Adalimumab: a biologic injection for autoimmune conditions

The NHS says adalimumab is used for conditions in which the immune system attacks healthy parts of the body by mistake. It names psoriasis and hidradenitis suppurativa, rheumatoid arthritis, Crohn disease and ulcerative colitis, and uveitis, an autoimmune eye condition. It is usually given by a specialist after other medicines have not worked.

It belongs to the group called biologic DMARDs, which work by blocking the parts of the immune system that cause swelling, helping relieve symptoms. Several versions of the medicine are on the market under different brand names.

It comes in a pre-filled syringe or injector pen that you inject into the skin of your belly or inner thigh, once every 1 or 2 weeks depending on the condition. Your care team shows you how to inject at home and provides a sharps box for used syringes or injectors. If it works well it may be used long term.

If you forget an injection, do it as soon as you remember and take the next when due. If it is nearly time for the next one, ask your care team. Never take two injections at the same time. An extra dose can be dangerous, so get medical advice, and do not drive yourself if told to go to A&E.

Common effects are itchy, red and painful skin where you inject (redness may be harder to see on brown or black skin), headaches, stomach pain, nausea and vomiting, rash, muscle, joint and bone pain, mood changes such as anxiety or depression, blurred vision and dizziness. If you feel dizzy or have blurred vision, do not drive, ride a bike or use machinery until it stops.

The NHS highlights infection as a common and serious side effect: urinary tract infections, colds, flu and skin infections, and rarer ones such as tuberculosis. Signs include a high temperature, hot and painful skin, a cough that will not go away and pain when peeing. Rarer serious effects include anaphylaxis, Stevens-Johnson syndrome, stroke and heart attack. Call 999 for those, and 111 for any other serious effect.

Most adults can take it, and it is sometimes prescribed for children. It may not be suitable if you have had an allergic reaction or serious side effect from it before, have heart failure, or have a serious infection such as tuberculosis or hepatitis. Specialists usually screen for infections before starting.

Regular blood tests while taking it check the health of the liver and kidneys, and your care team will keep reviewing whether it is working.

Tell your doctor if you are pregnant or become pregnant. Adalimumab can be used during pregnancy if needed, after a discussion of risks and benefits, and the doctor will prescribe the lowest possible effective dose.

It can be used while breastfeeding as only very small amounts pass into breast milk. Rarely do breastfed babies get side effects, but speak to a healthcare professional about any concerns.

The NHS lists vaccines that contain live viruses or bacteria, such as the chickenpox vaccine, and some chemotherapy medicines as things that may not mix well. Tell the care team about all medicines, herbal remedies, vitamins and supplements, and tell anyone giving a vaccination that you take adalimumab.

You can eat and drink as normal. It is not a painkiller as such; the benefit comes from reducing inflammation, and medicines such as methotrexate are sometimes used alongside it, a decision for your specialist.