7 Adalimumab (Humira) Interactions to Consider
Key takeaways:
Adalimumab (Humira) is a biologic medication that treats autoimmune conditions such as rheumatoid arthritis, Crohn’s disease, and psoriatic arthritis. It lowers inflammation and affects the immune system by blocking a protein called tumor necrosis factor (TNF).
Adalimumab interacts with other medications that block TNF, such as etanercept (Enbrel). It also interacts with methotrexate (Trexall), rituximab (Rituxan), and Janus kinase (JAK) inhibitors such as upadacitinib (Rinvoq).
Adalimumab interactions usually raise the risk of serious infection due to a weakened immune system. Your healthcare provider can help manage your medication to limit problematic interactions.
Table of contents
Adalimumab (Humira) is an injectable biologic medication that’s FDA approved to treat several autoimmune disorders, including rheumatoid arthritis (RA), psoriatic arthritis, and Crohn’s disease.
Adalimumab is a tumor necrosis factor (TNF) blocker. By blocking TNF (a protein involved in inflammation), adalimumab helps relieve symptoms in the joints, skin, and gut. It also helps lower the risk of your condition worsening over time.
While adalimumab is effective for treating many conditions, there are a few things to know before taking it. Understanding potential drug interactions can help you safely use the medication. Below, we cover seven notable adalimumab drug interactions to keep in mind.
1. Other TNF blockers, such as etanercept (Enbrel)
Adalimumab interacts with other TNF blockers, including etanercept (Enbrel). All TNF blockers carry a risk of serious infection. These infections can happen because of TNF blockers’ impact on the immune system. Blocking TNF helps reduce inflammation, but it also weakens the immune system. This means your body may have a harder time fighting off infections.
It’s not recommended to use other TNF blockers if you use adalimumab. Combining multiple TNF blockers can raise the risk of serious infection. You may also experience new or worsening side effects with little added benefit.
Your healthcare provider will ensure that you aren’t prescribed other TNF blockers while you’re taking adalimumab.
2. Methotrexate
Methotrexate (Trexall) is an anti-inflammatory medication approved to treat many of the same conditions as adalimumab. It’s common to use both methotrexate and adalimumab, even though they interact. That’s because the benefits of the combination outweigh the risks for most people.
Methotrexate slows down the removal of adalimumab from the body. This often raises adalimumab levels in the body and may help boost its effectiveness. But it can also possibly lead to more side effects, such as headaches and skin rashes.
The good news is that dosage changes typically aren’t needed with this adalimumab interaction. But if you’re getting started with this combination, watch for new or worsening side effects. If you notice anything unusual or bothersome, tell your healthcare provider.
3. Rituximab (Rituxan)
Rituximab (Rituxan) is also a biologic medication. It can treat different cancers, autoimmune disorders, and other health conditions. But you may need to avoid adalimumab if you’ve recently taken rituximab. People who have taken both have experienced a higher rate of serious infection.
You can get rituximab as an injection in a healthcare setting. If you use adalimumab, tell all your healthcare providers. They can help you navigate your treatment options and suggest alternatives.
4. Abatacept (Orencia)
Abatacept (Orencia) is another injectable biologic medication. It can be prescribed to treat autoimmune diseases such as RA and to prevent graft versus host disease after a stem cell or bone marrow transplant. People with RA who received both adalimumab and abatacept had a higher risk of serious infection.
It’s recommended to avoid combining adalimumab and abatacept, which treat similar conditions. Your healthcare provider can help you transition from one to the other if needed.
5. Anakinra (Kineret)
Anakinra (Kineret) is another biologic medication that interacts with adalimumab. Anakinra can treat RA and a few other conditions. Receiving anakinra and a TNF blocker such as adalimumab can raise your risk of serious infection.
Avoid taking both anakinra and adalimumab. If you need to change from one medication to the other, your healthcare provider will help you do so safely.
6. JAK inhibitors, such as upadacitinib (Rinvoq)
Janus kinase (JAK) inhibitors treat many of the same conditions as adalimumab. Examples include upadacitinib (Rinvoq) and tofacitinib (Xeljanz). The combination of JAK inhibitors and adalimumab raises the risk of infection, including serious infection.
Avoid taking a JAK inhibitor while taking adalimumab. If you’re switching from one to the other, your care team will ensure these medications don’t overlap.
7. Live vaccines
Live vaccines contain a live but weakened virus. Common examples include the measles-mumps-rubella (MMR) and nasal spray flu vaccines. If you’re prescribed adalimumab, you should avoid receiving live vaccines. This combination hasn’t been well studied, so experts don’t know if it’s safe or effective.
It’s best to receive all of your necessary vaccines, including live vaccines, before starting adalimumab. Your care team can help you with vaccine timing during adalimumab treatment.
Good to know: For vaccines that aren't live, such as the injectable flu or COVID-19 vaccines, you can safely receive them while receiving adalimumab. But they may be less effective because of adalimumab’s impact on the immune system.
When should I contact my healthcare provider about adalimumab interactions?
It’s best to discuss potential adalimumab interactions before starting the medication. That way, any medication changes are addressed up front. Your healthcare provider and pharmacist can screen for interactions when reviewing your medication list.
If you’re already receiving adalimumab, you can still ask questions about interactions. If you’re experiencing new or worse side effects, they may be related to a medication interaction. If needed, your provider can adjust your medication or make other changes to relieve your symptoms.
The bottom line
Most adalimumab (Humira) interactions raise the risk of serious infection from a weakened immune system. Adalimumab interacts with other medications in its class, such as etanercept (Enbrel). It also interacts with biologic medications like rituximab (Rituxan) and Janus kinase (JAK) inhibitors like upadacitinib (Rinvoq). Avoid combining these medications with adalimumab.
Adalimumab also interacts with methotrexate (Trexall). But the benefits of this combination often outweigh the possible risks. Give your medication list to your healthcare provider and pharmacist before starting adalimumab. That way, they can help prevent or manage interactions.
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References
A-S Medication Solutions. (2023). Humira - adalimumab [package insert].
Centers for Disease Control and Prevention. (2023). Altered immunocompetence.
Van Huizen, A., et al. (2023). Quantifying the effect of methotrexate on adalimumab response in psoriasis by pharmacokinetic–pharmacodynamic modeling. Journal of Investigative Dermatology.
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