Adalimumab

What is adalimumab?

Adalimumab is a medicine that is​ used to treat diseases of the immune system including Juvenile Idiopathic Arthritis (JIA), uveitis, and Crohn's disease when other medicines have not worked. It works by lowering the body's harmful response from diseases of the immune system. Adalimumab is a type of medicine called a TNF-blocking agent and it belongs to a group of drugs known as monoclonal antibodies. You may hear adalimumab called by its brand name, Humira. Adalimumab comes as a liquid for injection in a pre-filled syringe.

Before giving adalimumab to your child

Tell your child's doctor if your child:

• has an allergy to adalimumab or any of the ingredients in the adalimumab injection.
• is scheduled to receive any vaccinations.

Talk with your child's doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• a latex allergy.
• an infection (bacterial, fungal, or viral), especially serious infections such as tuberculosis (TB) or hepatitis B.
• congestive heart failure (heart cannot pump enough blood to meet the body's needs).
• demyelinating diseases of the nervous system (for example, multiple sclerosis).

How should you give your child adalimumab?

Your child's first dose of adalimumab will likely be given in the hospital or in clinic. If your child is to receive adalimumab at home, arrangements may be made to have a nurse come into the home to give it. Alternatively, you may be taught by one of the nurses to give your child the subcutaneous (sc) injections (injections under the skin) at home. If you give the injections at home:

• Make sure you understand and are comfortable with the way to prepare and inject adalimumab and know how to dispose of the needle and syringe in a needle/sharps disposal container
• Do not inject adalimumab at the same site. The injection site should be rotated
• Adalimumab should not be injected at sites that are red, tender, bruised, or hard.

What should you do if your child misses a dose of adalimumab?

• Give the missed dose as soon as you re​​member.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long does adalimumab take to work?

Some patients see improvements after their first or second dose of adalimumab, however it may take up to 3 months before the full benefit is seen. It is important to stay on track with the dosing schedule even if you see the effects right away.

What are the possible side effects of adalimumab?

Your child may have some of these side effects while they take adalimumab. Check with your child's doctor if your child continues to have any of these side effects, if they do not go away, or if they bother your child:

• Irritation, pain, or redness at the place of injection
• Headache

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• Signs of a life-threatening reaction, including: wheezing, shortness of breath, chest tightness or chest pain, difficulty breathing, fever, itching, bad cough, blue skin colour, swelling of the face, lips, tongue, or throat
• Rash or hives (red raised spots on the skin), peeling or blisters on the skin
• Signs of an infection, including: fever, chills, generally not feeling well (weak or tired), sore throat, runny nose, cough, and headache
• Numbness or tingling
• Sudden weight gain
• Bruising or bleeding very easily, looking very pale

What safety measures should you take when your child is using adalimumab?

There are some medicines that should not be taken together with adalimumab or in some cases the dose of adalimumab or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medications (prescription, over the counter or herbal) including:

• abatacept (Orencia​)
• anakinra (Kineret)
• Immunosuppressants (for example, tacrolimus, cyclosporine, mycophenolate, and prednisone)
• Live vaccines (for example, the measles, mumps, and rubella (MMR) vaccine, the chicken pox vaccine, and the oral polio vaccine)

There have been rare cases of cancers in children and teenage patients taking TNF-blocking agents (such as adalimumab). For children taking TNF-blocker medicines, the chances of developing lymphoma or other cancers may increase. Although this risk is higher than the general population, it is still quite low.

It is important that your child be tested for tuberculosis (TB) and hepatitis B to make sure they do not have one of these infections before they receive adalimumab.

It is also important to make sure that your child's immunizations are up to date before they start therapy with adalimumab. Vaccines may not work as well if they are given to your child while they are being treated with adalimumab, or the vaccine dose may need to be adjusted.

What other important information should you know about adalimumab?

• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Make sure you always have enough adalimumab to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
• Keep adalimumab in the refrigerator. Do not freeze this medicine. Protect this medicine from light.
• An adalimumab syringe can be stored at room temperature for a maximum of 14 days. Once taken out of the refrigerator for room temperature storage, the adalimumab syringe must be used within 14 days even if it is put back in the refrigerator.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep adalimumab out of your child’s sight and reach and locked up in a safe place. If your child takes too much adalimumab, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.