Biologic DMARD (TNF-alpha inhibitor, monoclonal antibody) Pregnancy: Should only be used during pregnancy if clearly needed; women of childbearing potential should consider adequate contraception during and for at least five months after last treatment (UK SPC §4.6)

Adalimumab

Brand names: Humira, Amgevita, Hyrimoz (biosimilars)

Adalimumab is a fully human anti-tumour necrosis factor (TNF) monoclonal antibody and biologic disease-modifying antirheumatic drug used in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other immune-mediated conditions.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 40 mg

Route: SC

Frequency: Every other week (once every two weeks)

Rheumatoid arthritis (recommended adult dose): 40 mg every other week as a single subcutaneous injection; methotrexate should be continued. In monotherapy, some patients with a decreased response may benefit from increasing to 40 mg every week or 80 mg every other week; clinical response usually achieved within 12 weeks. Ankylosing spondylitis, axial spondyloarthritis without radiographic evidence of AS, and psoriatic arthritis: 40 mg every other week. Psoriasis (adults): initial dose 80 mg, then 40 mg every other week starting one week after the initial dose. Treatment initiated and supervised by a specialist; dose interruption may be needed before surgery or with serious infection. Paediatric: Juvenile idiopathic arthritis (per US labelling, children 2 years and older, by weight): 10 kg to <15 kg = 10 mg every other week; 15 kg to <30 kg = 20 mg every other week; 30 kg and greater = 40 mg every other week (subcutaneous). Paediatric Crohn's disease dosing (6 years and older) is also stated by weight band in the US labelling — clinician to verify against UK SPC and a children's formulary.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active tuberculosis or other severe infections such as sepsis, and opportunistic infections
Moderate to severe heart failure (NYHA class III/IV)

Side effects

Infections (nasopharyngitis, upper respiratory tract infection, sinusitis) — very common
Injection site reactions (erythema, itching, haemorrhage, pain or swelling)
Headache
Musculoskeletal pain
Serious infections including sepsis, opportunistic infections and TB, HBV reactivation, and malignancies (including lymphoma) — reported/serious

Interactions

Anakinra (increased risk of serious infections; combination not recommended)
Abatacept (increased risk of serious infections; combination not recommended)
Live vaccines (avoid; do not give live vaccines such as BCG to infants exposed in utero for 5 months after mother's last dose)
Methotrexate (reduces apparent adalimumab clearance; no dose adjustment needed)

Clinical monograph

How it works

It binds and neutralises tumour necrosis factor alpha, preventing its interaction with cell-surface receptors and reducing the inflammatory cascade driving these diseases.

Prescribing in practice

Screen for and treat latent tuberculosis and check hepatitis B status before starting, as TNF inhibition can reactivate serious infections.
Avoid initiating during active serious infection and use with caution in heart failure and in patients with a history of demyelinating disease.
Live vaccines should be avoided during treatment; bring immunisations up to date beforehand where possible.

Monitoring

Monitor for signs of infection and tuberculosis reactivation throughout treatment, and review periodically for malignancy risk and disease response.

Counselling the patient

Report fever, persistent cough, weight loss or night sweats, which may indicate infection or tuberculosis.
Avoid live vaccines and tell other clinicians you are on a biologic; carry your alert card.
Store the injection in the fridge and follow training on self-injection technique and sharps disposal.

Evidence & guidelines

NICE technology appraisals support adalimumab across several inflammatory conditions after inadequate response to conventional therapy.

Reference: NICE TA715/TA130; BSR Biologic DMARD Guidelines 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways