USA - engelsk - NLM (National Library of Medicine)

mylan specialty l.p. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab-fkjp is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab-fkjp can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab-fkjp is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab-fkjp can be used alone or in combination with methotrexate . adalimumab-fkjp is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab-fkjp can be used alone or in combination with non-biologic dmards. adalimumab-fkjp is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. adalimumab-fkjp is indicated for the treatment of moderately to severely active crohn’s disease in adults and pediatric patients 6 years of age and older . adalimumab-fkjp is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients. limitations of use the effectiveness of adalimumab products has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies (14.7, 14.8)] . adalimumab-fkjp is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. adalimumab-fkjp should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions (5)] . adalimumab-fkjp is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients. hulio is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adult patients . none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn’s disease (cd) treated with adalimumab. registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data) . adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in-utero exposed infant (see clinical considerations) . in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data) . the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester (see data) . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to adalimumab products in utero  [see use in specific populations (8.4)] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with adalimumab, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of adalimumab was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16-19.7 mcg/ml in cord blood, 4.28-17.7 mcg/ml in infant serum, and 0-16.1 mcg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 mcg/ml), 7 weeks (1.31 mcg/ml), 8 weeks (0.93 mcg/ml), and 11 weeks (0.53 mcg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab products on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for adalimumab-fkjp and any potential adverse effects on the breastfed child from adalimumab-fkjp or from the underlying maternal condition. the safety and effectiveness of adalimumab-fkjp have been established for: pediatric assessments for adalimumab-fkjp demonstrate that adalimumab-fkjp is safe and effective for pediatric patients in indications for which humira (adalimumab) is approved. however, adalimumab-fkjp is not approved for such indications due to marketing exclusivity for humira (adalimumab). due to their inhibition of tnfα, adalimumab products administered during pregnancy could affect immune response in the in utero -exposed newborn and infant. data from eight infants exposed to adalimumab in utero suggest adalimumab crosses the placenta [see use in specific populations (8.1)] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. post-marketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including adalimumab products [see warnings and precautions (5.2)] . juvenile idiopathic arthritis in study jia-i, adalimumab was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies (14.2)] . in study jia-ii, the safety profile for patients 2 to <4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions (6.1)] . adalimumab products have not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of adalimumab in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions (6.1)] . the safety and effectiveness of adalimumab products have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn’s disease the safety and effectiveness of adalimumab products for the treatment of moderately to severely active crohn’s disease have been established in pediatric patients 6 years of age and older. use of adalimumab products for this indication is supported by evidence from adequate and well-controlled studies in adults with additional data from a randomized, double-blind, 52-week clinical study of two dose concentrations of adalimumab in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions (6.1), clinical pharmacology (12.2, 12.3), clinical studies (14.6)] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of adalimumab products have not been established in pediatric patients with crohn’s disease less than 6 years of age. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received adalimumab in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among adalimumab treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of adalimumab-fkjp in patients 65 years of age and older. in patients treated with adalimumab-fkjp, closely monitor for the development of infection or malignancy [see warnings and precautions (5.1, 5.2)] . adalimumab-fkjp pen injection for subcutaneous use 40 mg/0.8 ml single-dose prefilled pen for subcutaneous (under the skin) use only read these instructions carefully before using your pen. this information does not replace talking to your healthcare provider about your medical condition and your treatment. do not try to inject adalimumab-fkjp yourself until you have been shown the right way to give the injections and have read and understand this instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of adalimumab-fkjp at home, you should receive training on the right way to prepare and inject adalimumab-fkjp. it is important that you read, understand, and follow these instructions so that you inject adalimumab-fkjp the right way. it is also important to talk to your healthcare provider to be sure you understand your adalimumab-fkjp dosing instructions. to help you remember when to inject adalimumab-fkjp, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver has any questions about the right way to inject adalimumab-fkjp. for questions or assistance, call mylan at 1-877-446-3679 (1-877-4-info-rx) caution: never put your thumb, fingers, or hand over the orange activator after cap is removed. never press or push the orange activator with your thumb, fingers, or hand. the orange activator is where the needle comes out. if accidental injection to your fingers or hands occurs, apply first-aid and either call your healthcare provider or go to the nearest hospital emergency room if needed.   dosage: adalimumab-fkjp pen is for single dose (1-time) use only. important: do not use adalimumab-fkjp if frozen, even if it has been thawed. do not uncap your adalimumab-fkjp pen until you are ready to inject and will not be interrupted. do not recap. recapping your adalimumab-fkjp pen can damage the needle. a loud “click” will occur when the orange activator is pressed down to deliver your dose of adalimumab-fkjp. parts of the adalimumab-fkjp pen storing and handling the adalimumab-fkjp pen if needed, for example when traveling, adalimumab-fkjp may be stored at room temperature up to 77°f (25°c) for a period of up to 14 days, with protection from light. discard (throw away) adalimumab-fkjp if not used within the 14 day period. record the date on the carton and dose tray when adalimumab-fkjp is first removed from the refrigerator. gather supplies for injection find a quiet area with a well-lit, clean and flat work surface and gather all the supplies you will need to give yourself or receive an injection. supplies you will need: included in adalimumab-fkjp carton not included in adalimumab-fkjp carton if you do not have all the supplies you need to give yourself an injection, visit or call your local pharmacist. preparing the pen remove the pen from the refrigerator 30 minutes before using. check the viewing window to make sure: do not use the pen if medicine is not near the fill marker. use another pen or contact your healthcare provider. do not use the pen if it is cloudy, discolored, or has particles in it. choosing and preparing injection site your healthcare provider should show you proper injection site techniques. giving the injection caution: injection process must be completed without interruption. read all steps first before beginning injection. step 1 uncap important: step 2 squeeze and hold injection site the thigh injection site is shown here (see figure f). perform these steps the same way for abdomen (belly) injection sites. step 3 place pen step 4 begin injection step 5 hold down for 2nd “click”, orange indicator and 10 seconds continue pushing the body of the pen down against the injection site until: caution: make sure all three of these have occurred to ensure all medicine was delivered. if the needle did not retract or you do not think you received the full dose contact your healthcare provider for assistance. step 6 end of injection, remove adalimumab-fkjp pen dispose of the adalimumab-fkjp pen and cap put the used pen and cap in an fda-cleared sharps disposal container or puncture resistant container right away to avoid injury (see “how should i throw away (dispose of) the used adalimumab-fkjp pen and cap?” in step 7). pen is for single-dose only. do not reuse the pen if all of the medicine was not injected. do not try to recap the pen as it could lead to a needle stick injury. step 7 how should i throw away (dispose of) the used adalimumab-fkjp pen and cap? if you do not have an fda-cleared sharps disposal container, you may use a household container that is: when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and pens. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. do not recycle your used sharps disposal container. step 8 write down the date you received your injection and the injection site used in the injection diary. injection diary date injection site used                     customer service for questions or assistance, call mylan at 1-877-446-3679 (1-877-4-info-rx) the brands listed are trademarks of their respective owners. the logo is a trademark of bgp products operations gmbh, a viatris company. © 2023 viatris inc. manufactured by: mylan pharmaceuticals inc. morgantown, wv 26505 u.s.a. manufactured for: mylan specialty l.p. morgantown, wv 26505 u.s.a. u.s. license no. 2210 product of japan this instructions for use has been approved by the u.s. food and drug administration. revised: 06/2023 pci:adalub:ifup:r2 725787 adalimumab-fkjp injection for subcutaneous use 20 mg/0.4 ml and 40 mg/0.8 ml single-dose prefilled syringe for subcutaneous (under the skin) use only read these instructions carefully before using your syringe. this information does not replace talking to your healthcare provider about your medical condition and your treatment. do not try to inject adalimumab-fkjp yourself until you have been shown the right way to give the injections and have read and understand this instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of adalimumab-fkjp at home, you should receive training on the right way to prepare and inject adalimumab-fkjp. it is important that you read, understand, and follow these instructions so that you inject adalimumab-fkjp the right way. it is also important to talk to your healthcare provider to be sure you understand your adalimumab-fkjp dosing instructions. to help you remember when to inject adalimumab-fkjp, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver has any questions about the right way to inject adalimumab-fkjp. for questions or assistance, call mylan at 1-877-446-3679 (1-877-4-info-rx) dosage: adalimumab-fkjp prefilled syringe is for single dose (1-time) use only. important: parts of the adalimumab-fkjp prefilled syringe (syringe) see figure a storing and handling the syringe if needed, for example when traveling, adalimumab-fkjp may be stored at room temperature up to 77°f (25°c) for a period of up to 14 days, with protection from light. discard (throw away) adalimumab-fkjp if not used within the 14-day period. record the date on the carton and dose tray when adalimumab-fkjp is first removed from the refrigerator. gather supplies for injection find a quiet area with a well-lit, clean and flat work surface and gather all the supplies you will need to give yourself or receive an injection. supplies you will need: included in the adalimumab-fkjp carton (taken from refrigerator 30 minutes prior to intended injection time to allow syringe to reach room temperature) not included in adalimumab-fkjp carton if you do not have all the supplies you need to give yourself an injection, visit or call your local pharmacist. preparing the syringe remove the syringe from the refrigerator 30 minutes before using. check the viewing window to make sure: do not use the syringe if medicine is not near the fill marker. use another syringe or contact your healthcare provider. do not use the syringe if it is cloudy, discolored, or has particles in it. choosing and preparing injection site your healthcare provider should show you proper injection site techniques. wait for it to dry on its own, do not fan or blow dry. giving the injection caution: injection process must be completed without interruption.               read all steps first before beginning injection. step 1 uncap caution: step 2 squeeze and hold injection site the thigh injection site is shown here (see figure f). perform these steps the same way for abdomen (belly) injection sites. step 3 insert needle into site at a 45° angle to the injection site, with your other hand use a quick dart-like motion to insert the needle into the site (see figure g). be careful to insert the needle so that it will not inject into your fingers holding the injection site. step 4 inject medicine after the needle is in, let go of squeezing the injection site. slowly push the plunger all the way down with your thumb until all the medicine is injected and the syringe is empty (see figure h). if the plunger is not pressed all the way down the needle safety feature will not activate afterwards to cover the needle. do not move, twist, or rotate syringe during injection. step 5 end of injection, remove syringe pull the syringe away from the injection site, then release your thumb from the plunger. the needle will retract and the needle safety feature will cover the needle (see figure i). caution : if the needle did not retract or you do not think you received the full dose, contact your healthcare provider for assistance. if the needle does not retract, carefully place the syringe into a sharps or puncture resistant container to avoid injury. dispose of the adalimumab-fkjp syringe and needle cap put the used syringe and needle cap in an fda-cleared sharps disposal container or puncture resistant container right away to avoid injury (see “how should i throw away (dispose of) the used adalimumab-fkjp prefilled syringe and needle cap?” in step 6). syringe is for single-dose only. do not reuse the syringe even if all of the medicine was not injected. do not try to recap the needle as it could lead to a needle stick injury. step 6 how should i throw away (dispose of) the used adalimumab-fkjp prefilled syringe and needle cap? if you do not have an fda-cleared sharps disposal container, you may use a household container that is: when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. do not recycle your used sharps disposal container. step 7 write down the date you received your injection and the injection site used in the injection diary. injection diary date injection site used                          customer service for questions or assistance, call mylan at 1-877-446-3679 (1-877-4-info-rx) the brands listed are trademarks of their respective owners. the logo is a trademark of bgp products operations gmbh, a viatris company. © 2023 viatris inc. manufactured by: mylan pharmaceuticals inc. morgantown, wv 26505 u.s.a. manufactured for: mylan specialty l.p. morgantown, wv 26505 u.s.a. u.s. license no. 2210 product of japan this instructions for use has been approved by the u.s. food and drug administration. issued: 06/2023 pci:adalub:ifus:r2 725784

USA - engelsk - NLM (National Library of Medicine)

fresenius kabi usa, llc - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab-aacf is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab-aacf can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab-aacf is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab-aacf can be used alone or in combination with methotrexate. adalimumab-aacf is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab-aacf can be used alone or in combination with non-biologic dmards. adalimumab-aacf is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. adalimumab-aacf is indicated for the treatment of moderately to severely active crohn's disease in adults and pediatric patients 6 years of age and older. adalimumab-aacf is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients. limitations of use the effectiveness of adalimumab products has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies (14.7)] . adalimumab-aacf is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. adalimumab-aacf should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions (5)] . adalimumab-aacf is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients. adalimumab-aacf is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adults. none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn's disease (cd) treated with adalimumab. registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease-matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data) . adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in-utero exposed infant (see clinical considerations) . in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data) . the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester (see data) . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to adalimumab products in utero [see use in specific populations (8.4)] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with adalimumab, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of adalimumab was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16-19.7 mcg/ml in cord blood, 4.28-17.7 mcg/ml in infant serum, and 0-16.1 mcg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 mcg/ml), 7 weeks (1.31 mcg/ml), 8 weeks (0.93 mcg/ml), and 11 weeks (0.53 mcg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab products on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for adalimumab-aacf and any potential adverse effects on the breastfed child from adalimumab-aacf or from the underlying maternal condition. the safety and effectiveness of adalimumab-aacf have been established for: - reducing signs and symptoms of moderately to severely active polyarticular jia in pediatric patients 2 years of age and older. - the treatment of moderately to severely active crohn's disease in pediatric patients 6 years of age and older. pediatric assessments for adalimumab-aacf demonstrate that adalimumab-aacf is safe and effective for pediatric patients in indications for which humira (adalimumab) is approved. however, adalimumab-aacf is not approved for such indications due to marketing exclusivity for humira (adalimumab). due to their inhibition of tnfα, adalimumab products administered during pregnancy could affect immune response in the in utero-exposed newborn and infant. data from eight infants exposed to adalimumab in utero suggest adalimumab crosses the placenta [see use in specific populations (8.1)] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. post-marketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including adalimumab products [see warnings and precautions (5.2)] . juvenile idiopathic arthritis in study jia-i, adalimumab was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies (14.2)] . in study jia-ii, the safety profile for patients 2 to <4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions (6.1)] . adalimumab products have not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of adalimumab in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions (6.1)] . the safety and effectiveness of adalimumab-aacf have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn's disease the safety and effectiveness of adalimumab-aacf for the treatment of moderately to severely active crohn's disease have been established in pediatric patients 6 years of age and older. use of adalimumab-aacf for this indication is supported by adalimumab-aacf's approval as a biosimilar to adalimumab and evidence from adequate and well-controlled studies in adults with additional data of adalimumab from a randomized, double-blind, 52-week clinical study of two dose concentrations of adalimumab in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions (6.1), clinical pharmacology (12.2, 12.3), clinical studies (14.6)] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of adalimumab-aacf have not been established in pediatric patients with crohn's disease less than 6 years of age. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received adalimumab in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among adalimumab treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of adalimumab-aacf in patients 65 years of age and older. in patients treated with adalimumab-aacf, closely monitor for the development of infection or malignancy [see warnings and precautions ( 5.1, 5.2 )] . read this instructions for use before using your adalimumab-aacf prefilled pen. do not try to inject adalimumab-aacf yourself until you have been shown the right way to give the injections and have read and understand this instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of adalimumab-aacf at home, you should receive training on the right way to prepare and inject adalimumab-aacf. it is important that you read, understand, and follow these instructions so that you inject adalimumab-aacf the right way. it is also important to talk to your healthcare provider to be sure you understand your adalimumab-aacf dosing instructions. to help you remember when to inject adalimumab-aacf, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject adalimumab-aacf. important information - read the medication guide that comes with your adalimumab-aacf prefilled pen for important information you need to know before using it. - call your healthcare provider if you have any questions about adalimumab-aacf or how to give your injection. - adalimumab-aacf prefilled pen is for single-dose (one-time) use only. - do not share your adalimumab-aacf prefilled pen with another person. you may give another person an infection or get an infection from them. storing adalimumab-aacf prefilled pens - store adalimumab-aacf prefilled pen in the original carton to protect it from light. - store adalimumab-aacf prefilled pen in the refrigerator between 36°f to 46°f (2°c to 8°c). - do not freeze adalimumab-aacf. do not use adalimumab-aacf if frozen, even if it has been thawed. - refrigerated adalimumab-aacf may be used until the expiration date printed on the adalimumab-aacf carton, dose tray or pen. do not use adalimumab-aacf after the expiration date. - if needed, for example when traveling, adalimumab-aacf prefilled pen can be stored at room temperature between 68°f to 77°f (20°c to 25°c) for up to 28 days. - throw away adalimumab-aacf if it has been kept at room temperature and not been used within 28 days. - record the date you first remove adalimumab-aacf from the refrigerator in the spaces provided on the carton. - throw away (dispose of) the adalimumab-aacf prefilled pen in a sharps disposal container if it has been stored above 77°f (25°c). (see step 7 “dispose of your prefilled pens” ). - do not store adalimumab-aacf in extreme heat or cold. - do not use adalimumab-aacf if the liquid is cloudy, discolored, or has flakes or particles in it. - do not drop or crush adalimumab-aacf. - keep the adalimumab-aacf prefilled pen, injection supplies, and all other medicines out of the reach and sight of children. using the adalimumab-aacf prefilled pen - only use adalimumab-aacf prefilled pen if your healthcare provider has instructed you on how to use it. - do not try to reuse the adalimumab-aacf prefilled pen. - before injecting, let adalimumab-aacf sit at room temperature for 15-30 minutes after removing it from the refrigerator. - always inject adalimumab-aacf using the technique your healthcare provider taught you. - do not use an adalimumab-aacf prefilled pen to give adalimumab-aacf to a child who weighs less than 66 pounds (30 kg). - do not insert your fingers into the opening of the safety guard. - do not use the prefilled pen if the new carton is open or damaged. - do not use an adalimumab-aacf prefilled pen that has been frozen or left in direct sunlight. - do not use and do call your healthcare provider or pharmacist if: you drop or crush your adalimumab-aacf prefilled pen. your adalimumab-aacf prefilled pen - you will need the following supplies for each injection of adalimumab-aacf (figure c). find a clean flat surface, such as a table or countertop, in a well-lit area. 1 alcohol swab 1 cotton ball or gauze (not included in your adalimumab-aacf carton) 1 adalimumab-aacf prefilled pen (see figure a) puncture-resistant sharps disposal container for adalimumab-aacf prefilled pen disposal (not included in your adalimumab-aacf carton. (see step 7 “dispose of used prefilled pens ”). - 1 alcohol swab - 1 cotton ball or gauze (not included in your adalimumab-aacf carton) - 1 adalimumab-aacf prefilled pen (see figure a) - puncture-resistant sharps disposal container for adalimumab-aacf prefilled pen disposal (not included in your adalimumab-aacf carton. (see step 7 “dispose of used prefilled pens ”). - place two fingers on the label - pull the pen straight up and out of the packaging (figure f) - place the capped pen on a clean flat surface - do not warm the pen in any other way, such as in a microwave, hot water, or direct sunlight. - do not remove the needle cap until you are ready to inject. - the liquid is clear and colorless to pale yellow, and free of particles and flakes (figure j). - the syringe is not cracked or damaged. (figure j). - the name on the pen says adalimumab-aacf (figure k). - the expiration date (exp:) on the pen has not passed (figure k). do not use the prefilled pen if the label does not have adalimumab-aacf on it or the expiration date has passed. dispose of the pen in your sharps disposal container (see step 7 “dispose of used prefilled pens” ) and call your healthcare provider or pharmacist. - your stomach (abdomen). if you choose your stomach, do not use the area 2 inches around your belly button (navel) or - the front of your thighs (figure l) - do not inject adalimumab-aacf into skin that is sore (tender), bruised, red, hard, scarred or where you have stretch marks or tattoos. - if you have psoriasis, do not inject into any lesions or red, thick, raised or scaly patches. - do not inject through your clothes. - hold the pen upwards. - remove the needle cap with your other hand by pulling the cap straight off (figure n). do not twist the cap. do not insert your fingers into the opening of the safety guard - dispose of the needle cap in your sharps disposal container. - hold the pen so that you can see the transparent syringe housing. - place your thumb above (not touching) the yellow injection button (figure o) - place the pen straight and flat against your skin at a 90° angle (figure p). - push and hold the pen firmly against your skin until the safety guard is fully pushed down. this will unlock the injection button (figure q). - push the injection button with your thumb (figure r). you will hear a loud ‘click’, which means the injection has started. - continue to hold the pen firmly. - watch the syringe plunger to make sure it moves all the way down to the bottom of the transparent syringe housing (figure r). - continue holding the pen for 5 seconds after the syringe plunger has reached the bottom of the transparent syringe housing. (figure s) - lift the pen from your skin (figure t). the safety guard will slide down and lock into place to cover the needle (figure t). - if you do not have a fda-cleared sharps disposal container, you may use a household container that is: - made of a heavy-duty plastic, - can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, - upright and stable during use, - leak-resistant, and - properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should dispose of used needles and pens. - for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda's website at: http://www.fda.gov/safesharpsdisposal manufactured by: fresenius kabi usa, llc lake zurich, illinois 60047 u.s. license no. 2146 this instructions for use has been approved by the u. s. food and drug administration         approved: november/2023

USA - engelsk - NLM (National Library of Medicine)

celltrion usa, inc. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab-aaty is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab-aaty can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab-aaty is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab-aaty can be used alone or in combination with methotrexate. adalimumab-aaty is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab-aaty can be used alone or in combination with non-biologic dmards. adalimumab-aaty is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. adalimumab-aaty is indicated for the treatment of moderately to severely active crohn's disease in adults and pediatric patients 6 years of age and older. adalimumab-aaty is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients. limitations of use the effectiveness of adalimumab products has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies (14.7)] . adalimumab-aaty is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. adalimumab-aaty should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions (5)] . adalimumab-aaty is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients. none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn's disease (cd) treated with adalimumab. registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease- matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data) . adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in-utero exposed infant (see clinical considerations) . in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data) . the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester [see data] . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to adalimumab products in utero [see use in specific populations (8.4)] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with adalimumab, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of adalimumab was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16-19.7 mcg/ml in cord blood, 4.28-17.7 mcg/ml in infant serum, and 0-16.1 mcg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 mcg/ml), 7 weeks (1.31 mcg/ml), 8 weeks (0.93 mcg/ml), and 11 weeks (0.53 mcg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab products on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for adalimumab-aaty and any potential adverse effects on the breastfed child from adalimumab-aaty or from the underlying maternal condition. the safety and effectiveness of adalimumab-aaty have been established for: - reducing signs and symptoms of moderately to severely active polyarticular jia in pediatric patients 2 years of age and older. - the treatment of moderately to severely active crohn's disease in pediatric patients 6 years of age and older. due to their inhibition of tnfα, adalimumab products administered during pregnancy could affect immune response in the in utero -exposed newborn and infant. data from eight infants exposed to adalimumab in utero suggest adalimumab crosses the placenta [see use in specific populations (8.1)] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. post-marketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including adalimumab products [see warnings and precautions (5.2)] . juvenile idiopathic arthritis in study jia-i, adalimumab-aaty was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies (14.2)] . in study jia-ii, the safety profile for patients 2 to < 4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions (6.1)] . adalimumab products have not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of adalimumab-aaty in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions (6.1)] . the safety and effectiveness of adalimumab-aaty have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn's disease the safety and effectiveness of adalimumab-aaty for the treatment of moderately to severely active crohn's disease have been established in pediatric patients 6 years of age and older. use of adalimumab-aaty for this indication is supported by adalimumab-aaty's approval as a biosimilar to adalimumab and evidence from adequate and well-controlled studies in adults with additional data of adalimumab from a randomized, double-blind, 52-week clinical study of two dose concentrations of adalimumab in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions (6.1), clinical pharmacology (12.2, 12.3), clinical studies (14.6)] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of adalimumab-aaty have not been established in pediatric patients with crohn's disease less than 6 years of age. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received adalimumab in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among adalimumab treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of adalimumab-aaty in patients 65 years of age and older. in patients treated with adalimumab-aaty, closely monitor for the development of infection or malignancy [see warnings and precautions (5.1, 5.2) ]. for subcutaneous use only read and follow the instructions for use that come with your adalimumab-aaty auto-injector before you start using it and each time you get a refill. there may be new information. this information does not take the place of talking to your doctor about your medical condition or treatment. important information - use the auto-injector only if your doctor has trained you on the right way to prepare for and to give an injection. - ask your doctor how often you will need to give an injection. - do not shake the auto-injector at any time. - do not remove the cap until you are ready to inject. - do not share the auto-injector with anyone. how to store the auto-injector - store the auto-injector in a refrigerator between 36°f to 46°f (2°c to 8°c). - keep the auto-injector in the original carton until use to protect it from light. - do not use an auto-injector that has been left in direct sunlight. - do not freeze the auto-injector. if the auto-injector has been frozen, do not use the auto-injector even if it is thawed. - if needed, you may store the auto-injector at room temperature up to 77°f (25°c) for up to 31 days. - after the auto-injector has reached room temperature, do not put it back in the refrigerator. - keep the auto-injector and all medicines out of the reach of children. read instructions on all pages before using the adalimumab-aaty auto-injector prepare for injection - do not  use the auto-injector if;-it is cracked or damaged.-the expiration date has passed. figure b - do not use the auto-injector if the liquid is the discolored (yellow or dark brown), cloudy, or contains particles in it. - you may see air bubbles in the liquid. this is normal. figure c - do not warm the auto-injector using heat sources such as hot water or a microwave. figure d - do not inject into skin that is within 2 in (5 cm) of your belly button (navel), or is red, hard, tender, damaged, bruised, or scarred. - if you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin. - do not inject through your clothes. - do not inject the same injection site each time you give an injection. - each new injection site should be at least 1.2 in (3 cm) away from the injection site you used before. figure e figure f - do not blow on or touch the injection site again before giving the injection. figure g - do not recap the auto-injector. - do not remove the cap until you are ready to inject. - do not touch the needle or needle cover. doing so may result in a needle stick injury because the needle is inside the needle cover. figure h figure i - when the injection starts you will hear the 1st loud "click" and the blue plunger rod will begin to fill the window. - do not change the position of the auto-injector after the injection has started. figure j - after you remove the auto-injector from the injection site, the needle will be automatically covered (see figure l ). - if the window has not turned completely blue or if the medicine is still injecting, this means you have not received a full dose. call your doctor immediately. - you may see grey stopper in the window. this is normal. - some bleeding may occur. - do not reuse the auto-injector. - do not rub the injection site. figure k figure l - do not throw away (dispose of) the auto-injector in your household trash. - if you do not have an fda-cleared sharps disposal container, you may use a household container that is:-made of a heavy-duty plastic,-can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out,-upright and stable during use,-leak-resistant, and-properly labeled to warn of hazardous waste inside the container. figure m - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of it. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda's website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. for subcutaneous use only read and follow the instructions for use that come with your adalimumab-aaty prefilled syringe before you start using it and each time you get a refill. there may be new information. this information does not take the place of talking to your doctor about your medical condition or treatment. important information - use the prefilled syringe with needle guard only if your doctor has trained you on the right way to prepare for and to give an injection. - ask your doctor how often you will need to give an injection. - do not shake the prefilled syringe at any time. - do not remove the cap until you are ready to inject. - do not share the prefilled syringe with anyone. - only use each prefilled syringe for one injection. - do not pull back on the plunger rod at any time. how to store the prefilled syringe - store the prefilled syringe in a refrigerator between 36°f to 46°f (2°c to 8°c). - keep the prefilled syringe in the original carton to protect it from light. - do not use a prefilled syringe that has been left in direct sunlight. - do not freeze the prefilled syringe. if the prefilled syringe has been frozen, do not use the prefilled syringe even if it is thawed. - if needed, you may store the prefilled syringe at room temperature up to 77°f (25°c) for up to 31 days. - after the prefilled syringe has reached room temperature, do not put it back in the refrigerator. - keep the prefilled syringe and all medicines out of the reach of children. read instructions on all pages before using the adalimumab-aaty prefilled syringe prepare for injection - hold the prefilled syringe body when removing it from the carton. do not touch the plunger rod. - do not  use the prefilled syringe if;-it is cracked or damaged.-the expiration date has passed. figure b - do not use the prefilled syringe if the liquid is the discolored (yellow or dark brown), cloudy, or contains particles in it. - you may see air bubbles in the liquid. this is normal. figure c - do not warm the prefilled syringe using heat sources such as hot water or a microwave. figure d - do not inject into skin that is within 2 in (5 cm) of your belly button (navel), or is red, hard, tender, damaged, bruised, or scarred. - if you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin. - do not inject through your clothes. figure e figure f - do not blow on or touch the injection site again before giving the injection. figure g - do not pull back on the plunger rod at any time. - do not recap the prefilled syringe. - do not remove the cap until you are ready to inject. - do not touch the needle. doing so may result in a needle stick injury. figure h - do not change the position of the prefilled syringe after the injection has started. figure i figure j - some bleeding may occur. - do not reuse the prefilled syringe. - do not touch or recap the needle. - do not rub the injection site. figure k - do not throw away (dispose of) the prefilled syringe in your household trash. - if you do not have an fda-cleared sharps disposal container, you may use a household container that is:-made of a heavy-duty plastic,-can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out,-upright and stable during use,-leak-resistant, and-properly labeled to warn of hazardous waste inside the container. figure l - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of it. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda's website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. for subcutaneous use only read and follow the instructions for use that come with your adalimumab-aaty prefilled syringe before you start using it and each time you get a refill. there may be new information. this information does not take the place of talking to your doctor about your medical condition or treatment. important information - use the prefilled syringe only if your doctor has trained you on the right way to prepare for and to give an injection. - ask your doctor how often you will need to give an injection. - do not shake the prefilled syringe at any time. - do not remove the cap until you are ready to inject. - do not share the prefilled syringe with anyone. - do not pull back on the plunger rod at any time. how to store the prefilled syringe - store the prefilled syringe in a refrigerator between 36°f to 46°f (2°c to 8°c). - keep the prefilled syringe in the original carton to protect it from light. - do not use a prefilled syringe that has been left in direct sunlight. - do not freeze the prefilled syringe. if the prefilled syringe has been frozen, do not use the prefilled syringe even if it is thawed. - if needed, you may store the prefilled syringe at room temperature up to 77°f (25°c) for up to 31 days. - after the prefilled syringe has reached room temperature, do not put it back in the refrigerator. - keep the prefilled syringe and all medicines out of the reach of children. read instructions on all pages before using the adalimumab-aaty prefilled syringe prepare for injection - hold the prefilled syringe body when removing it from the carton. do not touch the plunger rod. - do not  use the prefilled syringe if;-it is cracked or damaged.-the expiration date has passed. figure b - do not use the prefilled syringe if the liquid is the discolored (yellow or dark brown), cloudy, or contains particles in it. - you may see air bubbles in the liquid. this is normal. figure c - do not warm the prefilled syringe using heat sources such as hot water or a microwave. figure d - do not inject into skin that is within 2 in (5 cm) of your belly button (navel), or is red, hard, tender, damaged, bruised, or scarred. - if you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin. - do not inject through your clothes. figure e figure f - do not blow on or touch the injection site again before giving the injection. figure g - do not pull back on the plunger rod at any time. - do not recap the prefilled syringe. - do not remove the cap until you are ready to inject. - do not touch the needle. doing so may result in a needle stick injury. figure h - do not change the position of the prefilled syringe after the injection has started. figure i figure j - some bleeding may occur. - do not reuse the prefilled syringe. - do not touch the needle. - do not rub the injection site. figure k - do not throw away (dispose of) the prefilled syringe in your household trash. - if you do not have an fda-cleared sharps disposal container, you may use a household container that is:-made of a heavy-duty plastic,-can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out,-upright and stable during use,-leak-resistant, and-properly labeled to warn of hazardous waste inside the container. figure l - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of it. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda's website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container.

USA - engelsk - NLM (National Library of Medicine)

sandoz inc. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab can be used alone or in combination with methotrexate. adalimumab is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab can be used alone or in combination with non-biologic dmards. adalimumab is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. adalimumab is indicated for the

USA - engelsk - NLM (National Library of Medicine)

abbvie inc. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab 40 mg in 0.8 ml - humira is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. humira can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards).  humira is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. humira can be used alone or in combination with methotrexate. humira is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. humira can be used alone or in combination with non-biologic dmards. humira is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. humira is indicated for the treatment of moderately to severely active crohn’s disease in adults and pediatric patients 6 years of age and older. humira is indicated for the treatment of moderately to severely active ulcerative colitis in adults and pediatric patients 5 years of age and older. limitations of use the effectiveness of humira has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies ( 14.7 , 14.8 )] . humira is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. humira should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions ( 5 ) ] . humira is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. humira is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adults and pediatric patients 2 years of age and older. none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby humira pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn’s disease (cd). registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease-matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data ) . adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in-utero exposed infant (see clinical considerations ) . in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data ) . the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester (see data ) . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to humira in utero  [see use in specific populations ( 8.4 ) ] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with humira, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of humira was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16-19.7 µg/ml in cord blood, 4.28-17.7 µg/ml in infant serum, and 0-16.1 µg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 µg/ml), 7 weeks (1.31 µg/ml), 8 weeks (0.93 µg/ml), and 11 weeks (0.53 µg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for humira and any potential adverse effects on the breastfed child from humira or from the underlying maternal condition. the safety and effectiveness of humira have been established for: - reducing signs and symptoms of moderately to severely active polyarticular jia in pediatric patients 2 years of age and older. - the treatment of moderately to severely active crohn’s disease in pediatric patients 6 years of age and older. - the treatment of moderately to severely active ulcerative colitis in pediatric patients 5 years of age and older. - the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. - the treatment of non-infectious intermediate, posterior, and panuveitis in pediatric patients 2 years of age and older. due to its inhibition of tnfα, humira administered during pregnancy could affect immune response in the in utero -exposed newborn and infant. data from eight infants exposed to humira in utero suggest adalimumab crosses the placenta [see use in specific populations ( 8.1 )] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. post-marketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including humira [see warnings and precautions ( 5.2 ) ] . juvenile idiopathic arthritis in study jia-i, humira was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies ( 14.2 ) ] . in study jia-ii, the safety profile for patients 2 to <4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions ( 6.1 ) ] . humira has not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of humira in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions ( 6.1 ) ] . the safety and effectiveness of humira have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn’s disease the safety and effectiveness of humira for the treatment of moderately to severely active crohn’s disease have been established in pediatric patients 6 years of age and older. use of humira for this indication is supported by evidence from adequate and well-controlled studies in adults with additional data from a randomized, double-blind, 52-week clinical study of two dose concentrations of humira in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions ( 6.1 ) , clinical pharmacology ( 12.2 , 12.3 ), clinical studies ( 14.6 ) ] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of humira have not been established in pediatric patients with crohn’s disease less than 6 years of age. pediatric ulcerative colitis the safety and effectiveness of humira for the treatment of moderately to severely active ulcerative colitis have been established in pediatric patients 5 years of age and older. use of humira for this indication is supported by evidence from adequate and well-controlled studies in adults with additional data from a randomized, double-blind, 52-week clinical study of two dose concentrations of humira in 93 pediatric patients (5 years to 17 years of age) [see adverse reactions ( 6.1 ) , clinical pharmacology ( 12.3 ) , clinical studies ( 14.8 ) ] . the adverse reaction profile in patients 5 years to 17 years of age was similar to adults. the effectiveness of humira has not been established in patients who have lost response or were intolerant to tnf blockers. the safety and effectiveness of humira have not been established in pediatric patients with ulcerative colitis less than 5 years of age. pediatric uveitis the safety and effectiveness of humira for the treatment of non-infectious uveitis have been established in pediatric patients 2 years of age and older. the use of humira is supported by evidence from adequate and well-controlled studies of humira in adults and a 2:1 randomized, controlled clinical study in 90 pediatric patients [see clinical studies ( 14.12 ) ] . the safety and effectiveness of humira have not been established in pediatric patients with uveitis less than 2 years of age. hidradenitis suppurativa use of humira in pediatric patients 12 years of age and older for hs is supported by evidence from adequate and well-controlled studies of humira in adult hs patients. additional population pharmacokinetic modeling and simulation predicted that weight-based dosing of humira in pediatric patients 12 years of age and older can provide generally similar exposure to adult hs patients. the course of hs is sufficiently similar in adult and adolescent patients to allow extrapolation of data from adult to adolescent patients. the recommended dosage in pediatric patients 12 years of age or older is based on body weight [see dosage and administration ( 2.6 ) , clinical pharmacology ( 12.3 ) , and clinical studies ( 14.10 ) ] . the safety and effectiveness of humira have not been established in patients less than 12 years of age with hs. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received humira in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among humira treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of humira in patients 65 years of age and older. in patients treated with humira, closely monitor for the development of infection or malignancy [see warnings and precautions ( 5.1 , 5.2 )] . instructions for use humira ® (hu-mare-ah) (adalimumab) 40 mg/0.8 ml single-dose pen do not try to inject humira yourself until you have been shown the right way to give the injections and have read and understand this instructions for use. if your doctor decides that you or a caregiver may be able to give your injections of humira at home, you should receive training on the right way to prepare and inject humira. it is important that you read, understand, and follow these instructions so that you inject humira the right way. it is also important to talk to your doctor to be sure you understand your humira dosing instructions. to help you remember when to inject humira, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject humira.  important: - do not use humira if frozen, even if it has been thawed. - the humira pen contains glass. do not drop or crush the pen because the glass inside may break. - each humira pen has 2 caps on it. do not remove the gray cap (cap #1) or the plum-colored cap (cap #2) until right before your injection. - when the plum-colored button on the humira pen is pressed to give your dose of humira, you will hear a loud “click” sound. you must practice injecting humira with your doctor or nurse so that you are not startled by this click when you start giving yourself the injections at home. the loud click sound means the start of the injection. you will know that the injection has finished when the yellow indicator appears fully in the window view and stops moving. - you must practice injecting humira with your doctor or nurse so that you are not startled by this click when you start giving yourself the injections at home. - the loud click sound means the start of the injection. - you will know that the injection has finished when the yellow indicator appears fully in the window view and stops moving. see the section below called “prepar ing the humira pen” . gather the supplies for your injection - you will need the following supplies for each injection of humira. find a clean, flat surface to place the supplies on. 1 alcohol swab 1 cotton ball or gauze pad (not included in your humira carton) 1 humira pen (see figure a) puncture-resistant sharps disposal container for humira pen disposal (not included in your humira carton). see the “how should i throw away (dispose of) the used humira pen?” section at the end of this instructions for use. - 1 alcohol swab - 1 cotton ball or gauze pad (not included in your humira carton) - 1 humira pen (see figure a) - puncture-resistant sharps disposal container for humira pen disposal (not included in your humira carton). see the “how should i throw away (dispose of) the used humira pen?” section at the end of this instructions for use. if more comfortable, take your humira pen out of the refrigerator 15 to 30 minutes before injecting to allow the liquid to reach room temperature. do not remove the gray cap (cap #1) or the plum-colored cap (cap #2) while allowing it to reach room temperature. do not warm humira in any other way (for example, do not warm it in a microwave or in hot water). if you do not have all the supplies you need to give yourself an injection, go to a pharmacy or call your pharmacist. the figure below shows what the humira pen looks like. see figure a. figure a check the carton, dose tray, and humira pen . 1. make sure the name humira appears on the carton, dose tray, and humira pen label. 2. do not use and do call your doctor or pharmacist if: - you drop or crush your humira pen. - the seals on the top or bottom of the carton are broken or missing. - the expiration date on the carton, dose tray, and pen has passed. - the humira pen has been frozen or left in direct sunlight. - humira has been kept at room temperature for longer than 14 days or humira has been stored above 77°f (25°c). see the “how should i store humira?” section at the end of this instructions for use. 3. hold the pen with the gray cap (cap # 1) pointed down. 4. make sure the amount of liquid in the pen is at the fill line or close to the fill line seen through the window. this is the full dose of humira that you will inject. see figure b. 5. if the pen does not have the full amount of liquid, do not use that pen . call your pharmacist. figure b 6. turn the pen over and hold the pen with the gray cap (cap # 1) pointed up. see figure c. 7. check the solution through the windows on the side of the pen to make sure the liquid is clear and colorless. do not use your humira pen if the liquid is cloudy, discolored, or if it has flakes or particles in it. call your pharmacist. it is normal to see one or more bubbles in the window. figure c choose the injection site 8. wash and dry your hands well. 9. choose an injection site on: - the front of your thighs or - your lower abdomen (belly). if you choose your abdomen, do not use the area 2 inches around your belly button (navel). see figure d. figure d - choose a different site each time you give yourself an injection. each new injection should be given at least one inch from a site you used before. - do not inject humira into skin that is: sore (tender) bruised red hard scarred or where you have stretch marks - sore (tender) - bruised - red - hard - scarred or where you have stretch marks - if you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin. - do not inject through your clothes. prepare the injection site 10. wipe the injection site with an alcohol prep (swab) using a circular motion. - do not touch this area again before giving the injection. allow the skin to dry before injecting. do not fan or blow on the clean area. preparing the humira pen 11. do not remove the gray cap (cap # 1) or the plum-colored cap (cap # 2) until right before your injection. 12. hold the middle of the pen (gray body) with one hand so that you are not touching the gray cap (cap # 1) or the plum-colored cap (cap # 2). turn the pen so that the gray cap (cap # 1) is pointing up. see figure e. figure e 13. with your other hand, pull the gray cap (cap # 1) straight off (do not twist the cap). make sure the small needle cover of the syringe has come off with the gray cap (cap # 1). see figure f. 14. throw away the gray cap (cap # 1). figure f - do not put the gray cap (cap # 1) back on the pen. putting the gray cap (cap # 1) back on may damage the needle. - the white needle sleeve, which covers the needle, can now be seen. - do not touch the needle with your fingers or let the needle touch anything. - you may see a few drops of liquid come out of the needle. this is normal. 15. remove the plum-colored cap (cap # 2) from the bottom of the pen by pulling it straight off (do not twist the cap). the pen is now activated. throw away the plum-colored cap (cap # 2). - do not put the plum-colored cap (cap # 2) back on the pen because it could cause medicine to come out of the syringe. the plum-colored activator button: - turn the pen so the plum-colored activator button is pointed up. see figure g. figure g - do not press the plum-colored activator button until you are ready to inject humira. pressing the plum-colored activator button will release the medicine from the pen. - hold the pen so that you can see the window. see figure h. it is normal to see one or more bubbles in the window. figure h position the pen and inject humira 16. position the pen: - squeeze the area of the cleaned skin and hold it firmly until the injection is complete. see figure i. you will inject into this raised area of skin. figure i 17. place the white end of the pen straight (at a 90º angle ) and flat against the raised area of your skin that you are squeezing. place the pen so that it will not inject the needle into your fingers that are holding the raised skin. see figure j. figure j 18. inject humira - it is important that you firmly push the pen down all the way against the injection site before starting the injection. - keep pushing down to prevent the pen from moving away from the skin during the injection. - press the plum-colored activator button with your thumb to begin the injection. try not to cover the window. see figure k. figure k - you will hear a loud ‘click’ when you press the plum-colored activator button. the loud click means the start of the injection. - keep pressing the plum-colored activator button and continue to push the pen against your squeezed, raised skin until all the medicine is injected. this can take up to 10 seconds, so count slowly to ten. keep pushing the pen against the squeezed, raised skin of your injection site for the whole time so you get the full dose of medicine. - you will know that the injection has finished when the yellow indicator fully appears in the window view and stops moving. see figure l. figure l 19. when the injection is finished, slowly pull the pen from your skin. the white needle sleeve will move to cover the needle tip. see figure m. - do not touch the needle. the white needle sleeve is there to prevent you from touching the needle. figure m - there may be a small amount of liquid on the injection site. this is normal. - press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. do not rub the injection site. you may have slight bleeding. this is normal. 20. throw away (dispose of) your used humira pen in a sharps disposal container right away after use. see the section “how should i dispose of the used humira pen?” 21. keep a record of the dates and location of your injection sites. to help you remember when to take humira, you can mark your calendar ahead of time. how should i throw away ( dispose of ) the used humira pen? - put your pen in a fda-cleared sharps disposal container right away after use. see figure n. do not throw away the pen in your household trash.   - do not try to touch the needle. the white needle sleeve is there to prevent you from touching the needle. figure n - if you do not have a fda-cleared sharps disposal container, you may use a household container that is: ○ made of a heavy-duty plastic, ○ can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, ○ upright and stable during use, ○ leak-resistant, and ○ properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. - for the safety and health of you and others, never re-use your humira pens. - the used alcohol pads, cotton balls, dose trays and packaging may be placed in your household trash. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container.   - always keep the sharps container out of the reach of children. how should i store humira? - store humira in the refrigerator between 36ºf to 46ºf (2ºc to 8ºc). store humira in the original carton until use to protect it from light. - do not freeze humira. do not use humira if frozen, even if it has been thawed. - refrigerated humira may be used until the expiration date printed on the humira carton, dose tray or pen. do not use humira after the expiration date. - if needed, for example when you are traveling, you may also store humira at room temperature up to 77°f (25°c) for up to 14 days. store humira in the original carton until use to protect it from light. - throw away humira if it has been kept at room temperature and not been used within 14 days. - record the date you first remove humira from the refrigerator in the spaces provided on the carton and dose tray. - do not store humira in extreme heat or cold. - do not use a pen if the liquid is cloudy, discolored, or has flakes or particles in it. - do not drop or crush humira. - keep humira, injection supplies, and all other medicines out of the reach of children. this instructions for use has been approved by the u.s. food and drug administration. manufactured by: abbvie inc. north chicago, il 60064, u.s.a. us license number 1889 20066944 revised: 02/2021  - liquid is cloudy, discolored, or has flakes or particles in it - expiration date has passed - liquid has been frozen (even if thawed) or left in direct sunlight - the pen has been dropped or crushed - store humira in the refrigerator between 36°f to 46°f (2°c to 8°c). - store humira in the original carton until use to protect it from light. - do not freeze - refrigerated humira may be used until the expiration date printed on the humira carton, dose tray or pen. - if needed, for example when you are traveling, you may also store humira at room temperature up to 77°f (25°c) for up to 14 days. - throw away humira if it has been kept at room temperature and not used within 14 days. - record the date you first remove humira from the refrigerator in the spaces provided on the carton and dose tray. - do not store humira in extreme heat or cold. - do not remove the gray cap (cap #1) or plum-colored cap (cap #2) while allowing humira to reach room temperature - do not warm humira in any other way. for example, do not warm it in a microwave or in hot water. - do not use the pen if liquid has been frozen (even if thawed) - 1 single-dose pen and alcohol swab - 1 cotton ball or gauze pad (not included) - puncture-resistant sharps disposal container (not included). see step 9 at the end of this instructions for use for instructions on how to throw away (dispose of) your humira pen - on the front of your thighs or - your abdomen (belly) at least 2 inches from your navel (belly button) - different from your last injection site - do not inject through clothes - do not inject into skin that is sore, bruised, red, hard, scarred, has stretch marks, or areas with psoriasis plaques - it is normal to see 1 or more bubbles in the window - make sure the liquid is clear and colorless - do not use the pen if the liquid is cloudy, discolored, or has flakes or particles in it - do not use the pen if it has been dropped or crushed - it is normal to see a few drops of liquid come out of the needle - a loud “click” will signal the start of the injection - keep pushing the pen down firmly against the injection site until the injection is complete - injection is complete when the yellow indicator has stopped moving - a small amount of liquid on the injection site is normal - do not rub - slight bleeding at the injection site is normal - put your used needles, pens, and sharps in a fda cleared sharps disposal container right away after use. do not throw away (dispose of) loose needles, syringes, and the pen in the household trash. - if you do not have a fda cleared sharps disposal container, you may use a household container that is: ○ made of a heavy-duty plastic, ○ can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, ○ upright and stable during use, ○ leak-resistant, and ○ properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. - call your healthcare provider or 1-800-4humira (1-800-448-6472) or visit www.humira.com if you need help - the yellow indicator has stopped moving. this takes up to 10 seconds.  - call 1-800-4humira (1-800-448-6472) for help - call 1-800-4humira (1-800-448-6472) for a free fda-cleared sharps disposal container - liquid is cloudy, discolored, or has flakes or particles in it - expiration date has passed - liquid has been frozen (even if thawed) or left in direct sunlight - the pen has been dropped or crushed - store humira in the refrigerator between 36°f to 46°f (2°c to 8°c). - store humira in the original carton until use to protect it from light. - do not freeze - refrigerated humira may be used until the expiration date printed on the humira carton, dose tray or pen. - if needed, for example when you are traveling, you may also store humira at room temperature up to 77°f (25°c) for up to 14 days. - throw away humira if it has been kept at room temperature and not used within 14 days. - record the date you first remove humira from the refrigerator in the spaces provided on the carton and dose tray. - do not store humira in extreme heat or cold. - do not remove the gray cap (cap #1) or plum-colored cap (cap #2) while allowing humira to reach room temperature - do not warm humira in any other way. for example, do not warm it in a microwave or in hot water - do not use the pen if liquid has been frozen (even if thawed) - 1 single-dose pen and alcohol swab - 1 cotton ball or gauze pad (not included) - puncture-resistant sharps disposal container (not included). see step 9 at the end of this instructions for use for instructions on how to throw away (dispose of) your humira pen - on the front of your thighs or - your abdomen (belly) at least 2 inches from your navel (belly button) - different from your last injection site - do not inject through clothes - do not inject into skin that is sore, bruised, red, hard, scarred, has stretch marks, or areas with psoriasis plaques - it is normal to see 1 or more bubbles in the window - make sure the liquid is clear and colorless - do not use the pen if the liquid is cloudy, discolored, or has flakes or particles in it - do not use the pen if it has been dropped or crushed - it is normal to see a few drops of liquid come out of the needle - a loud “click” will signal the start of the injection - keep pushing the pen down firmly against the injection site until the injection is complete - injection is complete when the yellow indicator has stopped moving - a small amount of liquid on the injection site is normal - do not rub - slight bleeding at the injection site is normal - put your used needles, pens, and sharps in a fda cleared sharps disposal container right away after use. do not throw away (dispose of) loose needles, syringes, and the pen in the household trash. - if you do not have a fda-cleared sharps disposal container, you may use a household container that is: ○ made of a heavy-duty plastic, ○ can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, ○ upright and stable during use, ○ leak-resistant, and ○ properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. - call your healthcare provider or 1-800-4humira (1-800-448-6472) or visit www.humira.com if you need help - the yellow indicator has stopped moving. this takes up to 15 seconds.  - call 1-800-4humira (1-800-448-6472) for help - call 1-800-4humira (1-800-448-6472) for a free fda-cleared sharps disposal container instructions for use humira ® (hu-mare-ah) (adalimumab) 40 mg/0.8 ml, 20 mg/0.4 ml and 10 mg/0.2 ml single-dose prefilled syringe do not try to inject humira yourself until you have been shown the right way to give the injections and have read and understand this instructions for use. if your doctor decides that you or a caregiver may be able to give your injections of humira at home, you should receive training on the right way to prepare and inject humira. it is important that you read, understand, and follow these instructions so that you inject humira the right way. it is also important to talk to your doctor to be sure you understand your humira dosing instructions. to help you remember when to inject humira, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject humira. gather the supplies for your injection - you will need the following supplies for each injection of humira. find a clean, flat surface to place the supplies on. ● 1 alcohol swab ● 1 cotton ball or gauze pad (not included in your humira carton) ● 1 humira prefilled syringe (see figure a) ● puncture-resistant sharps disposal container for humira prefilled syringe disposal (not included in your humira carton). see the “how should i throw away (dispose of) the used prefilled syringes and needles?” section at the end of this instructions for use. if more comfortable, take your humira prefilled syringe out of the refrigerator 15 to 30 minutes before injecting to allow the liquid to reach room temperature. do not remove the needle cover while allowing it to reach room temperature. do not warm humira in any other way (for example, do not warm it in a microwave or in hot water). if you do not have all the supplies you need to give yourself an injection, go to a pharmacy or call your pharmacist. the figure below shows what a prefilled syringe looks like. see figure a. figure a check the carton, dose tray, and prefilled syringe 1. make sure the name humira appears on the dose tray and prefilled syringe label. 2. do not use and do call your doctor or pharmacist if: - the seals on top or bottom of the carton are broken or missing. - the humira labeling has an expired date. check the expiration date on your humira carton and do not use if the date has passed. - the prefilled syringe has been frozen or left in direct sunlight. - humira has been kept at room temperature for longer than 14 days or humira has been stored above 77°f (25°c). - the liquid in the prefilled syringe is cloudy, discolored or has flakes or particles in it. make sure the liquid is clear and colorless. see the “how should i store humira?” section at the end of this instructions for use. choose the injection site 3. wash and dry your hands well. 4. choose an injection site on: - the front of your thighs or - your lower abdomen (belly). if you choose your abdomen, do not use the area 2 inches around your belly button (navel). see figure b. figure b - choose a different site each time you give yourself an injection. each new injection should be given at least one inch from a site you used before. - do not inject into skin that is: sore (tender) bruised red hard scarred or where you have stretch marks - sore (tender) - bruised - red - hard - scarred or where you have stretch marks - if you have psoriasis, do not inject directly into any raised, thick, red or scaly skin patches or lesions on your skin. - do not inject through your clothes. prepare the injection site 5. wipe the injection site with an alcohol prep (swab) using a circular motion. 6. do not touch this area again before giving the injection. allow the skin to dry before injecting. do not fan or blow on the clean area. prepare the syringe and needle 7. check the fluid level in the syringe: - hold the syringe with the covered needle pointing down. see figure c. figure c - hold the syringe at eye level. look closely to make sure that the amount of liquid in the syringe is the same or close to the: 0.8 ml line for the 40 mg prefilled syringe. see figure d. 0.4 ml line for the 20 mg prefilled syringe. see figure d. 0.2 ml line for the 10 mg prefilled syringe. see figure d. - 0.8 ml line for the 40 mg prefilled syringe. see figure d. - 0.4 ml line for the 20 mg prefilled syringe. see figure d. - 0.2 ml line for the 10 mg prefilled syringe. see figure d. figure d 8. the top of the liquid may be curved. if the syringe does not have the correct amount of liquid, do not use that syringe . call your pharmacist. 9. remove the needle cover: - hold the syringe in one hand. with the other hand gently remove the needle cover. see figure e. - throw away the needle cover. figure e - do not touch the needle with your fingers or let the needle touch anything. 10. turn the syringe so the needle is facing up and hold the syringe at eye level with one hand so you can see the air in the syringe. using your other hand, slowly push the plunger in to push the air out through the needle. see figure f. figure f - you may see a drop of liquid at the end of the needle. this is normal. position the prefilled syringe and inject humira position the syringe 11. hold the body of the prefilled syringe in one hand between the thumb and index finger. hold the syringe in your hand like a pencil. see figure g. figure g - do not pull back on the plunger at any time. - with your other hand, gently squeeze the area of the cleaned skin and hold it firmly. see figure h. figure h inject humira 12. using a quick, dart-like motion, insert the needle into the squeezed skin at about a 45-degree angle . see figure i. figure i - after the needle is in, let go of the skin. pull back gently on the plunger. if blood appears in the syringe: - it means that you have entered a blood vessel. - do not inject humira. - pull the needle out of the skin while keeping the syringe at the same angle. - press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. see figure j. figure j - do not use the same syringe and needle again. throw away the needle and syringe in your sharps container. - do not rub the injection site. you may have slight bleeding. this is normal. - repeat steps 1 through 12 with a new prefilled syringe. if no blood appears in the syringe: - slowly push the plunger all the way in until all the liquid is injected and the syringe is empty. - pull the needle out of the skin while keeping the syringe at the same angle. - press a cotton ball or gauze pad over the injection site and hold it for 10 seconds. do not rub the injection site. you may have slight bleeding. this is normal. 13. throw away the used prefilled syringe and needle in a sharps disposal container right away after use. see “how should i throw away ( dispose of ) used prefilled syringes and needles?” 14. keep a record of the dates and location of your injection sites. to help you remember when to take humira, you can mark your calendar ahead of time. how should i throw away ( dispose of ) used prefilled syringes and needles? - put your used needles and syringes in a fda-cleared sharps disposal container right away after use. see figure k. do not throw away (dispose of) loose needles and syringes in your household trash.   - do not try to touch the needle. figure k - if you do not have a fda-cleared sharps disposal container, you may use a household container that is: ○ made of a heavy-duty plastic, ○ can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, ○ upright and stable during use, ○ leak-resistant, and ○ properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. - for the safety and health of you and others, needles and used syringes must never be re-used. - the used alcohol pads, cotton balls, dose trays and packaging may be placed in your household trash. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. - always keep the sharps container out of the reach of children. how should i store humira? - store humira in the refrigerator between 36ºf to 46ºf (2ºc to 8ºc). store humira in the original carton until use to protect it from light. - do not freeze humira. do not use humira if frozen, even if it has been thawed. - refrigerated humira may be used until the expiration date printed on the humira carton, dose tray or prefilled syringe. do not use humira after the expiration date. - if needed, for example when you are traveling, you may also store humira at room temperature up to 77°f (25°c) for up to 14 days. store humira in the original carton until use to protect it from light. - throw away humira if it has been kept at room temperature and not been used within 14 days. - record the date you first remove humira from the refrigerator in the spaces provided on the carton and dose tray. - do not store humira in extreme heat or cold. - do not use a prefilled syringe if the liquid is cloudy, discolored, or has flakes or particles in it. - do not drop or crush humira. the prefilled syringe is glass. - keep humira, injection supplies, and all other medicines out of the reach of children. this instructions for use has been approved by the u.s. food and drug administration. manufactured by: abbvie inc. north chicago, il 60064, u.s.a. us license number 1889 20066947 revised: 02/2021  - liquid is cloudy, discolored, or has flakes or particles in it - expiration date has passed - liquid has been frozen (even if thawed) or left in direct sunlight - the prefilled syringe has been dropped or crushed - store humira in the refrigerator between 36°f to 46°f (2°c to 8°c). - store humira in the original carton until use to protect it from light. - do not freeze - refrigerated humira may be used until the expiration date printed on the humira carton, dose tray or prefilled syringe. - if needed, for example when you are traveling, you may also store humira at room temperature up to 77°f (25°c) for up to 14 days. - throw away humira if it has been kept at room temperature and not used within 14 days. - record the date you first remove humira from the refrigerator in the spaces provided on the carton and dose tray. - do not store humira in extreme heat or cold. - do not remove the needle cover while allowing humira to reach room temperature - do not warm humira in any other way. for example, do not warm it in a microwave or in hot water. - do not use the prefilled syringe if liquid has been frozen (even if thawed) - 1 single-dose prefilled syringe and alcohol swab - 1 cotton ball or gauze pad (not included) - puncture-resistant sharps disposal container (not included). see step 9 at the end of this instructions for use for instructions on how to throw away (dispose of) your prefilled syringe - on the front of your thighs or - your abdomen (belly) at least 2 inches from your navel (belly button) - different from your last injection site - do not inject through clothes - do not inject into skin that is sore, bruised, red, hard, scarred, has stretch marks, or areas with psoriasis plaques - throw the needle cover away - do not touch the needle with your fingers or let the needle touch anything - hold the prefilled syringe at eye level with one hand so you can see the air in the prefilled syringe - using your other hand, slowly push the plunger in to push the air out through the needle. - you may see a drop of liquid at the end of the needle. this is normal. - after the needle is in, let go of the skin. - do not rub - slight bleeding at the injection site is normal - put your used needles, syringes, and sharps in a fda-cleared sharps disposal container right away after use. do not throw away (dispose of) loose needles and syringes in the household trash. - if you do not have a fda-cleared sharps disposal container, you may use a household container that is: ○ made of a heavy-duty plastic, ○ can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out, ○ upright and stable during use, ○ leak-resistant, and ○ properly labeled to warn of hazardous waste inside the container. - when your sharps disposal container is almost full, you will need to follow your community guidelines for the right way to dispose of your sharps disposal container. there may be state or local laws about how you should throw away used needles and syringes. for more information about safe sharps disposal, and for specific information about sharps disposal in the state that you live in, go to the fda’s website at: http://www.fda.gov/safesharpsdisposal. - do not dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. do not recycle your used sharps disposal container. - call your healthcare provider or 1-800-4humira (1-800-448-6472) or visit www.humira.com if you need help - call 1-800-4humira (1-800-448-6472) for a free fda-cleared sharps disposal container

USA - engelsk - NLM (National Library of Medicine)

golden state medical supply, inc. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab-fkjp is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab-fkjp can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab-fkjp is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab-fkjp can be used alone or in combination with methotrexate. adalimumab-fkjp is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab-fkjp can be used alone or in combination with non-biologic dmards. adalimumab-fkjp is indicated for reducing signs and symptoms in adult patients with active ankylosing spondyliti

USA - engelsk - NLM (National Library of Medicine)

boehringer ingelheim pharmaceuticals, inc. - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - adalimumab-adbm is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. adalimumab-adbm can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). adalimumab-adbm is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. adalimumab-adbm can be used alone or in combination with methotrexate. adalimumab-adbm is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. adalimumab-adbm can be used alone or in combination with non-biologic dmards. adalimumab-adbm is indicated for reducing signs and symptoms in adult patients with active ankylosing spondyliti

Israel - engelsk - Ministry of Health

neopharm (israel)1996 ltd - adalimumab - solution for injection - adalimumab 50 mg/ml - adalimumab - • rheumatoid arthritis: idacio in combination with methotrexate is indicated for:- the treatment of moderate to severe, active rheumatoid arthritis in adult patients when the response to disease-modifying anti-rheumatic drugs including methotrexate has been inadequate.- the treatment of severe, active and progressive rheumatoid arthritis in adults not previously treated with methotrexate. idacio can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate. adalimumab has been shown to reduce the rate of progression of joint damage as measured by x-ray and to improve physical function, when given in combination with methotrexate.• axial spondyloarthritis:-ankylosing spondylitis (as): idacio is indicated for the treatment of adults with severe active ankylosing spondylitis who have had an inadequate response to conventional therapy.-axial spondyloarthritis without radiographic evidence of as: idacio is indicated for the treatment of adults with severe axial spondyloarthritis without radiographic evidence of as, but with objective signs of inflammation by radiological and/or laboratory tests including mri and serum crp levels, who have had an inadequate response to, or are intolerant to, non-steroidal anti-inflammatory drugs.• psoriatic arthritis: idacio is indicated for the treatment of active and progressive psoriatic arthritis in adults when the response to previous disease-modifying anti rheumatic drug therapy has been inadequate. adalimumab has been shown to reduce the rate of progression of peripheral joint damage as measured by x-ray in patients with polyarticular symmetrical subtypes of the disease and to improve physical function.• psoriasis: idacio is indicated for the treatment of moderate to severe chronic plaque psoriasis in adult patients who are candidates for systemic therapy.• hidradenitis suppurativa (hs): idacio is indicated for the treatment of active moderate to severe hidradenitis suppurativa (acne inversa) in adult patients with an inadequate response to conventional systemic hs therapy.• crohn’s disease: idacio is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active crohn’s disease who have had an inadequate response to conventional therapy. idacio is indicated for reducing signs and symptoms and inducing clinical remission in these patients if they have also lost response to or are intolerant to infliximab. • ulcerative colitis: idacio is indicated for treatment of moderately to severely active ulcerative colitis in adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies. • uveitis:idacio is indicated for the treatment of non-infectious intermediate, posterior and panuveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroid-sparing, or in whom corticosteroid treatment is inappropriate.• intestinal behcet's disease: idacio is indicated for the treatment of intestinal behcet’s disease in patients who have had an inadequate response to conventional therapy.

USA - engelsk - NLM (National Library of Medicine)

pfizer laboratories div pfizer inc - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - abrilada is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. abrilada can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). abrilada is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. abrilada can be used alone or in combination with methotrexate. abrilada is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. abrilada can be used alone or in combination with non-biologic dmards. abrilada is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. abrilada is indicated for the treatment of moderately to severely active crohn's disease in adults and pediatric patients 6 years of age and older. abrilada is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients. limitations of use the effectiveness of adalimumab products has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies (14.7)] . abrilada is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. abrilada should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions (5)] . abrilada is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients. abrilada is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adult patients. none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn's disease (cd) treated with adalimumab. registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease-matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data). adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in utero exposed infant (see clinical considerations). in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data). the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester (see data) . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to adalimumab products in utero [see use in specific populations (8.4)] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with adalimumab, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of adalimumab was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16–19.7 mcg/ml in cord blood, 4.28–17.7 mcg/ml in infant serum, and 0–16.1 mcg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 mcg/ml), 7 weeks (1.31 mcg/ml), 8 weeks (0.93 mcg/ml), and 11 weeks (0.53 mcg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab products on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for abrilada and any potential adverse effects on the breastfed child from abrilada or from the underlying maternal condition. the safety and effectiveness of abrilada have been established for: pediatric assessments for abrilada demonstrate that abrilada is safe and effective for pediatric patients in indications for which humira (adalimumab) is approved. however, abrilada is not approved for such indications due to marketing exclusivity for humira (adalimumab). due to their inhibition of tnfα, adalimumab products administered during pregnancy could affect immune response in the in utero -exposed newborn and infant. data from eight infants exposed to adalimumab in utero suggest adalimumab crosses the placenta [see use in specific populations (8.1)] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. postmarketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including adalimumab products [see warnings and precautions (5.2)] . juvenile idiopathic arthritis in study jia-i, adalimumab was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies (14.2)] . in study jia-ii, the safety profile for patients 2 to <4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions (6.1)] . adalimumab products have not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of adalimumab in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions (6.1)] . the safety and effectiveness of adalimumab products have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn's disease the safety and effectiveness of adalimumab products for the treatment of moderately to severely active crohn's disease have been established in pediatric patients 6 years of age and older. use of adalimumab products for this indication is supported by evidence from adequate and well-controlled studies in adults with additional data from a randomized, double-blind, 52-week clinical study of two dose concentrations of adalimumab in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions (6.1), clinical pharmacology (12.2, 12.3), clinical studies (14.6)] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of adalimumab products have not been established in pediatric patients with crohn's disease less than 6 years of age. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received adalimumab in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among adalimumab-treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of abrilada in patients 65 years of age and older. in patients treated with abrilada, closely monitor for the development of infection or malignancy [see warnings and precautions (5.1, 5.2)] . abrilada (ah brill-ah-dah) (adalimumab-afzb) 40 mg/0.8 ml single-dose prefilled pen injection, for subcutaneous (under the skin) use keep this leaflet. these instructions show step by step directions on how to prepare and give an injection. storage information: keep abrilada, injection supplies, and all other medicines out of the reach of children. abrilada for injection comes in a disposable (throw away) single-use pen that contains a single dose of medicine. abrilada for injection can be given by a patient, caregiver or healthcare provider. do not try to inject abrilada yourself until you are shown the right way to give the injections and read and understand the instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of abrilada at home, you should receive training on the right way to prepare and inject abrilada. it is important that you read, understand, and follow these instructions so that you inject abrilada the right way. it is important to talk to your healthcare provider to be sure you understand your abrilada dosing instructions. to help you remember when to inject abrilada, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject abrilada. step 1. supplies you need step 2. getting ready   questions and answers what should i do with my pen if it has been dropped? do not use it, even if it looks undamaged. dispose of your pen in the same way as a used pen. you will need to use a new pen to give your injection. can i use my pen straight from the refrigerator? yes, however you may find that using the pen at room temperature reduces stinging or discomfort. if you allow your pen to reach room temperature before use, you must keep it away from direct sunlight as this can damage your medicine. what should i do if i need to travel? when you are traveling, you may store your pen in its carton at room temperature up to 86°f (30°c) for up to 30 days. is it okay to shake my pen before i use it? no, do not shake your pen. shaking can damage your medicine. when you check your medicine, gently tilt your pen back and forth while looking carefully into the window. it is normal to see one or more air bubbles. do i need to remove any air bubbles before using my pen? no, do not attempt to remove air bubbles. drops of medicine have appeared at the needle tip. is this okay? yes, it is normal to see a few drops of medicine at the needle tip when you remove the cap. can i re-insert the needle if i change my mind where i want to inject? no, you should not re-insert the needle into your skin. if you change your mind, you will need a replacement pen if the needle has already been inserted into the skin. after the injection button has been pressed, you must not lift your pen from the skin until the injection has finished. i pushed my pen against the skin but could not press the button down. what should i do? take your finger off the injection button and push your pen down more firmly against the skin. then try pushing the button again. if this does not work, stretching the skin may make the injection site firmer, making pressing the injection button easier. can i pinch or stretch the skin at the injection area? yes, pinching or stretching the skin before injection may make the injection site firmer, making it easier to press the injection button. do i need to keep my finger pressed on the injection button for the whole injection? no, you can stop pressing the button when the injection has started. however, make sure you keep holding the pen firmly against the skin. the pen will continue to deliver your medicine. how long will the injection take? from the time the dose begins until you hear the 2nd click, it usually takes 3 to 10 seconds. after the 2nd click, you should continue to hold your pen in place for at least 5 more seconds to make sure you give the full dose. what should i do if i see more than a small drop of medicine on the skin after giving my injection? nothing this time, but for your next injection wait a little longer before removing the pen from the skin to make sure all of the medicine went into your skin. what should i do if i have any questions about my abrilada pen or medicine? contact your healthcare provider or pharmacist. this instructions for use has been approved by the u.s. food and drug administration. manufactured by pfizer inc. new york, ny 10001 distributed by pfizer labs division of pfizer inc. new york, ny 10001 us license no. 2001 lab-1352-3.0 revised: 06/2023 abrilada (ah brill-ah-dah) (adalimumab-afzb) 10 mg/0.2 ml, 20 mg/0.4 ml, 40 mg/0.8 ml single-dose prefilled syringe injection, for subcutaneous (under the skin) use only keep this leaflet. these instructions show step by step directions on how to prepare and give an injection. storage information: keep abrilada, injection supplies, and all other medicines out of the reach of children. abrilada for injection comes in a disposable (throw away) single use prefilled syringe that contains a single dose of medicine. abrilada for injection can be given by a patient, caregiver or healthcare provider. do not try to inject abrilada yourself until you are shown the right way to give the injections and read and understand the instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of abrilada at home, you should receive training on the right way to prepare and inject abrilada. it is important that you read, understand, and follow these instructions so that you inject abrilada the right way. it is important to talk to your healthcare provider to be sure you understand your abrilada dosing instructions. to help you remember when to inject abrilada, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject abrilada. step 1. supplies you need step 2. getting ready wash your hands with soap and water, and dry completely. if you have any questions about your medicine, please contact your healthcare provider or pharmacist.   questions and answers what should i do with my prefilled syringe if it has been dropped? do not use it if it has been dropped or the carton containing your prefilled syringe has been dropped even if it looks undamaged. dispose of your prefilled syringe in the same way as a used prefilled syringe. you will need to use a new prefilled syringe to give your injection. can i use my prefilled syringe straight from the refrigerator? yes, however you may find that using the prefilled syringe at room temperature reduces stinging or discomfort. if you allow your prefilled syringe to reach room temperature before use, you must keep it away from direct sunlight as this can damage your medicine. what should i do if i need to travel? when you are traveling, you may store your prefilled syringe in its carton at room temperature up to 86°f (30°c) for up to 30 days. is it okay to shake my prefilled syringe before i use it? no, do not shake your prefilled syringe. shaking can damage your medicine. when you check your medicine, gently tilt your syringe back and forth while looking carefully into the window. it is normal to see one or more bubbles. do i need to remove any air bubbles before using my prefilled syringe? no, do not attempt to remove air bubbles. drops of medicine have appeared at the needle tip. is this okay? yes, it is normal to see a few drops of medicine at the needle tip when you remove the needle cover. can i re-insert the needle into my skin? no, you should not re-insert the needle into the skin. you will need a replacement prefilled syringe if the needle has already been inserted into the skin. how long will the injection take? dose delivery will take approximately 2 to 5 seconds. remember to hold your prefilled syringe in place for at least 5 seconds after the plunger has been pushed down all the way. what should i do if i have any questions about my prefilled syringe or medicine? contact your healthcare provider or pharmacist. this instructions for use has been approved by the u.s. food and drug administration. manufactured by pfizer inc. new york, ny 10001 distributed by pfizer labs division of pfizer inc. new york, ny 10001 us license no. 2001 lab-1353-3.0 revised: 06/2023

USA - engelsk - NLM (National Library of Medicine)

pfizer laboratories div pfizer inc - adalimumab (unii: fys6t7f842) (adalimumab - unii:fys6t7f842) - abrilada is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. abrilada can be used alone or in combination with methotrexate or other non-biologic disease-modifying anti-rheumatic drugs (dmards). abrilada is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. abrilada can be used alone or in combination with methotrexate. abrilada is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. abrilada can be used alone or in combination with non-biologic dmards. abrilada is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis. abrilada is indicated for the treatment of moderately to severely active crohn's disease in adults and pediatric patients 6 years of age and older. abrilada is indicated for the treatment of moderately to severely active ulcerative colitis in adult patients. limitations of use the effectiveness of adalimumab products has not been established in patients who have lost response to or were intolerant to tnf blockers [see clinical studies (14.7)] . abrilada is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. abrilada should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician [see warnings and precautions (5)] . abrilada is indicated for the treatment of moderate to severe hidradenitis suppurativa in adult patients. abrilada is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adult patients. none. risk summary available studies with use of adalimumab during pregnancy do not reliably establish an association between adalimumab and major birth defects. clinical data are available from the organization of teratology information specialists (otis)/mothertobaby pregnancy registry in pregnant women with rheumatoid arthritis (ra) or crohn's disease (cd) treated with adalimumab. registry results showed a rate of 10% for major birth defects with first trimester use of adalimumab in pregnant women with ra or cd and a rate of 7.5% for major birth defects in the disease-matched comparison cohort. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects (see data). adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in utero exposed infant (see clinical considerations). in an embryo-fetal perinatal development study conducted in cynomolgus monkeys, no fetal harm or malformations were observed with intravenous administration of adalimumab during organogenesis and later in gestation, at doses that produced exposures up to approximately 373 times the maximum recommended human dose (mrhd) of 40 mg subcutaneous without methotrexate (see data). the estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively. clinical considerations disease-associated maternal and embryo/fetal risk published data suggest that the risk of adverse pregnancy outcomes in women with ra or inflammatory bowel disease (ibd) is associated with increased disease activity. adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth. fetal/neonatal adverse reactions monoclonal antibodies are increasingly transported across the placenta as pregnancy progresses, with the largest amount transferred during the third trimester (see data) . risks and benefits should be considered prior to administering live or live-attenuated vaccines to infants exposed to adalimumab products in utero [see use in specific populations (8.4)] . data human data a prospective cohort pregnancy exposure registry conducted by otis/mothertobaby in the u.s. and canada between 2004 and 2016 compared the risk of major birth defects in live-born infants of 221 women (69 ra, 152 cd) treated with adalimumab during the first trimester and 106 women (74 ra, 32 cd) not treated with adalimumab. the proportion of major birth defects among live-born infants in the adalimumab-treated and untreated cohorts was 10% (8.7% ra, 10.5% cd) and 7.5% (6.8% ra, 9.4% cd), respectively. the lack of pattern of major birth defects is reassuring and differences between exposure groups may have impacted the occurrence of birth defects. this study cannot reliably establish whether there is an association between adalimumab and major birth defects because of methodological limitations of the registry, including small sample size, the voluntary nature of the study, and the non-randomized design. in an independent clinical study conducted in ten pregnant women with ibd treated with adalimumab, adalimumab concentrations were measured in maternal serum as well as in cord blood (n=10) and infant serum (n=8) on the day of birth. the last dose of adalimumab was given between 1 and 56 days prior to delivery. adalimumab concentrations were 0.16–19.7 mcg/ml in cord blood, 4.28–17.7 mcg/ml in infant serum, and 0–16.1 mcg/ml in maternal serum. in all but one case, the cord blood concentration of adalimumab was higher than the maternal serum concentration, suggesting adalimumab actively crosses the placenta. in addition, one infant had serum concentrations at each of the following: 6 weeks (1.94 mcg/ml), 7 weeks (1.31 mcg/ml), 8 weeks (0.93 mcg/ml), and 11 weeks (0.53 mcg/ml), suggesting adalimumab can be detected in the serum of infants exposed in utero for at least 3 months from birth. animal data in an embryo-fetal perinatal development study, pregnant cynomolgus monkeys received adalimumab from gestation days 20 to 97 at doses that produced exposures up to 373 times that achieved with the mrhd without methotrexate (on an auc basis with maternal iv doses up to 100 mg/kg/week). adalimumab did not elicit harm to the fetuses or malformations. risk summary limited data from case reports in the published literature describe the presence of adalimumab in human milk at infant doses of 0.1% to 1% of the maternal serum concentration. published data suggest that the systemic exposure to a breastfed infant is expected to be low because adalimumab is a large molecule and is degraded in the gastrointestinal tract. however, the effects of local exposure in the gastrointestinal tract are unknown. there are no reports of adverse effects of adalimumab products on the breastfed infant and no effects on milk production. the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for abrilada and any potential adverse effects on the breastfed child from abrilada or from the underlying maternal condition. the safety and effectiveness of abrilada have been established for: pediatric assessments for abrilada demonstrate that abrilada is safe and effective for pediatric patients in indications for which humira (adalimumab) is approved. however, abrilada is not approved for such indications due to marketing exclusivity for humira (adalimumab). due to their inhibition of tnfα, adalimumab products administered during pregnancy could affect immune response in the in utero -exposed newborn and infant. data from eight infants exposed to adalimumab in utero suggest adalimumab crosses the placenta [see use in specific populations (8.1)] . the clinical significance of elevated adalimumab concentrations in infants is unknown. the safety of administering live or live-attenuated vaccines in exposed infants is unknown. risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants. postmarketing cases of lymphoma, including hepatosplenic t-cell lymphoma and other malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with tnf-blockers including adalimumab products [see warnings and precautions (5.2)] . juvenile idiopathic arthritis in study jia-i, adalimumab was shown to reduce signs and symptoms of active polyarticular jia in patients 4 to 17 years of age [see clinical studies (14.2)] . in study jia-ii, the safety profile for patients 2 to <4 years of age was similar to the safety profile for patients 4 to 17 years of age with polyarticular jia [see adverse reactions (6.1)] . adalimumab products have not been studied in patients with polyarticular jia less than 2 years of age or in patients with a weight below 10 kg. the safety of adalimumab in patients in the polyarticular jia trials was generally similar to that observed in adults with certain exceptions [see adverse reactions (6.1)] . the safety and effectiveness of adalimumab products have not been established in pediatric patients with jia less than 2 years of age. pediatric crohn's disease the safety and effectiveness of adalimumab products for the treatment of moderately to severely active crohn's disease have been established in pediatric patients 6 years of age and older. use of adalimumab products for this indication is supported by evidence from adequate and well-controlled studies in adults with additional data from a randomized, double-blind, 52-week clinical study of two dose concentrations of adalimumab in 192 pediatric patients (6 years to 17 years of age) [see adverse reactions (6.1), clinical pharmacology (12.2, 12.3), clinical studies (14.6)] . the adverse reaction profile in patients 6 years to 17 years of age was similar to adults. the safety and effectiveness of adalimumab products have not been established in pediatric patients with crohn's disease less than 6 years of age. a total of 519 ra patients 65 years of age and older, including 107 patients 75 years of age and older, received adalimumab in clinical studies ra-i through iv. no overall difference in effectiveness was observed between these patients and younger patients. the frequency of serious infection and malignancy among adalimumab-treated patients 65 years of age and older was higher than for those less than 65 years of age. consider the benefits and risks of abrilada in patients 65 years of age and older. in patients treated with abrilada, closely monitor for the development of infection or malignancy [see warnings and precautions (5.1, 5.2)] . abrilada (ah brill-ah-dah) (adalimumab-afzb) 40 mg/0.8 ml single-dose prefilled pen injection, for subcutaneous (under the skin) use keep this leaflet. these instructions show step by step directions on how to prepare and give an injection. storage information: keep abrilada, injection supplies, and all other medicines out of the reach of children. abrilada for injection comes in a disposable (throw away) single-use pen that contains a single dose of medicine. abrilada for injection can be given by a patient, caregiver or healthcare provider. do not try to inject abrilada yourself until you are shown the right way to give the injections and read and understand the instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of abrilada at home, you should receive training on the right way to prepare and inject abrilada. it is important that you read, understand, and follow these instructions so that you inject abrilada the right way. it is important to talk to your healthcare provider to be sure you understand your abrilada dosing instructions. to help you remember when to inject abrilada, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject abrilada. step 1. supplies you need step 2. getting ready   questions and answers what should i do with my pen if it has been dropped? do not use it, even if it looks undamaged. dispose of your pen in the same way as a used pen. you will need to use a new pen to give your injection. can i use my pen straight from the refrigerator? yes, however you may find that using the pen at room temperature reduces stinging or discomfort. if you allow your pen to reach room temperature before use, you must keep it away from direct sunlight as this can damage your medicine. what should i do if i need to travel? when you are traveling, you may store your pen in its carton at room temperature up to 86°f (30°c) for up to 30 days. is it okay to shake my pen before i use it? no, do not shake your pen. shaking can damage your medicine. when you check your medicine, gently tilt your pen back and forth while looking carefully into the window. it is normal to see one or more air bubbles. do i need to remove any air bubbles before using my pen? no, do not attempt to remove air bubbles. drops of medicine have appeared at the needle tip. is this okay? yes, it is normal to see a few drops of medicine at the needle tip when you remove the cap. can i re-insert the needle if i change my mind where i want to inject? no, you should not re-insert the needle into your skin. if you change your mind, you will need a replacement pen if the needle has already been inserted into the skin. after the injection button has been pressed, you must not lift your pen from the skin until the injection has finished. i pushed my pen against the skin but could not press the button down. what should i do? take your finger off the injection button and push your pen down more firmly against the skin. then try pushing the button again. if this does not work, stretching the skin may make the injection site firmer, making pressing the injection button easier. can i pinch or stretch the skin at the injection area? yes, pinching or stretching the skin before injection may make the injection site firmer, making it easier to press the injection button. do i need to keep my finger pressed on the injection button for the whole injection? no, you can stop pressing the button when the injection has started. however, make sure you keep holding the pen firmly against the skin. the pen will continue to deliver your medicine. how long will the injection take? from the time the dose begins until you hear the 2nd click, it usually takes 3 to 10 seconds. after the 2nd click, you should continue to hold your pen in place for at least 5 more seconds to make sure you give the full dose. what should i do if i see more than a small drop of medicine on the skin after giving my injection? nothing this time, but for your next injection wait a little longer before removing the pen from the skin to make sure all of the medicine went into your skin. what should i do if i have any questions about my abrilada pen or medicine? contact your healthcare provider or pharmacist. this instructions for use has been approved by the u.s. food and drug administration. manufactured by pfizer inc. new york, ny 10001 distributed by pfizer labs division of pfizer inc. new york, ny 10001 us license no. 2001 lab-1352-3.0 revised: 06/2023 abrilada (ah brill-ah-dah) (adalimumab-afzb) 10 mg/0.2 ml, 20 mg/0.4 ml, 40 mg/0.8 ml single-dose prefilled syringe injection, for subcutaneous (under the skin) use only keep this leaflet. these instructions show step by step directions on how to prepare and give an injection. storage information: keep abrilada, injection supplies, and all other medicines out of the reach of children. abrilada for injection comes in a disposable (throw away) single use prefilled syringe that contains a single dose of medicine. abrilada for injection can be given by a patient, caregiver or healthcare provider. do not try to inject abrilada yourself until you are shown the right way to give the injections and read and understand the instructions for use. if your healthcare provider decides that you or a caregiver may be able to give your injections of abrilada at home, you should receive training on the right way to prepare and inject abrilada. it is important that you read, understand, and follow these instructions so that you inject abrilada the right way. it is important to talk to your healthcare provider to be sure you understand your abrilada dosing instructions. to help you remember when to inject abrilada, you can mark your calendar ahead of time. call your healthcare provider if you or your caregiver have any questions about the right way to inject abrilada. step 1. supplies you need step 2. getting ready wash your hands with soap and water, and dry completely. if you have any questions about your medicine, please contact your healthcare provider or pharmacist.   questions and answers what should i do with my prefilled syringe if it has been dropped? do not use it if it has been dropped or the carton containing your prefilled syringe has been dropped even if it looks undamaged. dispose of your prefilled syringe in the same way as a used prefilled syringe. you will need to use a new prefilled syringe to give your injection. can i use my prefilled syringe straight from the refrigerator? yes, however you may find that using the prefilled syringe at room temperature reduces stinging or discomfort. if you allow your prefilled syringe to reach room temperature before use, you must keep it away from direct sunlight as this can damage your medicine. what should i do if i need to travel? when you are traveling, you may store your prefilled syringe in its carton at room temperature up to 86°f (30°c) for up to 30 days. is it okay to shake my prefilled syringe before i use it? no, do not shake your prefilled syringe. shaking can damage your medicine. when you check your medicine, gently tilt your syringe back and forth while looking carefully into the window. it is normal to see one or more bubbles. do i need to remove any air bubbles before using my prefilled syringe? no, do not attempt to remove air bubbles. drops of medicine have appeared at the needle tip. is this okay? yes, it is normal to see a few drops of medicine at the needle tip when you remove the needle cover. can i re-insert the needle into my skin? no, you should not re-insert the needle into the skin. you will need a replacement prefilled syringe if the needle has already been inserted into the skin. how long will the injection take? dose delivery will take approximately 2 to 5 seconds. remember to hold your prefilled syringe in place for at least 5 seconds after the plunger has been pushed down all the way. what should i do if i have any questions about my prefilled syringe or medicine? contact your healthcare provider or pharmacist. this instructions for use has been approved by the u.s. food and drug administration. manufactured by pfizer inc. new york, ny 10001 distributed by pfizer labs division of pfizer inc. new york, ny 10001 us license no. 2001 lab-1353-3.0 revised: 06/2023