescribed. 
• Someone you know can also help you with your injection after he/she has been shown how to prepare and inject HUMIRA.
• Do not try to inject HUMIRA yourself until you have been shown the right way to give the injections. If your doctor decides that you or a caregiver may be able to give your injections of HUMIRA at home, you should receive training on the right way to prepare and inject HUMIRA.
• Do not miss any doses of HUMIRA unless your doctor says it is okay. If you forget to take HUMIRA, inject a dose as soon as you remember. 
• Then, take your next dose at your regular scheduled time. This will put you back on schedule. In case you are not sure when to inject HUMIRA, call your doctor or pharmacist.
• If you take more HUMIRA than you were told to take, call your doctor.

What are the ingredients in HUMIRA?

Active ingredient: adalimumab
Inactive ingredients: sodium chloride, monobasic sodium phosphate dihydrate, dibasic sodium phosphate dihydrate, sodium citrate, citric

Reviewed by:	Review Date:
Joseph V. Madia, MD	Friday, June 17, 2011

Source: FDA