Parenteral Manual

Adalimumab (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Disease-modifying Antirheumatic drug, Tumor Necrosis Factor (TNF) - Blocking agent
Original Date: 
September 2008
  • Active rheumatoid arthritis (moderate-severe) and active psoriatic arthritis; may be used alone or in combination with disease-modifying antirheumatic drugs (DMARDs) 
  • Ankylosing spondylitis
  • Active Crohn's disease (moderate - severe) in patients with inadequate response to conventional treatment, or patients who have lost response to or are intolerant of infliximab
  • Juvenile idiopathic arthritis (moderate - severe)
Reconstitution and Stability: 
  • Available as 40 mg/0.8 mL vial and 40 mg/0.8 mL prefilled syringe
  • Refrigerate  -do not freeze
  • Protect from light
  • Needle cap of prefilled syringe may contain latex

-Solutions Compatible:  No Information

-Additives/Above Cassette Compatible:  No information

-Y-site Compatible:  No information

Incompatible:  No information


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

Rotate injection sites. 
Do not administer to skin which is red,tender,bruised, or hard
IV Push NO
IV Intermittent Infusion NO
IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


- Juvenile idiopathic arthritis: Children  >4 years

  • 15 kg to <30 kg: 20 mg every other week
  • >30 kg: 40 mg every other week


-Rheumatoid arthritis:

  • 40 mg every other week; may be administered with other DMARDs; patients not taking methotrexate may increase dose to 40 mg every week

-Ankylosing spondylitis, psoriatic arthritis:

  • 40 mg every other week

-Crohn's disease:

  •  Initial: 160 mg given as 4 injections on day 1 or over 2 days, then 80 mg 2 weeks later (day 15); Maintenance: 40 mg every other week beginning day 29
Potential hazards of parenteral administration: 
  • Local reactions:  erythema, itching, hemorrhage, pain, swelling
  • Headache, nausea, abdominal pain, flu-like symptoms
  • Allergic reactions:  rash , anaphylaxis (rare) -medications for treatment of hypersensitivity reactions should be available for immediate use
  • Increased susceptibility to  infections  including tuberculosis, invasive fungal infections, & other opportunistic infections (Histoplasma, Aspergillus, & Nocardia)
  • Rare cases of autoimmune disorder, including lupus-like syndrome reported
  • Perform tuberculin skin test prior to initiating therapy
  • DO NOT administer live vaccines concurrently  - bring immunizations up to date before initiating therapy
  • Use with caution in patients with chronic infection, history of recurrent infection or predisposition to infection.  DO NOT give to patients with active chronic or localized infection,  monitor closely if a new infection develops  while on treatment, and discontinue treatment if  a serious infection or lupus-like syndrome develops

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