9 Cimzia Side Effects and How to Manage Them

Cimzia (certolizumab pegol) is a biologic medication that’s prescribed to treat a variety of autoimmune conditions. Crohn’s disease, rheumatoid arthritis, and psoriasis are a few examples. You can inject Cimzia at home into your stomach or upper thigh.

Cimzia works by making your immune system less active, which helps lower inflammation. But it can also lead to side effects you should be aware of. Knowing what to expect and how to manage Cimzia side effects can help you feel more prepared during treatment.

Cimzia side effects at a glance

Cimzia side effects are generally mild. But serious side effects are also possible. Below are lists of common and rare Cimzia side effects to know about. Be sure to discuss any side effects that occur during treatment with a healthcare professional, even if they aren’t listed below.

Common Cimzia side effects include:

• Upper respiratory tract infections (URTIs)

• Skin rashes

• Urinary tract infections (UTIs)

• Herpes infections

• Joint or back pain

• Fever

• Headache

• Injection site reactions

• Cough

• Fatigue

Cimzia can also cause rare but serious side effects and reactions, such as:

• High blood pressure

• New or worsening heart failure

• Low blood cell counts

• Lupus-like symptoms, such as unusual joint pain or a rash that gets worse in the sun

• Allergic reactions, including anaphylaxis

• Increased risk of certain cancers

• Significant hair loss

• Nerve-related conditions, such as Guillain-Barré syndrome (an autoimmune nerve condition)

Cimzia also contains a boxed warning, the FDA’s most serious medication warning. It warns of the increased risk of serious infections, such as sepsis or tuberculosis, while receiving Cimzia. It also warns of an increased risk of lymphoma and other types of cancer, which may be fatal among children and adolescents receiving medications in the same class as Cimzia.

Let’s take a closer look at nine noteworthy Cimzia side effects and how to manage them.

1. Infection, including respiratory infections and urinary tract infections

Cimzia reduces your immune system activity by design. This helps manage autoimmune disorders, but it also makes it harder for your body to fight infections. That’s why you may experience URTIs or UTIs more often after starting it.

URTIs, such as the common cold, typically cause symptoms such as a sore throat, stuffy or runny nose, and tiredness. Most of these symptoms should clear up on their own after a few days. But if they’re not improving within 10 days, or if they’re severe or getting worse, it’s best to seek medical care.

UTIs, on the other hand, require antibiotics in most cases. So if you notice symptoms such as pain or burning when you pee or frequent urination, schedule a visit with your prescriber.

Good to know: Staying up to date with your vaccines can help protect you against certain infections. But you should avoid live vaccines, such as Flumist (intranasal flu vaccine) while you’re receiving Cimzia. These vaccines contain a live, weakened form of a virus that could potentially cause an infection among people taking immunosuppressants. It's best to receive live vaccines at least 2 weeks (14 days) before starting Cimzia or 3 months after stopping it.

2. Injection site reactions

Injection site reactions are possible with any injectable medication, including Cimzia. After a dose, you may notice symptoms near the Cimzia injection site, such as:

• Redness

• Pain

• Swelling

• Bruising

• Skin discoloration

These symptoms are typically short lived and tend to go away on their own within a week. But applying an ice pack to the affected area and taking an over-the-counter (OTC) pain reliever — such as Tylenol (acetaminophen) or Advil (ibuprofen) — can help relieve discomfort in the meantime.

Your healthcare team should show you how to inject Cimzia properly to help prevent injection site discomfort. Rotating your injection sites each time can help. If your dose requires two injections, you should inject them at least 1 inch apart from one another. You should also avoid injecting into skin that is tender, bruised, or hard.

3. Skin rashes

Skin rashes are a relatively common Cimzia side effect. They’re mild in most cases. But to play it safe, it’s best to reach out to your healthcare team if you develop a rash while using Cimzia.

Your prescriber may recommend an OTC rash medication for mild rashes. Topical hydrocortisone cream is one option. If itching is more of an issue, the oral antihistamine Benadryl (diphenhydramine) may help.

If you experience a rash along with hives or difficulty breathing, you may be having a severe allergic reaction to Cimzia. In this case, call 911 or have someone take you to the nearest ER.

Good to know: If you have a latex allergy, be aware that the needle shield on Cimzia’s prefilled syringe contains an ingredient similar to natural rubber latex. Wearing latex-free gloves while injecting Cimzia can help prevent a reaction.

4. Headache

Headache is another common Cimzia side effect. In fact, this side effect is quite common among tumor necrosis factor (TNF) inhibitors — the group of biologics Cimzia belongs to. Certain autoimmune disorders can also increase the risk of headaches.

Typically, headaches are mild and go away as your body gets used to the medication. Staying hydrated, exercising, and getting a good night’s sleep are all strategies that can prevent and alleviate headaches. Avoiding dietary triggers and reducing stress (when possible) are helpful, too. When needed, you can also turn to an OTC pain reliever, such as Tylenol.

If headaches are severe or persistent, it’s best to see a healthcare professional for guidance.

5. Increased blood pressure

Cimzia may raise your blood pressure. This tends to happen more among people who are already living with hypertension (high blood pressure).

Plus, certain medications can raise your blood pressure even higher when combined with Cimzia. Corticosteroids, such as prednisone, are one example. Nonsteroidal anti-inflammatory drugs — such as Advil — are another.

Depending on your situation, your prescriber may monitor your blood pressure throughout Cimzia treatment. They may encourage you to check it at home, too.

6. New or worsening heart failure

Heart failure happens when your heart has a hard time pumping blood throughout your body. This can cause fluid to build up in your body, among other effects.

In rare cases, TNF inhibitors may cause or make heart failure symptoms worse. But the risk of heart failure from Cimzia appears to be low overall.

Still, keep an eye out for heart failure symptoms such as shortness of breath, swelling in your legs or arms, and dizziness. Your prescriber may occasionally run tests, such as an electrocardiogram, to check how well your heart is working while you’re receiving Cimzia.

7. Serious infection

As mentioned, Cimzia can raise your risk of infection. In most cases, infections are mild. But in rare cases, more serious infections can occur.

Certain factors can raise the risk of developing a serious infection. This includes having multiple chronic health conditions, taking other immunosuppressants, or being age 65 or older. Let your prescriber know if you experience symptoms of a serious infection, including:

• Severe or persistent cough

• Fever

• Chills

• Shortness of breath

• Sudden nausea and vomiting

• Diarrhea

• Unusual fatigue

• Stomach pain

• Yellow skin or eyes

• Red skin or sores

Your prescriber will likely recommend pausing Cimzia until your symptoms improve or stopping treatment altogether.

8. Rare reports of cancer

Cimzia carries a boxed warning for an increased risk of certain cancers, such as lymphoma and skin cancer. But this side effect is rare overall. And there’s some conflicting evidence about this risk. Some research suggests that TNF blockers don’t actually elevate the risk of these cancers.

Your prescriber will likely monitor you for any signs or symptoms of cancer during and after Cimzia treatment. But you can watch for changes, too. Keep an eye out for lymphoma symptoms such as swollen lymph nodes, tiredness, and unexplained weight loss. And take note of any moles, bumps, or sores that aren’t normal for your skin.

9. Nerve-related conditions

In rare cases, TNF inhibitors such as Cimzia can cause new or worsening nerve-related conditions. Multiple sclerosis, optic neuritis (eye nerve swelling), and Guillain-Barré syndrome are a few examples. The risk of this side effect seems higher for those already living with a nerve-related condition. 

Keep an eye out for any nerve-related symptoms, such as dizziness, blurred vision, or weakness in the arms and legs, while you’re receiving Cimzia. If you have a pre-existing nerve condition, your prescriber may recommend avoiding Cimzia altogether.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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