Adalimumab: what it treats, how to use it, and side effects
Last updated September 7, 2026.
**Adalimumab is an injectable biologic medicine called a tumor necrosis factor (TNF) blocker, sold as Humira and as biosimilars such as Amjevita, Hyrimoz, Yuflyma, and Hadlima.** It binds TNF alpha, a protein that drives inflammation, so joint swelling, gut inflammation, and skin plaques calm down over weeks rather than hours. Because TNF is also part of how your body fights infection, adalimumab raises the risk of serious bacterial, fungal, and tuberculosis infections, and the FDA label carries a boxed warning about serious infections and about lymphoma and other cancers. Everyone gets tested for latent tuberculosis and hepatitis B before starting, and any fever or new infection while on treatment needs to be reported the same day.
What does it treat?
Adalimumab is approved for moderate to severe rheumatoid arthritis, polyarticular juvenile idiopathic arthritis in children 2 years and older, psoriatic arthritis, ankylosing spondylitis, moderate to severe Crohn disease and ulcerative colitis, moderate to severe chronic plaque psoriasis, hidradenitis suppurativa, and non-infectious intermediate, posterior, and panuveitis. In practice it is used when the pattern is inflammatory rather than mechanical: morning stiffness lasting more than an hour, symmetric swollen joints, bloody or urgent diarrhea with weight loss, thick scaly plaques over elbows and knees, or recurring painful abscesses and tunnels in the armpits and groin. It is often started after methotrexate, sulfasalazine, mesalamine, or topical therapy has not controlled disease, and in rheumatoid arthritis it is frequently continued alongside methotrexate, which improves response and lowers the chance of antibodies forming against the drug. There is no fixed dose combination product; adalimumab comes only as a single ingredient injection.
How do you take it?
Adalimumab comes as a prefilled pen and a prefilled syringe (10 mg, 20 mg, 40 mg, and 80 mg strengths) given as a subcutaneous injection into the front of the thigh or the abdomen, rotating sites and staying at least one inch from the last spot and away from skin that is tender, bruised, red, hard, or scarred. Typical adult dosing from the label: rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, 40 mg every other week, and in rheumatoid arthritis not taking methotrexate the dose may be increased to 40 mg every week or 80 mg every other week; Crohn disease and ulcerative colitis, 160 mg on day 1 (given as four 40 mg injections in one day or two injections a day for two days), 80 mg on day 15, then 40 mg every other week starting day 29; plaque psoriasis and uveitis, 80 mg once, then 40 mg every other week starting one week later; hidradenitis suppurativa, 160 mg on day 1, 80 mg on day 15, then 40 mg every week or 80 mg every other week starting day 29. There is no daily ceiling because it is not a daily drug, and the practical ceiling is the labeled maximum of 80 mg every other week or 40 mg weekly for adults, so never inject extra doses to catch up on symptoms. Food and alcohol do not affect absorption, so there are no meal rules; store pens and syringes in the refrigerator at 36 to 46 degrees F, do not freeze, and let a dose sit at room temperature for 15 to 30 minutes before injecting so it stings less. If you miss a dose, inject it as soon as you remember, then go back to your original schedule and do not double up; if you are more than a few days late, ask your prescriber which day to restart. Stop injecting and call your clinician before the next dose if you get a fever, chills, a cough that will not clear, burning with urination, an expanding red warm area of skin, unexplained weight loss or night sweats, new numbness or vision change, or if you are about to have surgery or receive a live vaccine.
Side effects to know
- Common: The most common effects are injection site redness, itching, swelling, pain, or bruising that fades within a few days, plus headache, rash, nausea, and more frequent colds and sinus infections.
- Serious: Get medical help right away for signs of a serious infection such as fever, chills, drenching night sweats, a productive cough, or a spreading warm red painful patch of skin, and for an allergic reaction with hives, facial or throat swelling, or trouble breathing. Also call the same day for new or worsening shortness of breath, ankle swelling, unexplained bruising or bleeding, yellowing of the eyes or skin, a new lump or persistent swollen lymph node, or new numbness, tingling, weakness, or vision changes.
Who should not take it?
Do not start adalimumab if you have an active infection of any kind, including active tuberculosis, and do not use it if you have had a severe allergic reaction to adalimumab or to latex in the needle cover of some products. Everyone needs a tuberculosis skin or blood test and hepatitis B screening first, because adalimumab can wake up latent TB and can reactivate hepatitis B; tell your clinician if you have lived in or traveled to areas where TB, histoplasmosis, blastomycosis, or coccidioidomycosis are common. Talk to a doctor first if you have moderate to severe heart failure, multiple sclerosis or another demyelinating disease, a history of lymphoma or other cancer, recurring infections, or diabetes, since these change whether TNF blockers are appropriate. Do not combine adalimumab with other TNF blockers such as etanercept, infliximab, certolizumab, or golimumab, or with anakinra, abatacept, tocilizumab, or tofacitinib, because infection risk goes up without added benefit; avoid live vaccines such as MMR, varicella, yellow fever, and live intranasal flu while on treatment, and get inactivated vaccines like the flu shot, COVID vaccine, pneumococcal, and shingles (Shingrix) instead, ideally before you start. Combining adalimumab with azathioprine or 6-mercaptopurine has been linked to a rare aggressive hepatosplenic T-cell lymphoma, mostly in adolescent and young adult males with inflammatory bowel disease. In pregnancy the FDA label reports no clear increase in birth defects and adalimumab is often continued when disease control requires it, but the drug crosses the placenta in the third trimester and infants exposed in the womb should not get live vaccines such as rotavirus for about 5 months after birth, so plan this with your obstetrician and pediatrician. Adalimumab is present in human milk at very low levels and is generally considered compatible with breastfeeding. Alcohol does not interact with adalimumab itself, but if you also take methotrexate, keep alcohol low or none because of combined liver strain.
When is it an emergency?
Call 911 in the US if you collapse, cannot breathe, have swelling of the lips, tongue, or throat, break out in hives with lightheadedness, have chest pain, or become confused and hard to wake, and use an epinephrine auto injector first if you have one. Go to an emergency room the same day for a fever above 100.4 degrees F with shaking chills, a rapidly spreading red or purple painful skin area, severe abdominal pain with vomiting, coughing up blood, sudden one sided weakness or loss of vision, or heavy unexplained bleeding or bruising. Adalimumab overdose is uncommon because doses are pre measured, and up to 10 mg per kg has been given in trials without dose limiting toxicity, but if extra doses are injected or a child gets hold of a pen, call Poison Control at 1-800-222-1222 right away and watch for fever and infection over the following days. Bring your pen or syringe carton with you so the team can see the exact product, strength, and date of your last dose.
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Common questions
What is the maximum dose of adalimumab I can take?
There is no daily maximum because adalimumab is not a daily drug. For adults the labeled ceiling is 40 mg every week or 80 mg every other week, and most people stay at 40 mg every other week. Higher amounts are used only as loading doses at the start of treatment for Crohn disease, ulcerative colitis, hidradenitis suppurativa, psoriasis, and uveitis, and those are one time steps on specific days. Adding extra injections does not speed up the response and does raise infection risk, so call your prescriber instead of increasing the dose yourself.
Can I drink alcohol while on adalimumab?
Alcohol does not interact directly with adalimumab, and moderate drinking does not change how the injection works. The real issue is what else you take with it. Many people on adalimumab also take methotrexate, which is hard on the liver, and combining that with regular alcohol raises the chance of liver injury. If you take methotrexate, keep alcohol to none or very little and get your liver blood tests on schedule. Heavy drinking also raises infection risk on its own, which matters more on a TNF blocker.
Is adalimumab safe during pregnancy and breastfeeding?
The FDA label reports that available data have not shown a clear increase in major birth defects or miscarriage, and many people with rheumatoid arthritis or inflammatory bowel disease stay on adalimumab through pregnancy because uncontrolled disease is itself a risk to the pregnancy. Adalimumab crosses the placenta in the second and third trimesters and can be detected in the baby's blood for months after birth. Because of that, babies exposed in the womb should not receive live vaccines such as rotavirus for about 5 months after delivery, so tell the pediatrician. Adalimumab passes into breast milk at very low levels and is broken down in the infant's gut, so breastfeeding is generally considered compatible. Decide the plan with your obstetrician and the doctor who manages your condition rather than stopping on your own.
Do I need to take adalimumab with food, and how should I store it?
Food does not matter because adalimumab is injected under the skin, not swallowed, so you can take it any time of day with or without a meal. Keep pens and syringes in the refrigerator at 36 to 46 degrees F in the original carton to protect them from light, and never freeze them. A single pen or syringe can be kept at room temperature up to 77 degrees F for up to 14 days, and if it is not used in that window you must throw it away rather than put it back in the fridge. Let the dose sit out for 15 to 30 minutes before injecting, since cold liquid stings more. Do not use it if the liquid is cloudy, discolored, or has flakes in it.
What are the signs I have taken too much or that something is seriously wrong?
Adalimumab overdose is rare because each pen holds a fixed dose, and doses up to 10 mg per kg have been given in studies without dose limiting toxicity. The bigger danger is infection rather than a toxic level, so after any extra dose watch for fever, chills, cough, night sweats, burning with urination, or spreading red skin over the following days. Call Poison Control at 1-800-222-1222 if extra doses were injected or a child handled a pen, and call 911 for collapse, trouble breathing, or swelling of the face or throat. Other red flags that need urgent evaluation are unexplained bruising or bleeding, yellow eyes or skin, new numbness or vision change, and new shortness of breath or leg swelling.
What medicines and vaccines interact with adalimumab?
Do not combine adalimumab with another TNF blocker such as etanercept, infliximab, certolizumab, or golimumab, and avoid pairing it with anakinra, abatacept, tocilizumab, or tofacitinib, since these combinations raise serious infection risk without extra benefit. Live vaccines including MMR, varicella, yellow fever, and the live nasal flu spray should not be given while you are on treatment, but inactivated vaccines like the flu shot, COVID vaccine, pneumococcal, and Shingrix are recommended and work best when given before you start. Taking adalimumab with azathioprine or 6-mercaptopurine has been linked to a rare aggressive lymphoma, mostly in young males with inflammatory bowel disease, so that combination is weighed carefully. Adalimumab can also change the levels of drugs with a narrow window such as warfarin, cyclosporine, and theophylline as inflammation improves, so monitoring may need to be tightened. Tell every clinician you see, including your dentist and surgeon, that you are on a TNF blocker.