Understanding Amgevita and Its Mechanism
Amgevita, a brand name for the biologic drug adalimumab, is a tumor necrosis factor (TNF) blocker [1.7.1]. It works by targeting and blocking TNF, a protein that can contribute to inflammation in autoimmune diseases. Doctors prescribe it for conditions like rheumatoid arthritis, psoriatic arthritis, Crohn's disease, and ulcerative colitis [1.7.1, 1.7.3]. By suppressing part of your immune system to reduce inflammation, Amgevita can make you more susceptible to infections [1.4.6]. Therefore, understanding the necessary precautions is a critical part of your treatment plan.
Before you start treatment, your doctor will screen you for underlying conditions, most notably tuberculosis (TB) and hepatitis B [1.2.2, 1.2.5]. Amgevita can reactivate latent TB or hepatitis B viruses that are already in your body [1.2.5, 1.3.2]. If you have a history of these conditions, your doctor will take steps to manage them before initiating Amgevita therapy.
Live Vaccines: A Strict Contraindication
One of the most critical safety measures is to avoid all live vaccines while on Amgevita [1.4.1, 1.7.2]. Live vaccines contain a weakened form of a virus or bacterium [1.3.1]. In a person with a healthy immune system, these vaccines trigger an immune response without causing illness. However, because Amgevita weakens your immune system, receiving a live vaccine can lead to you developing the very infection it's designed to prevent [1.3.1, 1.4.5].
It is recommended that you are up-to-date on all necessary vaccinations before starting Amgevita [1.4.8]. If a vaccine is needed during treatment, it's crucial to discuss it with your doctor to ensure it is not a live vaccine [1.4.6].
Examples of Live Vaccines to Avoid:
- Measles, Mumps, and Rubella (MMR) [1.3.1, 1.7.2]
- Nasal spray flu vaccine (FluMist) [1.3.1, 1.7.2]
- Chickenpox (varicella) vaccine [1.3.1, 1.4.2]
- Shingles vaccine (Zostavax is live, but Shingrix is a non-live alternative) [1.4.2]
- Yellow fever vaccine [1.4.2]
Inactivated (non-live) vaccines, like the standard flu shot and most COVID-19 vaccines, are considered safe, although Amgevita might make them slightly less effective [1.3.2].
Drug Interactions: Other Medications to Avoid or Use with Caution
Combining Amgevita with other medications that suppress the immune system can compound the risk of serious infections [1.2.5, 1.5.1]. It is essential to provide your doctor with a complete list of all medications you use, including prescription drugs, over-the-counter medicines, and herbal supplements [1.5.6].
Key Drug Interactions:
- Other TNF Blockers: Using Amgevita with other TNF blockers like etanercept (Enbrel) or infliximab (Remicade) is not recommended. This combination significantly increases the risk of serious infection with little to no added benefit [1.7.1, 1.5.1].
- Other Biologic DMARDs: Combining Amgevita with other biologic drugs such as abatacept (Orencia) or anakinra (Kineret) is also not recommended due to a higher risk of serious infections [1.2.4, 1.7.1].
- Janus Kinase (JAK) Inhibitors: Medications like tofacitinib (Xeljanz) or upadacitinib (Rinvoq) should be avoided in combination with Amgevita as they also increase infection risk [1.5.1, 1.7.1].
- Certain Immunosuppressants: Drugs like azathioprine and mercaptopurine, when taken with Amgevita, can increase the risk of side effects, including a higher risk of certain cancers [1.2.5, 1.3.1].
Comparison Table: High-Risk Medication Interactions
| Drug Class/Name | Examples | Reason to Avoid/Use with Caution |
|---|---|---|
| Other TNF Blockers | Etanercept (Enbrel), Infliximab (Remicade), Golimumab (Simponi) [1.5.1] | Significantly increases the risk of serious infections [1.7.1]. |
| Other Biologics | Abatacept (Orencia), Anakinra (Kineret), Rituximab (Rituxan) [1.5.1, 1.5.3] | Increases the risk of serious infections [1.2.4, 1.5.1]. |
| JAK Inhibitors | Tofacitinib (Xeljanz), Upadacitinib (Rinvoq), Baricitinib (Olumiant) [1.5.1, 1.7.1] | Increases the risk of infections [1.5.1]. |
| Immunosuppressants | Azathioprine, Mercaptopurine, Cyclosporine [1.3.1, 1.5.3] | Further weakens the immune system, increasing infection risk and potentially cancer risk [1.2.5, 1.3.1]. |
Pre-existing Conditions and Other Health Factors
Certain health conditions can be worsened by Amgevita. You must inform your doctor about your complete medical history [1.2.2].
Conditions of Concern:
- Active Infections: Treatment should not be started in patients with an active infection [1.2.4].
- Heart Failure: Amgevita may cause new or worsening congestive heart failure (CHF) [1.2.1, 1.3.2].
- Neurologic Conditions: Tell your doctor if you have a history of multiple sclerosis (MS) or Guillain-Barré syndrome, as Amgevita may worsen these conditions [1.2.2, 1.3.2].
- History of Cancer: As TNF blockers can affect the immune system's ability to control cancer cells, a history of malignancy is a serious consideration [1.2.5, 1.3.2].
- Allergies: Do not use Amgevita if you've had a previous allergic reaction to adalimumab. The Amgevita injection pen is also not latex-free, which is important for those with a latex allergy [1.2.2].
- Upcoming Surgery: You may need to temporarily stop taking Amgevita before and after major surgery to reduce the risk of infection [1.2.2, 1.6.4, 1.6.7].
Food and Alcohol Considerations
There are no direct known interactions between Amgevita and alcohol [1.2.5]. However, excessive alcohol consumption can lead to liver problems, and Amjevita itself carries a rare risk of liver issues. Alcohol can also worsen side effects like headaches and may exacerbate the symptoms of the underlying condition being treated, such as Crohn's disease [1.2.5, 1.3.1].
While there are no specific foods you must avoid, it is wise to practice good food safety. Because your immune system is suppressed, you are more vulnerable to foodborne illnesses. Avoid unpasteurized dairy, raw or undercooked eggs, meats, and seafood to minimize this risk [1.3.3, 1.3.8].
Conclusion
Navigating treatment with Amgevita requires a partnership between you and your healthcare provider. The most critical factors to avoid are live vaccines and concurrent use of other powerful immune-suppressing biologic drugs. Always disclose your full medical history, including any infections, a history of cancer, heart or nerve conditions, and any planned surgeries. By staying informed and maintaining open communication with your doctor, you can safely and effectively manage your condition with Amgevita.
For more detailed information, consult the official AMJEVITA® (adalimumab-atto) patient website.
