Humira (adalimumab) is a tumor necrosis factor (TNF) blocker used to manage several inflammatory autoimmune diseases, including rheumatoid arthritis, Crohn's disease, and psoriasis. By blocking TNF-alpha, the medication reduces inflammation, but this also suppresses the immune system, increasing the risk of infection. For this reason, patients must be aware of specific medications, vaccines, and health conditions that interact with Humira to ensure their safety.
Medications to Absolutely Avoid
Certain medications can dangerously increase the risk of serious side effects, particularly severe infections, when combined with Humira. Combining multiple immunosuppressants is typically not recommended.
Other Biologic Disease-Modifying Antirheumatic Drugs (DMARDs)
Combining Humira with other biologics offers no additional benefit but significantly increases the risk of infection. The following should be avoided:
- Other TNF blockers, such as etanercept (Enbrel), infliximab (Remicade), or certolizumab (Cimzia).
- Interleukin-1 (IL-1) antagonists, like anakinra (Kineret).
- T-cell costimulation modulators, like abatacept (Orencia).
- Janus kinase (JAK) inhibitors, such as upadacitinib (Rinvoq) or tofacitinib (Xeljanz).
- Monoclonal antibodies like rituximab (Rituxan).
Drugs with a Narrow Safety Range
Humira can alter the levels of certain medications in the body, potentially making them less effective or increasing the risk of toxic side effects. Your doctor will closely monitor your levels if you take:
- Warfarin (Jantoven): A blood thinner.
- Cyclosporine: An immunosuppressant.
- Theophylline: Used for asthma and other respiratory diseases.
Live Vaccines are Strictly Prohibited
Because Humira suppresses the immune system, receiving a live vaccine can lead to a serious infection from the weakened pathogen in the vaccine. You should never receive live vaccines while on Humira therapy.
Live vaccines to avoid include:
- Measles, mumps, and rubella (MMR)
- Nasal spray flu vaccine (FluMist)
- Varicella (chickenpox)
- Yellow fever
It is essential to get any necessary vaccinations up-to-date before starting Humira therapy. Inactivated vaccines, like the standard flu shot, are typically safe and recommended.
Other Considerations and Cautions
Alcohol Consumption
While no direct interaction between Humira and alcohol is known, drinking can increase the risk of certain side effects and worsen underlying conditions. Humira can, in rare cases, cause liver problems, and heavy alcohol use can put additional strain on the liver. Patients who are also taking methotrexate with Humira, a common combination for rheumatoid arthritis, must be especially cautious, as methotrexate and alcohol can both cause liver damage.
Active Infections and Medical History
Never start or continue Humira if you have an active infection, even a minor one, unless explicitly cleared by your doctor. This includes bacterial, viral, and fungal infections. Your doctor should test you for tuberculosis (TB) before starting treatment and periodically throughout. If you have or have ever had hepatitis B, Humira can cause the virus to reactivate, and you will need close monitoring.
Medical Conditions
Humira may not be suitable for patients with certain medical conditions, which should be discussed with a doctor before starting treatment.
- Congestive Heart Failure (CHF): Humira can cause new or worsening heart failure.
- Nervous System Disorders: Worsening or new onset of demyelinating diseases like multiple sclerosis or Guillain-Barré syndrome has been reported.
- Cancer: Humira can increase the risk of certain cancers, particularly lymphoma. Those with a history of cancer should consult their doctor.
- Latex Allergy: Some Humira prefilled syringes and pens may contain latex, so patients with an allergy should inform their doctor.
Comparison of Combinations and Contraindications
To highlight the importance of discussing all medications and conditions with your doctor, here is a comparison of what is and is not advisable when on Humira.
| Item | Inadvisable/Avoid | Advisable (with medical supervision) |
|---|---|---|
| Medications | Other TNF blockers (Enbrel), other biologics (Orencia, Kineret), JAK inhibitors (Rinvoq) | Methotrexate, corticosteroids (prednisone, short-term), NSAIDs (ibuprofen) |
| Vaccines | Live vaccines (MMR, nasal flu) | Inactivated vaccines (flu shot), get all recommended immunizations before starting |
| Alcohol | Excessive or heavy drinking | Moderate consumption, if approved by a doctor |
| Health Conditions | Active infection, active TB, uncontrolled CHF, history of cancer | Latent TB (treated prior), inactive Hepatitis B (monitored) |
| Procedures | Major surgery (without consulting doctor) | Scheduling surgery with doctor's guidance |
Before and During Humira Treatment
Patient safety while on Humira requires careful management and open communication with your healthcare team. Before starting, you should be screened for TB and hepatitis B. If you have diabetes, heart failure, or a history of cancer, your doctor will need to monitor you more closely. If you are scheduled for major surgery, Humira may need to be temporarily stopped to prevent infection.
Always report any symptoms of infection, allergic reactions, or other serious side effects to your doctor immediately. A comprehensive review of all medications, including over-the-counter drugs, supplements, and herbal products, is essential before beginning therapy. Your healthcare provider is your most reliable resource for personalized guidance while navigating treatment with Humira.
