Humira Pen

Adalimumab (rch)
Consumer Medicine Information
 

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. This page contains answers to some common questions about Humira Pen. It does not contain all the information that is known about Humira Pen. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risk of you using this medicine against the benefits he/she expects it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. Bookmark or print this page, 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 moderately 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 indicated for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis, which is an inflammatory disease, involving multiple joints, with diagnosis typically occurring in children between the ages of 4 and 17 years.
Psoriatic arthritis
Humira is used to reduce the signs and symptoms, as well as inhibit the progression of structural damage of moderately 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 in adults to reduce the signs and symptoms of the disease and to induce and maintain clinical remission in patients who have had an inadequate response to conventional therapies, or who have lost response to or are intolerant of infliximab.
Ulcerative Colitis
Humira is used for the treatment of moderate to severe ulcerative colitis in patients who have had an inadequate response 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 reduce the signs and symptoms of moderate to severe chronic plaque psoriasis, an inflammatory disease of the skin.
The active ingredient in this medicine is adalimumab, a fully human monoclonal antibody. Monoclonal antibodies are proteins that recognise and bind to other unique proteins. Adalimumab 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, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis and psoriasis.
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.

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
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.
If it has expired or is damaged, 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
you are a carrier of or you suspect you may be infected with the hepatitis B virus
a fungal infection
multiple sclerosis and other demyelinating disease
you experience allergic reactions such as chest tightness, wheezing, dizziness, swelling or rash
blood disorders
a suppressed immune system
heart conditions including congestive heart failure, heart attack or worsening of existing heart conditions
cancer or autoimmune disease
kidney or liver problems
an allergy to rubber or latex
You might get infections more easily while you are receiving Humira treatment. This risk may increase if your lung function is impaired. These infections may be serious and include tuberculosis, infections caused by viruses, fungi, parasites or bacteria, or other opportunistic infections and sepsis that may, in rare cases, be life-threatening.
It is important to tell your doctor if you get symptoms such as fever, wounds, feeling tired or dental problems.
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.
It is very important that you tell your doctor if you have ever had 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.
Tell your doctor if you are a carrier of the hepatitis B virus (HBV), if you have active HBV or if 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.
Tell your doctor if you are scheduled for any vaccines.
It is recommended that children with polyarticular juvenile idiopathic arthritis, 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 currently taking or have previously taken any medicine that lowers the body's resistance to disease.
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.
The effects of Humira in pregnant women are not known. Therefore the use of this medicine in pregnant women is not recommended.
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.
Tell your doctor if you live(d) or have travelled to countries where there is more risk for certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, or blastomycosis).
These infections may develop or become more severe if you take Humira.
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).
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.

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.

How much to use

Always use Humira exactly as your doctor has instructed you. You should check with your doctor or pharmacist if you are unsure.
The usual dose for adults with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is one 40mg injection fortnightly.
The usual dose for children with polyarticular juvenile idiopathic arthritis, age 4 to 17 years, with a body weight equal to and above 30 kg is 40mg given fortnightly as a single dose.
For children below 30 kg body weight the recommended dose is 20mg fortnightly. A 20 mg pre-filled syringe is available for this patient population.
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.
The usual dose for adults with psoriasis is an initial dose of 80mg, followed by 40mg given fortnightly starting one week after the initial dose.
Your doctor may prescribe other medicines for rheumatoid or psoriatic arthritis to take with this medicine.

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:
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 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 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 needlestick injury.
Do not place the pen down as this could cause the unit to discharge.

4. Giving the injection

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 control your symptoms.

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 give yourself two injections to make up for the injection that you missed.
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 the Poisons Information Centre (Australia Telephone 13 11 26; New Zealand: Telephone 0800 764 766), 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 polyarticular juvenile idiopathic arthritis patients, 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.

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.
Tell your doctor if you are sensitive to latex.
The needle cover of the syringe contains natural rubber (latex).
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.
The long term effects of Humira on the growth and development of children is 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.
If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
Severe rash, hives or other signs of allergic reaction
Swollen face, hands, feet
Trouble breathing, swallowing
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 rare.
Tell your doctor as soon as possible if you notice any of the following:
Persistent cough, weight loss, listlessness, fever
Signs of infection such as fever, malaise, wounds, dental problems, burning on urination
Signs of nervous system disorders such as numbness or tingling throughout your body, arm or leg weakness, double vision
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)
Headache, dizziness, vertigo, sensation disorders
Increased cough, sore throat
Abdominal symptoms such as nausea, diarrhoea, abdominal pain,
Rash, itching
Fatigue
Mouth inflammation and ulcers
Elevated liver enzymes
Musculoskeletal pain
Viral infections (including influenza, cold sore blisters, chicken pox and shingles)
Bacterial infections (including Urinary Tract Infection)
Fungal Infections
The above list includes the more common side effects of Humira. They are usually mild and short-lived.
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. In addition very rare cases of non-melanoma 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-8°C). Do not freeze.
Keep Humira in the refrigerator in a way children cannot get to it.
If you need to travel, make sure the medicine is kept at the right temperature. 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, but must be 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.

Disposal

After injecting Humira, immediately throw away the used pen in a special 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 or 6 pre-filled pens with 2 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 injection

Patient Support Programme

The myHEALTHguide patient support programme is available to patients prescribed Humira and offers the following:
In-home or over the phone nurse support for self-injecting
Access to a health coach providing tailored lifestyle support
Access to a free counselling service provided either face to face, over the phone or online
Medication reminders and personalised injecting schedules
Step-by-step support to quit smoking
Links to other support groups and resources
Comprehensive disease-specific on-line support
For further information visit myHEALTHguide.com.au or call 1800 HUMIRA or 1800 486 472

Distributor

Humira is distributed in Australia by:
AbbVie Pty Ltd
ABN 48 156 384 262
241 O'Riordan Street
Mascot NSW 2020
 
This leaflet was prepared in:
November 2014
 
Australian Registration Number:
AUST R 127116
 
Version 15