Adalimumab (rch)
Consumer Medicine Information
What is in this leaflet
This leaflet answers some common questions about Humira.
It does not contain all the available information.
It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you using this medicine against the benefits they expect it will have for you.
If you have any concerns about using this medicine, ask your doctor or pharmacist.
Read this leaflet carefully before you use Humira and keep it with the medicine.
You may need to read it again.
What Humira is used for
Humira is intended for the treatment of:
Rheumatoid arthritis
Humira is used to reduce the signs and symptoms of moderate to severely active rheumatoid arthritis, a painful disease of the joints, as well as to slow down and protect against damage to joints. Signs and symptoms of rheumatoid arthritis include joint pain, tenderness, swelling and stiffness.
Polyarticular Juvenile Idiopathic Arthritis
Humira is used for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis, which is an inflammatory disease involving multiple joints, in patients 2 years of age and older.
Enthesitis-related arthritis
Humira is used to treat enthesitis-related arthritis, an inflammatory disease of the joints in children.
Psoriatic arthritis
Humira is used to reduce the signs and symptoms, as well as inhibit the progression of joint damage of moderate to severely active psoriatic arthritis, a disease of the joints and skin, with some similarities to rheumatoid arthritis, as well as psoriasis and other factors.
Ankylosing spondylitis
Humira is used to reduce the signs and symptoms in patients with active ankylosing spondylitis, an inflammatory disease of the spine. Signs and symptoms of ankylosing spondylitis include back pain and morning stiffness.
Crohn's Disease
Humira is used for the treatment of moderate to severe Crohn's disease, an inflammatory disease of the digestive tract, in adults and children aged 6 years and above, to reduce the signs and symptoms of the disease and to induce and maintain periods where the symptoms are no longer present. Humira can be given to patients who have not responded well enough to conventional therapies, or who have lost response to or are intolerant to infliximab (another medicine used to treat Crohn's disease).
Ulcerative Colitis
Humira is used for the treatment of moderate to severe ulcerative colitis an inflammatory bowel disease, in patients who have not responded well enough to conventional therapy or who are intolerant to or have medical contraindications for such therapies. Patients should show a response within 8 weeks to continue treatment.
Psoriasis
Humira is used to treat chronic plaque psoriasis, an inflammatory disease of the skin. Plaque psoriasis can also affect nails, causing them to crumble, thicken and lift away from the nail bed which can be painful. Humira is used for moderate to severe forms of the disease in adults and severe forms in children and adolescents from 4 years of age who have not responded well enough to topical therapy and phototherapy, or who cannot be given those treatments.
Hidradenitis suppurativa
Humira is used for the treatment of adult and adolescents from 12 years of age with active moderate to severe hidradenitis suppurativa (acne inversa), a chronic and often painful inflammatory skin disease. Symptoms may include tender nodules (lumps) and abscesses (boils) that may leak pus. It most commonly affects specific areas of the skin, such as under the breasts, the armpits, inner thighs, groin and buttocks. Scarring may also occur in affected areas. Your doctor will schedule follow-up appointments to check on your progress to continue treatment.
Uveitis
Humira is used to treat non-infectious intermediate, posterior and pan-uveitis, an inflammatory disease of the uveal tract of the eye. Humira is used in adults who have not responded well to corticosteroids or whose disease flares when they taper off corticosteroids. Signs and symptoms include inflammation, vision impairment and pain.
The active ingredient in this medicine is adalimumab, a fully human monoclonal antibody. Monoclonal antibodies are proteins made by a type of blood cell to fight a foreign protein in the body. Adalimumab recognises and binds to a specific protein (tumour necrosis factor or TNF-alpha), which is present at increased levels in inflammatory diseases such as rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, enthesitis-related arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, hidradenitis suppurativa, psoriasis and uveitis.
Ask your doctor if you have any questions about why this medicine has been prescribed for you.
Your doctor may have prescribed it for another reason.
This medicine is not addictive.
This medicine is only available with a doctor's prescription.
The long term effects of Humira on the growth and development of children is not known.
Before you use Humira
When you must not use it
Do not use Humira if you have:
An allergy to any medicine containing adalimumab or any of the ingredients listed at the end of this leaflet. Symptoms of an allergic reaction may include:
chest tightness
shortness of breath, wheezing or difficulty breathing
swelling of the face, lips, tongue or other parts of the body
hives, itching or skin rash
You have a severe infection including infection of the bloodstream, active tuberculosis and other infections that can occur when the body's natural defences are lowered.
You are already using anakinra (Kineret) - a medicine for rheumatoid arthritis.
You have moderate to severe heart failure.
Do not use this medicine after the expiry date printed on the label / blister / carton or if the packaging is torn or shows signs of tampering.
Return it to your pharmacist for disposal.
Before you use it
Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.
Tell your doctor if you have or have had any of the following medical conditions:
an infection, including a long-term or localised infection (for example, leg ulcer)
a history of recurrent infections or other conditions that increase the risk of infections
a history of tuberculosis, or if you have been in close contact with someone who has had tuberculosis
If symptoms of tuberculosis (persistent cough, weight loss, listlessness, mild fever), or any other infection appear during or after therapy, tell your doctor immediately.
As cases of tuberculosis have been reported in patients treated with Humira, your doctor will check you for signs and symptoms of tuberculosis before starting this medicine. This will include a thorough medical history, a chest x-ray and tuberculin test.
The hepatitis B virus (HBV) if you are a carrier of, or you have active HBV or you think you might be at risk of contracting HBV.
Humira can cause reactivation of HBV in people who carry this virus. In some rare cases, especially if you are taking other medicines that suppress the immune system, reactivation of HBV can be life threatening.
a fungal infection, or have lived or travelled in countries where some fungal infections are common. These infections may develop or become more severe if you take Humira.
If you suffer from uveitis, your doctor may check for signs and symptoms of neurologic disease before starting this medicine.
multiple sclerosis a disease of the nervous system or other demyelinating disease
allergic reactions such as chest tightness, wheezing, dizziness, swelling or rash
blood disorders
low resistance to disease
heart conditions including congestive heart failure, heart attack or worsening of existing heart conditions
cancer or autoimmune disease
a lung disease called chronic obstructive pulmonary disease
kidney or liver problems
Tell your doctor if you are scheduled for any vaccines.
It is recommended that children, if possible, be brought up to date with all immunisations in agreement with current immunisation guidelines prior to initiating Humira therapy. Patients receiving Humira should not receive live vaccines.
Tell your doctor if you are a psoriasis sufferer who has undergone phototherapy.
Tell your doctor if you are pregnant or plan to become pregnant.
There is only limited experience in the effects of Humira in pregnant women. The use of this medicine in pregnant women is not recommended. Women of childbearing age are advised to use contraception to avoid falling pregnant.
Tell your doctor if you are breastfeeding or plan to breastfeed.
It is not known whether Humira passes into breast milk. If you are breastfeeding, your doctor may advise you to stop breastfeeding while you are using this medicine.
If you have not told your doctor or pharmacist about any of the above tell them before you start using Humira.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.
Some medicines and Humira may interfere with each other. Your doctor and pharmacist have more information on medicines to be careful with or avoid while using this medicine.
Tell your doctor or pharmacist if you are taking anakinra (Kineret) or abatacept (Orencia), other medicines used to treat some forms of arthritis.
Taking the two medicines together may increase the risk of infection.
Humira can be taken together with medicines used to treat arthritis, such as: methotrexate, steroids or pain medications including non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen.
Tell your doctor if you are taking any other medicines to treat your condition.
How to use Humira
Follow all directions given to you by your doctor and pharmacist carefully. They may differ from the information contained in this leaflet.
If you do not understand the instructions on the label or in this leaflet, ask your doctor or pharmacist for help.
Always use Humira exactly as your doctor has instructed you.
You should check with your doctor or pharmacist if you are unsure.
How much to use
Adults
Rheumatoid Arthritis & Psoriatic Arthritis & Ankylosing spondylitis
The usual dose for adults with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is one 40mg injection fortnightly.
Crohn's disease & Ulcerative Colitis
The usual dose for adults with Crohn's disease or ulcerative colitis is an initial dose of 160mg (given as four injections on one day or two injections a day over two days), followed by 80mg two weeks later (given on one day) then 40mg starting two weeks later and continuing every two weeks.
Psoriasis & Uveitis
The usual dose for adults with psoriasis or uveitis is an initial dose of 80mg, followed by 40mg given fortnightly starting one week after the initial dose.
For adults with psoriasis, depending on your response, your doctor may increase the dose frequency to 40mg every week.
Hidradenitis suppurativa
The usual dose for adults with hidradenitis suppurativa is an initial dose of 160mg (given as 4 injections in one day or 2 injections per day for two consecutive days), followed by an 80mg dose (as 2 injections on the same day) two weeks later. After a further two weeks, continue with a dose of 40mg every week.
Your doctor may prescribe other medicines for your condition to take with this medicine.
Children
Polyarticular Juvenile Idiopathic Arthritis
The usual dose for children with polyarticular juvenile idiopathic arthritis, or enthesitis-related arthritis depends on body weight:
with a body weight of 30 kg or above, the usual dose is 40mg given fortnightly.
with a body weight of 15 kg to less than 30 kg, the recommended dose is 20mg fortnightly.
with a body weight body between 10kg to less than 15kg, the usual dose is 10mg fortnightly.
Crohn's disease
The usual dose for children with Crohn's disease depends on body weight and the severity of disease.
-with a body weight of 40kg or above, the starting dose is 160mg (given as four injections on one day or two injections a day over two days), followed by 80mg two weeks later (given in one day). After a further two weeks, continue with 20mg or 40mg every two weeks, depending on severity of disease).
-with a body weight of less than 40kg, the starting dose is 80mg (given as two injection on one day), followed by 40mg two weeks later. After a further two weeks, continue with 10mg or 20mg every two weeks, depending on severity of disease).
Treatment of Crohn's disease in children should be supported by good nutrition to allow appropriate growth.
Psoriasis
The usual dose for children with psoriasis depends on body weight.
with a body weight of 40 kg or above, the usual dose is 40mg given once weekly for the first two weeks, then fortnightly.
with a body weight of less than 40kg, the usual dose is 20mg given once weekly for the first two weeks, then fortnightly.
Hidradenitis suppurativa
The usual dose for adolescents (from 12 years, weighing at least 30kg) with hidradenitis suppurativa is an initial dose of 80mg (two 40mg injections in one day), followed by 40mg fortnightly starting one week later. If you have an inadequate response, your doctor may increase the dose frequency to 40mg every week.
It is recommended you use an antiseptic wash daily on the affected areas.
If Humira has no effect on the child’s condition after 16 weeks, your doctor may tell you to stop using Humira.
How to use it
Humira is injected under the skin. The injection can be self-administered or given by another person, for example a family member or friend after proper training in injection technique, or your doctor or his/her assistant.
Instructions for preparing and giving an injection of Humira if you are using the Humira pen are provided on the Product Information/ Injecting instructions leaflet with the product:
Read these instructions carefully and follow them step by step. These instructions explain how to self-inject this medicine.
Do not attempt to self-inject until you are sure that you understand how to prepare and give the injection.
Your doctor or his/her assistant will also show you best how to self-inject.
1. What should I do before I give myself a Humira injection?
Wash your hands thoroughly
Take one dose tray containing a pre-filled pen of Humira from the refrigerator
Do not shake or drop the pre-filled pen
Set up the following items on a clean surface
One Humira pre-filled Pen.
One alcohol pad.
Check the expiry date on the pre-filled pen label. Do not use the product after the month and year shown.
Hold the pre-filled Pen with the grey cap (labelled '1') pointing up. Check the appearance of Humira solution through the windows on the sides of the pre-filled Pen. It must be clear and colourless. If it is cloudy or discoloured or has flakes or particles in it, you must not use it. Do not use it if the solution is frozen. Do not remove either the grey cap or the plum cap, until immediately before the injection.
2. Where should I give my injections?
Choose a site on your thigh or stomach (except the area around the navel).
Change the place that you inject each time so that you do not become sore in one area. Each new injection should be given at least 3 cm from the last injection site.
Do not inject in an area where the skin is reddened, bruised, or hard. This may mean there is an infection.
3. How do I give my injection?
Wipe your skin by using the enclosed alcohol pad, using a circular motion.
Only remove both the grey cap and the plum cap immediately before injection.
Hold the grey body of the pre-filled pen with one hand by placing this hand in the middle of the pen so that neither the grey cap nor the plum cap is covered. Hold the pre-filled pen with the grey cap pointing up.
With your other hand, pull the grey cap straight off and discard cap.
Check that the small grey needle cover of the syringe has been removed with the cap. If a few small drops of liquid come out of the needle, that is okay. The white needle sleeve will now be exposed.
Do not try to touch the needle housed in the barrel.
DO NOT RECAP the pen as you may damage the needle inside
Pull the plum safety cap (labelled '2') straight off to expose the plum coloured activation button.
The pre-filled pen is now ready to use. Do not press the plum activation button until properly positioned as this will result in discharge of medication.
DO NOT RECAP as this could cause the unit to discharge and could potentially cause needle stick injury.
Do not place the pen down as this could cause the unit to discharge.
With your free hand, gently grasp or pinch a sizable area of the cleaned skin at the injection site and hold firmly for the entire injection procedure.
Position the white end of the pre-filled Pen at a right angle (90 degrees) to the skin, so that you can see the window. The presence of one or more bubbles in the window is normal.
Holding the barrel of the pre-filled pen, press down slightly onto the injection site (holding in place without moving), but do not press plum end until ready for injection.
With your index finger or your thumb, press the plum coloured button on top once you are ready to begin the injection. You will hear a loud 'click' as the needle is released, and you will feel a small prick as the needle advances.
Keep pressing and continue to hold the Pen with steady pressure for about 10 seconds to ensure a complete injection. Do not remove the Pen while the injection is being given.
You will see a yellow indicator move into the window during the injection. The injection is complete when the yellow indicator stops moving.
Lift the Pen straight up from the injection site. The white needle sleeve will move down over the needle and lock into place over the needle tip. Do not try to touch the needle. The white needle sleeve is there to protect you from touching the needle
You may notice a spot of blood at the injection site. You can press a cotton ball or a piece of gauze over the injection site for 10 seconds. Do NOT rub the injection site. Use a plaster if you want to.
5. Throwing away supplies
Only use each Pen for one injection. Do not put either of the caps back on the Pen.
After injecting Humira, immediately throw away the used Pen in a special 'sharps' container as instructed by your doctor, nurse or pharmacist.
Keep this container out of reach and sight of children.
How long to use it
Keep using Humira for as long as your doctor tells you.
Humira will not cure your condition but should help your symptoms.
Ask your doctor if you are not sure how long to take the medicine for.
If you forget to use it
If you forget to give yourself an injection, you should inject the next dose of Humira as soon as you remember. Then inject your next dose as you would have on your originally scheduled day, had you not forgotten a dose.
Do not try to make up for missed doses by taking more than one dose at a time.
This may increase the chance of getting an unwanted side-effect.
If it is almost time for your next dose, skip the dose you missed and take the next dose when you are meant to.
If you are not sure what to do, ask your doctor or pharmacist.
If you use too much (overdose)
If you accidentally inject Humira more frequently than told to by your doctor, immediately telephone your doctor or go to Accident and Emergency at your nearest hospital. Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention. Always take the outer carton of the medicine with you.
While you are using Humira
Things you must do
Check with your doctor before you receive any vaccines.
It is recommended that children, if possible, be brought up to date with all immunisations in agreement with current immunisation guidelines prior to initiating Humira therapy.
Some vaccines, such as oral polio vaccine, should not be given while receiving Humira.
If you become pregnant while using Humira, tell your doctor immediately.
If you are about to be started on any new medicine, tell your doctor you are using Humira.
Tell all doctors, dentists, and pharmacists who are treating you that you are using Humira.
If you are going to have surgery, tell the surgeon or anaesthetist that you are using Humira. Your doctor may recommend temporary discontinuation of Humira.
Keep all of your doctor's appointments so that your progress can be checked.
Things you must not do
Do not give Humira to anyone else, even if they have the same condition as you.
Do not use Humira to treat any other complaints unless your doctor tells you to.
Do not stop taking Humira, without checking with your doctor.
Do not take Humira and anakinra (Kineret) together.
Do not take Humira and abatacept (Orencia) together.
Anakinra and abatacept are other medicines used to treat certain forms of arthritis.
Things to be careful of
It is important to tell your doctor if you get symptoms such as fever, wounds, feeling tired or have dental problems.
You might get infections more easily while you are receiving Humira treatment. These infections may be serious and include tuberculosis, infections caused by viruses, fungi or bacteria, or other opportunistic infections and sepsis that may, in rare cases, be life-threatening. Your doctor may recommend temporary discontinuation of Humira.
Be careful driving or operating machinery until you know how Humira affects you.
The effects on your ability to drive and use machines whilst taking this medicine are not known.
Side effects
Tell your doctor as soon as possible if you have any problems while using Humira, even if you do not think the problems are connected with the medicine or are not listed in this leaflet.
All medicines have some unwanted side effects. Sometimes they are serious, but most of the time they are not. You may need medical attention if you get some of the side-effects.
Do not be alarmed by this list of possible side effects. You may not experience any of them.
Ask your doctor or pharmacist any questions you may have.
Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you experience any of the following:
Signs of an allergic reaction such as:
Chest tightness
Shortness of breath, wheezing or difficulty breathing
Swelling of the face, lips, tongue or other parts of the body
Hives, itching or skin rash
Signs and symptoms suggestive of heart failure such as shortness of breath with exertion or upon lying down or swelling of the feet
Signs and symptoms suggestive of blood disorders such as persistent fever, bruising, bleeding, paleness
The above list includes very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are uncommon.
Tell your doctor as soon as possible if you notice any of the following:
Signs of tuberculosis such as persistent cough, weight loss, listlessness, fever
Signs of infection such as fever, malaise, wounds, dental problems, burning on urination
You might get infections more easily while you are receiving Humira treatment
Signs of nervous system disorders such as numbness or tingling throughout your body, arm or leg weakness, double vision
Signs of soft tissue infection, such as a bump or open sore that doesn't heal
The above list includes serious side effects. You may need urgent medical attention. Serious side effects are rare.
Tell your doctor if you notice any of the following and they worry you:
Injection site reactions (including pain, swelling, redness or itching)
Upper respiratory tract infections (including cold, runny nose, sinus infection, sore throat)
Lower respiratory tract infections (such as bronchitis, pneumonia)
Ear infections
Eye inflammation, inflammation of the eye lid or changes to your vision.
Headache, dizziness, vertigo, sensation disorders
Increased cough, sore throat
Abdominal symptoms such as nausea, vomiting, abdominal pain,
Rash, itching
Fatigue
Mouth inflammation and ulcers
Muscle or bone pain
Elevated lipids
Depression, anxiety
Increased heart rate
Viral infections (including the flu, cold sore blisters, chicken pox and shingles)
Bacterial infections (including urinary tract infection)
Fungal Infections
Changes in mood, feeling low or anxious
The above list includes the more common side effects of Humira. They are usually mild and short-lived.
Laboratory results
Some side effects observed with Humira may not have symptoms and may only be discovered through blood tests. These include increased lipids in the blood, elevated liver enzymes, and increased uric acid in the blood.
Tell your doctor or pharmacist if you notice anything else that is making you feel unwell.
Other side effects not listed above may occur in some people.
There have been cases of certain kinds of cancer in patients taking Humira or other TNF blockers. People with more serious rheumatoid arthritis that have had the disease for a long time may have a higher chance of getting a kind of cancer that affects the lymph system, called lymphoma, or that affects the blood, called leukaemia. If you take Humira your risk may increase. On rare occasions, a specific and severe type of lymphoma has been observed in patients taking Humira. Some of those patients were also treated with azathioprine or 6- mercaptopurine medicines that stop your body’s immune system defence mechanism. In addition cases of skin cancer have been observed in patients taking Humira. If new skin lesions appear during or after therapy or if existing lesions change appearance, tell your doctor.
There have been cases of cancers other than lymphoma in patients with a specific type of lung disease called Chronic Obstructive Pulmonary Disease (COPD) treated with another TNF blocker. If you have COPD, or are a heavy smoker, you should discuss with your doctor whether treatment with a TNF blocker is appropriate for you.
After using Humira
Storage
Keep your pre-filled pen in the pack until it is time to use it.
Keep Humira in a refrigerator (2°C to 8°C). Do not freeze.
Keep Humira in the refrigerator in a way children cannot get to it.
Keep the medicine at the right temperature when you travel.
This is important whether travelling by car, bus, train, plane or any other form of transport.
When required a single Humira pre-filled pen may be stored at room temperature (below 25°C) for a maximum period of 14 days, protected from light.
Once removed from the refrigerator, and stored at room temperature, the pen must be used within 14 days or discarded, even if it is returned to the refrigerator.
Write down the date you first remove the syringe from the refrigerator on the label, so you can check how long it has been.
Disposal
After injecting Humira, immediately throw away the used pen in a special 'sharps' container as instructed by your doctor, nurse or pharmacist.
If your doctor tells you to stop using Humira or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.
Product description
What it looks like
Humira is a clear, colourless, sterile solution of 40mg adalimumab in 0.8mL water in a syringe available in a Pre-filled pen for patient use in packs containing 2, 4 or 6 pre-filled pens with 2, 4 or 6 alcohol pads.
Ingredients
Humira contains 40mg of adalimumab as the active ingredient:
It also contains other ingredients including:
Mannitol
Citric acid monohydrate
Sodium citrate
Monobasic sodium phosphate dihydrate
Dibasic sodium phosphate dihydrate
Sodium chloride
Polysorbate 80
Water for injections
