Description
Adalimumab-ryvk injection is used to treat the symptoms and prevent the progression of moderate to severe rheumatoid arthritis. It is used in children 2 years of age and older to treat moderate to severe polyarticular juvenile idiopathic arthritis. This medicine is also used to treat psoriatic arthritis, which is a type of arthritis that causes pain and swelling in the joints along with patches of scaly skin on some areas of the body. Adalimumab-ryvk may be used alone or in combination with other medicines (eg, methotrexate).
Adalimumab-ryvk injection is also used to treat moderate to severe Crohn's disease, ulcerative colitis, and active ankylosing spondylitis.
Adalimumab-ryvk injection is also used to treat moderate to severe chronic plaque psoriasis, which is a skin disease with red patches and white scales that do not go away. It is also used to treat moderate to severe hidradenitis suppurativa, a chronic skin disease that causes small, painful lumps under the skin. This medicine is also used to treat non-infectious uveitis.
This product is available in the following dosage forms:
- Solution
Before Using
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of adalimumab-ryvk injection for the treatment of polyarticular juvenile idiopathic arthritis in children 2 years of age and older or for the treatment of Crohn's disease in children 6 years of age and older. However, safety and efficacy have not been established in children younger than 2 years of age for polyarticular juvenile idiopathic arthritis, in children younger than 6 years of age for Crohn's disease, and in children for other conditions.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of adalimumab-ryvk injection in the elderly. However, this medicine may cause serious infections and cancer more often in the elderly, which may require caution in patients receiving this medicine.
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abatacept
- Adenovirus Vaccine Type 4, Live
- Adenovirus Vaccine Type 7, Live
- Anakinra
- Anifrolumab-fnia
- Bacillus of Calmette and Guerin Vaccine, Live
- Baricitinib
- Certolizumab Pegol
- Cholera Vaccine, Live
- Cyclosporine
- Dengue Tetravalent Vaccine, Live
- Ebola Zaire Vaccine, Live
- Etanercept
- Golimumab
- Infliximab
- Influenza Virus Vaccine, Live
- Levoketoconazole
- Measles Virus Vaccine, Live
- Methotrexate
- Mumps Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Rilonacept
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Monkeypox Vaccine, Live Non-Replicating
- Smallpox Vaccine
- Theophylline
- Typhoid Vaccine, Live
- Varicella Virus Vaccine, Live
- Vedolizumab
- Warfarin
- Yellow Fever Vaccine
- Zoster Vaccine, Live
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Blood problems (eg, aplastic anemia, pancytopenia, thrombocytopenia), history of or
- Congestive heart failure or
- Guillain-Barré syndrome, history of or
- Infections (fungal, bacterial), history of or
- Leukopenia (low number of white blood cells) or
- Multiple sclerosis or
- Optic neuritis (eye problem) or
- Psoriasis (skin disease)—Use with caution. May make these conditions worse.
- Cancer, active or history of or
- Chronic obstructive pulmonary disease (COPD) or
- Granulomatosis with polyangiitis—Use with caution. May increase the chance of getting new cancers.
- Diabetes or
- Hepatitis B, history of or
- Opportunistic infections, history of or
- Tuberculosis, history of—May increase chance for side effects.
- Infection, active—Should not be used in patients with this condition.
- Tuberculosis, active—Should be treated first before receiving this medicine.
Proper Use
This medicine is given as a shot under the skin in the front of your thighs or stomach. It may be given at home if patients do not need to be in the hospital or clinic. If you are using this medicine at home, your healthcare provider will teach you how to prepare and inject the medicine. Be sure that you understand how to use this medicine.
This medicine comes with a Medication Guide and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.
If you use this medicine at home, you will be shown the body areas where this shot can be given. Use a different body area each time you give yourself or your child a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems.
To use the autoinjector:
- Wash your hands with soap and water before and after using this medicine.
- Allow 15 to 30 minutes for the autoinjector to warm up to room temperature. Do not warm using heat sources (eg, hot water, microwave).
- Do not remove the clear cap on the autoinjector while allowing the medicine to reach room temperature.
- Do not use the medicine if it has been dropped or crushed.
- Check the liquid in the autoinjector. It should be clear and colorless. Do not use the medicine if it is cloudy, discolored, or has particles in it.
- Do not inject into skin areas that are red, bruised, sore, hard, scarred, stretch marks, or areas with psoriasis.
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For injection dosage form (autoinjector):
- For Crohn's disease:
- Adults and children 6 years of age and older weighing 40 kilograms (kg) or more—At first (Day 1), 160 milligrams (mg) injected under the skin. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg is given at week 4 (Day 29) and every other week thereafter.
- Children younger than 6 years of age or weighing less than 40 kg—Use and dose must be determined by your doctor.
- For hidradenitis suppurativa:
- Adults—At first (Day 1), 160 milligrams (mg) injected under the skin. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg weekly or 80 mg every other week starting at week 4 (Day 29).
- Children—Use and dose must be determined by your doctor.
- For polyarticular juvenile idiopathic arthritis:
- Children 2 years of age and older weighing 30 kilograms (kg) or more—40 milligrams (mg) injected under the skin every other week.
- Children younger than 2 years of age or weighing less than 30 kg—Use and dose must be determined by your doctor.
- For plaque psoriasis or uveitis:
- Adults—At first, 80 milligrams (mg) injected under the skin, then 40 mg 1 week after the initial dose and every other week thereafter.
- Children—Use and dose must be determined by your doctor.
- For rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis:
- Adults—40 milligrams (mg) injected under the skin every other week. Your doctor may adjust your dose as needed. Some patients with rheumatoid arthritis who are not taking methotrexate may use 40 mg every week or 80 mg every other week.
- Children—Use and dose must be determined by your doctor.
- For ulcerative colitis:
- Adults—At first (Day 1), 160 milligrams (mg) injected under the skin. This may be given as four shots in 1 day or as two shots per day for 2 days. Then 2 weeks later (Day 15), a dose of 80 mg is given. A maintenance dose of 40 mg is given at week 4 (Day 29) and every other week thereafter.
- Children—Use and dose must be determined by your doctor.
- For Crohn's disease:
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store in the refrigerator. Do not freeze.
Keep the medicine in its original carton to protect from light. Do not use it if it has been frozen or thawed. If needed (eg, traveling), you may store this medicine at room temperature for up to 14 days. Throw away any unused medicine after 14 days. Do not store this medicine in extreme heat or cold temperatures.
Throw away used autoinjector, syringes, and needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.
Precautions
It is very important that your doctor check the progress of you or your child at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Do not take other medicines unless they have been discussed with your doctor. Using abatacept (Orencia®) and anakinra (Kineret®) together with this medicine may increase your risk of having serious side effects.
You or your child will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.
Adalimumab-ryvk injection will lower the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.
This medicine may cause other unwanted effects that may not occur until months or years after this medicine is used. A small number of people (including children and teenagers) who have used this type of medicine have developed certain types of cancer (eg, leukemia). Some patients also developed a rare type of cancer called lymphoma. Talk with your doctor if you or your child have unusual bleeding, bruising, or weakness, swollen lymph nodes in the neck, underarms, or groin, or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.
Adalimumab-ryvk injection may cause serious allergic reactions (eg, anaphylaxis, angioneurotic edema), which can be life-threatening and require immediate medical attention. Check with your doctor right away if you or your child have a cough, difficulty swallowing, dizziness, fast heartbeat, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, genitals, rash, itching, trouble breathing, or unusual tiredness or weakness after you receive the medicine.
Check with your doctor right away if you or your child have swelling of the face, fingers, feet, or lower legs, sudden weight gain, or trouble breathing. These may be signs of a heart condition called congestive heart failure (CHF).
Some people who have used this medicine developed lupus-like symptoms during treatment and got better after the medicine was stopped. Check with your doctor right away if you or your child start having chest pains, joint pain, trouble breathing, or a rash on your cheeks or arms that is sensitive to the sun.
Do not have any live vaccines (immunizations) while you or your child are being treated with adalimumab-ryvk. Your child's vaccines need to be current before he or she begins using this medicine. Be sure to ask your child's doctor if you have any questions about this.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
- Blurred vision
- body aches or pain
- chills
- cough
- dizziness
- ear congestion
- fever
- headache
- loss of voice
- pounding in the ears
- slow or fast heartbeat
- sneezing
- stuffy or runny nose
- trouble breathing
- unusual tiredness or weakness
Less common
- Abnormal healing
- agitation
- anxiety
- arm, back, jaw pain
- bleeding from the gums or nose
- blindness
- bloating or swelling of the face, arms, hands, lower legs, or feet
- bloody or black, tarry stools
- bloody or cloudy urine
- blue or pale skin
- bone pain or fractures
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- chest pain, discomfort, tightness, or heaviness
- coma
- confusion
- cough or hoarseness
- dark urine
- decreased vision
- depression
- diarrhea
- difficulty in moving
- difficulty in swallowing
- drowsiness
- dry mouth
- dry skin
- eye pain
- fainting
- feeling of illness
- frequent urge to urinate
- gaseous stomach pain
- hair loss
- hallucinations
- heartburn
- increased thirst
- increased urination
- indigestion
- irritability
- itching
- loss of appetite
- loss of strength or energy
- light-colored stools
- lower back or side pain
- mood or mental changes
- muscle pain, stiffness, cramps, tightness, rigidity, or spasms
- nausea
- no blood pressure or pulse
- pain, swelling, or redness in the joints
- pain in the arms or legs
- pain in the groin or genitals
- pain or burning in the throat
- painful or difficult urination
- pale skin
- pelvic pain
- rapid breathing
- rapid weight gain or loss
- rash
- recurrent fever
- redness or swelling of the lower leg
- ringing in the ears
- seizures
- shakiness in the legs, arms, hands, or feet
- sharp back pain just below ribs
- sore throat
- sores, ulcers, or white spots on the lips or tongue or inside the mouth
- stiff neck
- stomach pain
- stopping of the heart
- sunken eyes
- sweating
- tingling of the hands or feet
- trembling or shaking of the hands or feet
- trouble thinking
- unconsciousness
- unpleasant breath odor
- unusual bleeding or bruising
- unusual weight gain or loss
- visual disturbances
- vomiting
- vomiting of blood or material that looks like coffee grounds
- wrinkled skin
- yellow eyes or skin
Incidence not known
- Blistering, peeling, or loosening of skin
- blisters on the skin
- blue-yellow color blindness
- inability to move arms and legs
- red irritated eyes
- red skin lesions, often with a purple center
- sudden numbness and weakness in the arms and legs
- swelling in the arm or leg
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- pain or tenderness around eyes and cheekbones
Incidence not known
- Loss or thinning of the hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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