Interactions summary-

Anakinra - coadministration of anakirna with another TNF blocker has shown an increased
risk of serious infections, an increased risk of neutropenia and no added benefit.
Combination of anakirna with other TNF blockers , including certolizumab may
also result in toxicities  

Live vaccines - do not give live vaccines concurrentlt with certolizumab

Drug Lab interactions- 
Interfenece with certain coagulation assays treated with certolizumab

May cause erroneous elevated activated partial thromboplastine time aPTT  assays
in patients with coagulation abnormalites

Crohn's  disease

Disconituation- 8%  of patients treated on clinical trials

Most common adverse effects leading to discontinuation-
abdominal pain, diarrhea and intestinal obstruction 

Serious adverse reactions-  serious infections and malignancies

Common adverse reactions-  upper respiratory infection, arthalgia

Other adverse reactions-

Cardiovascular-
angina pectoris, arrhthmias, cardiac failure, hypertensive heart disease,
myocardial infarction, pericardial effusion,  pericarditis, vasculitis

CNS-
anxiety, biploar disorder, sicide attempt

GU -
 menstrual disorder, nephrotic syndrome,renal failure

Dermatologic- 
dermatitis, erythema nodosum, urticaria

Hepatic -
 elevated liver enzyme, hepatitis

Ophthalmic-
optic neuritis, retinal hemaorrhage, uvelitis

Miscellaneous-
 Alopecia,bleeding, injection reactions

Contraindications-
Not known

Special Precautions-

Serious infections- do not initiate treatment with certolizumab  inpatients with active
infections, including localised infections  with TNF blockers

TB-  TB assciated with adminisration on certolizumab have been reported
Monitor patients receiving certolizumab for signs and symptoms of active  TB.
Instruct patient to seek medical help if signs and symptoms of persistent cough,
wasting, weight loss, low grade fever,. suggetive of a TB infection occur

Hepatitis virus- use of TNF blockers including certolizumab may increase risk of
reaction of NBV in patients who are carriers of the virus.

Heart failure- cases of worsening congestive heart failure CHF and new onset of
CNF have been reported. Excercise caution when using certolizumab in patients
who have heart failure and monitor them carefully.

Pregnancy- Use during pregnancy only if required

Lactation- decide whether to discontinue  breast feeding or the drug dependeing on
the importance of the drug to the mother.

Children- safety and efficacy in children not established

Elderly- because of higher incidence of infections in elderly ,use caution
when treating elderly patients

Indication-
Crohn's disease

Dosage-
initial dose - 400mg given as 2 subcutaneous injections of 200mg initially at least
at weeks  2 and 4

Maintenance dose- recomended dose is 400mg every 4 weeks

1. Excercise caution in patients in administrting to patients with clinically important
active infections and advice patients of the importance of informing keeping doctor
informed about their health

2. Inform patient that certolizumab may lower the ability of the immune system to
fight infections

3. Council patients about  the possible risk of lymphoma and other malignancies
while receiving certolizumab.

4. Advice patients to seek medical attention if they experience symptoms of allergic conditions

5. Advice patients to report promptly any symptoms suggestive of a cytopenia such as
bleeding, bruising, or persistent fever

Pharmacology-
Cetrolizumab is aTNF blocker. It selectively neutralizes TNF alpha in vitro in L929 murine
fibrosarcoma cytotoxicity assay  but does not neutralize lymphotaxim alpha  TNF alpha

Pregnancy-
Use during pregnancy only if required

Lactation-
Decide whether to discontinue  breast feeding or the drug dependeing on
the importance of the drug to the mother.

Children-
Safety and efficacy in children not established

Elderly-
Because of higher incidence of infections in elderly ,use caution
when treating elderly patients