Drug interaction- summary-

Anakinra + adalimumab

Adalimumab + Anakinra

Coadmin of anakirna with another TNF- blocking agent has risk of serious infections.Concurrent use not recommended

Methotrexate + Adalimumab 

methorexate reduced adalimimab clearance after single and multiple dosing. Dosage adjustment necessary

Ankylosing spondylosis, Corhn's disease

Juvenile idiopathic arthiritis, Plaque psoriasis

Psoriatic arthiritis, Rheumatoid arthiritis

Adverse reactions reported in Rheumatoid arthiritis < 5%

GI - abdominal pain 6%, Nausea 8%

GU- hematuria 5%  urinary tract infection 7%

Respiratory-  sinusitis  10%, upper respirarory tract infection 15%

Miscellaneous - accidental injury 8%, back pain 5%, flu syndrome 6%

                          headache 10%, hypertension 5%, pain at injection site 10%

                          injecction site reaction 7% rash  10%

Lab test abnormalites-  alkaline phosphate increased 4%, hyperlipderma 6%

Not known

Special precautions-

Recurrent infections- Serious infections occurred  in patients on concomittant immunosuppressive therapy .

Excercise caution when considering use of adalimumab in patients with a history of recurrent infection or patients predisoposed to this condition

Tuberculosis- before initiating therapy, evaluate patients for tuberculosis risk factors and test for latent tuberculosis infection prior to staring  therapy with adalimumab 

Haematologic effects- rare cases  of pancycytoma  have been reported with TNF- blocking agents. advice patients to seek immediate medical attention if they develop signs or symptoms of blood dyscrasis or infection eg. bleeding, bruising, persistent fever etc.

Immunizations- patients on adalimumab can receive concurent vaccinations, except live vaccines. It is recommended that juvenile idiopathic arthiritis patients, be brought up to date with immunization guidelines before initiating adalimumab therapy

Pregnancy- use during pregnancy only if needed

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

Children- safety and efficacy in children not established

Elderly- because of higher incidence of infections malignancies in elderly population, use caution before administering on elderly patients

Indication-

Ankylosing spondylosis, Crohn's disease, Juvenille idiopathic arthiritis, plaque psoriasis, posriatic arthiritis, rheumatoid arthiritis

Dosage-c arthiritis

Ankylosing spondylisis - 40mg subcutaneously every other week

Crohn's disease- 160mg initially at day 1 ( given as four mg subcutaneous injection 1 day or as two 40mg subcutaneous inj per day for 2 consecutive days followed by 80mg 2 weeks later

Plaque psoriasis - 80mg subcutaneously every other week

Psoriatic arthiritis - 40mg subcutaneously very other week

Rheumatois arthiritis - 40mg suncutaneously every other week

1. Inform patients that adalimumab may lower their ability of their immune system to fight infections.

2. Advice patients to see or inform their doctor, if they suffer any symptoms of allergic reaction.

3. Advice patients to report to their doctor if any new signs of worsening medical condition such as heart disease 

Pregnancy-

Use during pregnancy only if needed

Lactation-

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

Children-

Safety and efficacy in children not established

Elderly-

Because of higher incidence of infections malignancies in elderly population, use caution before administering on elderly patients