Humira side effects and how to avoid them

Common Humira side effects | Serious side effects | Side effects timeline | Dosing | Contraindications | Interactions | How to avoid side effects | Humira alternatives | FAQs

Humira (adalimumab)—an injection of a naturally-occurring human antibody—induces remission and controls the symptoms of active autoimmune diseases. A healthcare provider may prescribe Humira for rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, psoriatic arthritis, plaque psoriasis, Crohn’s disease, ulcerative colitis, uveitis, and hidradenitis suppurativa. In all these conditions, flare-ups occur when the immune system mistakenly attacks healthy tissues. 

Humira suppresses the body’s immune response by blocking a chemical produced by the body—tumor necrosis factor or TNF—that causes swelling. As with all medications, the decision to take Humira must balance the benefits and risks of the medication, so it is important to discuss with your doctor the side effects, drug interactions, and warnings associated with the drug. 

RELATED: Learn more about Humira | Get Humira discounts

Common side effects of Humira

Humira suppresses the immune system, so infections and malignancies are common as well as potentially serious side effects. The most common side effects of Humira are:

• Injection site reactions (redness, swelling, pain, itching, and skin rash)
• Upper respiratory infections
• Sinus congestion
• Headache
• Development of autoimmune antibodies
• Rash
• Nausea
• Abdominal pain
• Abnormal liver function
• Urinary tract infection
• Flu or cold symptoms
• Back pain
• Increased levels of fat in the bloodstream
• Elevated serum cholesterol
• High blood pressure

By far the most common adverse reaction to Humira is injection site reactions. As many as 1 in 5 patients will experience pain, redness, swelling, itching, or bleeding. Fortunately, these are generally mild and don’t last long. It generally does not necessitate discontinuation of treatment. Those who did end up discontinuing treatment experienced a more serious rash or flare of their medical disorder.

One of the more worrisome potential adverse events is an increased risk of infections, some of them very serious. Humira works by slowing your body’s natural immune system and response. This helps to calm the symptoms of diseases such as rheumatoid arthritis or Crohn’s disease because your immune system is often overactive in these disorders and makes them worse. Unfortunately, slowing your immune system leaves you more vulnerable to viral infections and bacterial infections. Some of the most serious infections observed in patients treated with Humira include pneumonia, septic arthritis, cellulitis, diverticulitis, and tuberculosis. Patients taking Humira must use extra caution to avoid unnecessary exposure to tuberculosis, including travel to areas where tuberculosis is more commonly spread. Make sure your doctor is made aware of any travel plans or live vaccinations you intend to get while taking Humira.

Does Humira cause hair loss or weight gain?

In very rare cases, Humira may cause some hair loss. 

Unexplained weight loss or weight gain, though, is not directly caused by Humira. However, its active ingredient increases the risk of lymphoma, leukemia, and other cancers, many of which are characterized by loss of appetite and involuntary weight loss. Talk to a doctor immediately if you notice weight loss, decreased appetite, or getting full on a small amount of food while taking Humira.

Serious side effects of Humira

Because Humira suppresses the immune system, patients are at an increased risk of severe and even life-threatening infections and cancers. As with all antibody injections, allergic reactions are also a risk. The most severe side effects of Humira are

• Serious or life-threatening infections
• Cancer (lymphoma, leukemia, non-melanoma skin cancer, and other malignancies)
• Severe or life-threatening allergic reactions
• Tuberculosis or hepatitis B virus reactivation
• Exacerbation or onset of nervous system disorders such as multiple sclerosis or optic neuritis
• Heart problems (atrial fibrillation, tachycardia, cardiac arrhythmia, chest pain, heart attack)
• Worsening of congestive heart failure
• Lupus-like syndrome
• Lowered blood cell counts or anemia
• Liver damage or failure
• Gallstones
• Cataracts
• Arthritis
• Muscle weakness
• Confusion

You should stop taking Humira and seek immediate medical attention if you experience any of the following adverse reactions when taking Humira:

• Fever, fatigue, loss of appetite, abdominal pain, or other signs of a hepatitis B infection.
• Swollen glands, tiredness, fever, chills, night sweats, loss of appetite, involuntary weight loss, unusual lumps, easy bruising or bleeding, or other common signs of cancer.
• Hives, facial swelling, blistering, purple skin, trouble breathing, drop in blood pressure, dizziness, fainting, or other signs of a severe allergic reaction or anaphylaxis.
• Fatigue, fever, joint pain, facial rash, sunlight-induced skin lesions, shortness of breath, and other signs of lupus-like syndrome.
• Racing heartbeat, palpitations, chest pain, swelling in the lower legs, or other signs of heart irregularities or symptoms of heart failure.

Humira injections may be discontinued if any of these conditions are experienced.

You should immediately talk to your doctor about the possibility of discontinuing Humira if you experience:

• Fever, cough, swelling, chills, swollen glands, loss of appetite, abdominal pain, or other signs of infection.
• Weakness, fatigue, pale skin, fast heartbeat, easy bruising or bleeding, or other signs of blood problems.
• Yellow skin, yellowing eyes, right-side upper abdominal pain, abdominal swelling, disorientation, and other signs of acute liver problems.
• Muscle weakness, vision changes, muscle stiffness, muscle spasms, tingling, numbness, or other signs of nervous system disorders.

Humira is administered only once every two weeks, so doctors and patients have time to reconsider Humira in the face of adverse effects.

How long do Humira side effects last?

Humira side effects will vary in onset and duration. Injection site or allergic reactions typically occur within minutes of the injection and last a few minutes to a few days. The first injection will always be performed by a healthcare professional in a clinical setting to monitor for possible allergic reactions. Other common side effects such as headache, sinus congestion, nausea, and flu or cold symptoms are also brief and can be treated with over-the-counter medications and rest. 

Long Term Humira Side Effects

Serious side effects, such as liver problems, infections, and blood problems will take weeks or months to develop and may continue to worsen as long as Humira is taken. Severe infections, cancer, liver failure, heart problems, and auto-antibodies may have long-term or life-long consequences even after Humira is discontinued. Regular office visits and tests are necessary to monitor the longer-term effects of Humira.

Humira dosing for approved indications

Humira is indicated and highly effective in treating a variety of disorders. For many, Humira use has significantly improved their quality of life. Dosing is not the same in everyone or for every disorder it is used for. Dosing in children, when approved, is weight based. Below is a table comparing dosages approved by the Food and Drug Administration (FDA) for the most common possible uses of Humira. Your doctor will prescribe your dose of Humira based on your diagnosis.

Indication	Adult dosage	Pediatric dosage
Moderate to severe rheumatoid arthritis	40 mg subcutaneously every 2 weeks	Not indicated in pediatrics for this use
Moderate to severe polyarticular juvenile idiopathic arthritis	N/A	10 mg or 20mg every 2 weeks (weight based dosage)
Psoriatic arthritis	40 mg subcutaneously every 2 weeks	Not indicated in pediatrics for this use
Ankylosing spondylitis	40 mg subcutaneously every 2 weeks	Not indicated in pediatrics for this use
Plaque psoriasis	80 mg subcutaneously on day 1, then 40 mg subcutaneously every 2 weeks starting one week later	Not indicated in pediatrics for this use
Crohn’s disease	160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks	Weight of 40 kg or more: 160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks Weight of 17 to 39 kg:80 mg subcutaneously on day 1, then 40 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 20 mg subcutaneously every 2 weeks
Ulcerative colitis	160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks	Weight of 40 kg or more: 160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks Weight of 17 to 39 kg:80 mg subcutaneously on day 1, then 40 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 20 mg subcutaneously every 2 weeks
Hidradenitis suppurativa	160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks	Weight of 40 kg or more: 160 mg subcutaneously on day 1, then 80 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 40 mg subcutaneously every 2 weeks Weight of 17 to 39 kg:80 mg subcutaneously on day 1, then 40 mg subcutaneously on day 14, then on day 29 begin maintenance dose of 20 mg subcutaneously every 2 weeks

Humira contraindications & warnings

Humira is not always the right medication for everyone. People with infections, latent infections, exposure to tuberculosis, a history of cancer, congestive heart failure, nerve disorders such as multiple sclerosis, liver disease, or allergies to the drug or any of its ingredients may not be suitable candidates for taking Humira.

Serious infections

Humira contains a black-box warning for serious infections. Humira will be discontinued if a serious infection, sepsis, or invasive fungal infection develops while taking the drug. 

Patients will need to be tested for tuberculosis (TB) before and during treatment with Humira. Any patient who tests positive for latent tuberculosis will require TB treatment before receiving Humira. The drug will be discontinued if a patient develops TB during treatment as a very serious TB infection can occur.

Patients at risk for hepatitis B or histoplasmosis infections will also be tested before receiving Humira. Again, the drug will be discontinued if injections reactivate a latent hepatitis B infection.

Malignancies

Humira and other TNF blockers contain a black-box warning for malignancies, particularly lymphoma. Some patients on Humira and other TNF blockers have developed hepatosplenic T-cell lymphoma (HSTCL), an aggressive, rare, and often fatal type of lymphoma. Patients who have been treated for any cancer other than non-melanoma skin cancer may not be suitable candidates for treatment with Humira or similar TNF blockers. If a malignancy develops during treatment, Humira may be discontinued.  

Nervous system disorders

Patients with demyelinating disorders such as multiple sclerosis, Guillain-Barre syndrome, peripheral demyelinating disease, or optic neuritis may not be suitable candidates for Humira therapy. Demyelinating diseases are progressive nerve disorders that slowly strip away the protective sheath around nerve branches, decreasing their ability to pass nerve signals. Humira can cause flare-ups of any of these disorders, so Humira therapy will require constant monitoring in these patients.  

Congestive heart failure

Humira can worsen congestive heart failure, so patients with congestive heart failure will need to be monitored closely when taking Humira.  

Allergies

Patients with allergies to the drug, any of its ingredients, or rubber and latex may not be suitable candidates for Humira. The drug will be discontinued at any sign of a severe allergic reaction.

Pregnancy

Clinical data suggests that the relative risk of major birth defects is no higher in women treated with Humira versus those who are not. As a protein, Humira does pass through the placenta to the fetus. Few antibodies pass to the unborn baby during the first trimester, but the passage of antibodies steadily increases until it maximizes in the third trimester. Pregnant women may want to discuss with their doctors the risks and benefits of taking Humira during their pregnancy.

Breastfeeding

Humira is considered safe to take when breastfeeding infants. Humira does not appear to affect milk production or harm breastfeeding infants. Humira is present in breast milk but at one percent or less of its concentration in the bloodstream. It is also a protein, so it will be broken down in the infant’s digestive system. 

Abuse and dependence

Humira does not produce physical dependence or withdrawal symptoms. There are no known cases of Humira or other TNF blocker abuse.

Humira interactions

Some biologic immune-suppressing drugs should never be used with Humira because, in combination with Humira, these drugs dangerously suppress the immune system. Humira will not be prescribed in combination with the following immunosuppressants:

• Orencia (abatacept)
• Kineret (anakinra)
• Remicade (infliximab)
• Enbrel (etanercept)
• Cimzia (certolizumab pegol)
• Simponi (golimumab)

Humira may enhance the effects of other immune-suppressing or immune-modulating drugs, increasing the risk of infection and cancer. A doctor will exercise caution when prescribing Humira with:

• Imuran (azathioprine)
• Purinethol (6-mercaptopurine)
• Cladribine
• Rituxan (rituximab)
• Xgeva (denosumab)
• Ocrevus (ocrelizumab)
• Actemra (tocilizumab)
• Gilenya (fingolimod)
• Mayzent (siponimod)
• Daliresp (roflumilast)

Humira increases the toxicity and amplifies the side effects of certain medications, including the following:

• Arava (leflunomide)
• Ilaris (canakinumab)
• Tysabri (natalizumab)
• Entyvio (vedolizumab)
• Prograf (tacrolimus)
• Elidel (pimecrolimus)
• Arcalyst (rilonacept) 

Humira reduces the therapeutic effects of some drugs such as warfarin, vaccines, and echinacea. Although there is no danger, the healthcare team may need to modify these other prescriptions or their dosing.

The manufacturer of Humira does not indicate that alcohol should be avoided. It is possible, then, that drinking alcohol in moderation while taking Humira is safe. This may not be true, however, for patients with liver problems. Humira can cause liver problems and—in very rare cases—liver failure, so consult with a doctor about drinking alcohol while taking Humira.

How to avoid Humira side effects

Most drugs cause side effects, so there is no guaranteed way to avoid side effects when taking medications. However, you can reduce the risk and severity of side effects with a few tips.

1. Tell your doctor about all your medical conditions and medications

Because of the risk of serious side effects, you should tell your doctor about: 

• Active or previous infections (particularly hepatitis B or tuberculosis)
• A history of cancer, nervous system disorders (such as multiple sclerosis or Guillain-Barre syndrome), or heart failure
• If you are pregnant or breastfeeding
• Any medications or dietary supplements you may be taking, including over-the-counter medications
• Recent or forthcoming vaccinations
• Numbness, tingling, vision problems, or muscle weakness
• Rubber or latex allergies

When taking Humira, inform your doctor immediately if you fall ill or get pregnant. Do not start taking any drug or dietary supplement until talking to your doctor first.

2. Keep all follow-up medical appointments

Patients on Humira will be monitored to prevent serious side effects. This will require regular blood tests and office visits to catch problems before they develop into serious medical problems.

3. Avoid infections

Humira makes patients more vulnerable to infections. To keep yourself safe, practice social distancing, wear a mask in public, avoid people with infections, wash your hands regularly, shower regularly, and carry and regularly use hand sanitizer. The risk of serious infections while taking Humira shouldn’t be taken lightly.

4. Avoid live vaccines

You can receive vaccinations while taking Humira as long as they are not live vaccines. When given to immune-compromised patients, live vaccines not only carry a risk of causing an infection, the infection might spread throughout the entire body. Talk to a healthcare provider before taking a vaccine while taking Humira. The best practice is to get fully up-to-date on vaccines before starting Humira or any other immune-suppressing medication. When Humira is discontinued, wait at least two months before getting a live vaccine.

5. Keep a list of all your medications

To reduce the risk of side effects and potentially hazardous drug-drug interactions, it is always a good idea to keep a list of all your medications updated at all times. Include any over-the-counter medications, vitamins, and herbal supplements that you take regularly. Always show that list when seeing your doctor or when filling a prescription. 

6. Regularly switch the injection site

Humira’s most common side effects are injection site reactions. The easiest way to control injection site reactions is to change up the injection site with each injection. Humira is injected subcutaneously once every two weeks in the abdomen or thigh, so consider rotating the injection between each thigh and the abdomen. Avoid giving the injection into skin that is tender, irritated, red, swollen, bruised, or itchy. 

You might also reduce injection site reactions by removing the pre-filled syringe or pen injector from the refrigerator before the injection. Humira can be in a room temperature environment for up to 30 minutes prior to injection.  Make sure, however, it is not exposed to sunlight. Do not try to warm the medication in any other way.

7. Ask your doctor about citrate-free Humira

Citric acid is a buffer that helps to keep injectable medications—particularly proteins such as Humira—stable over several months of storage. Citrate buffers, however, often cause significant pain for a few minutes after the injection. If Humira injection pain is too much to bear, ask your doctor about citrate-free Humira as an alternative. 

What are some Humira alternatives?

Humira is a TNF-alfa inhibitor, and this class of prescription drugs suppress your body’s reaction to tumor necrosis factor (TNF). When an inflammatory process begins in your body, whether it presents as psoriasis, arthritis, or in the gastrointestinal tract like colitis, TNF is released and your body’s reaction (sometimes overreaction) is difficult to control on its own. This class of drugs calm the TNF response. Other drugs in this class include Enbrel (etanercept), Remicade (infliximab), and Simponi (golimumab). The active ingredient in Humira, adalimumab, is the active ingredient in other branded TNF-alfa products by the names of Amjevita and Cyltezo. There are other antirheumatics (immunosuppressant) drugs which can be treatment alternatives to Humira and TNF-alfa inhibitors. These include Plaquenil (hydroxychloroquine), Imuran (azathioprine), Rinvoq (upadacitinib), and Orencia (abatacept). 

Remember, only your doctor can decide which treatment is best for you.

Frequently asked questions about Humira

What does Humira treat?

Humira treats a variety of inflammatory conditions where the body’s natural response causes severe, unwanted conditions. While there are many approved indications for Humira, the most common conditions for which Humira is prescribed include: 

Moderate to severe rheumatoid arthritis

Moderate to severe polyarticular juvenile idiopathic arthritis

Psoriatic arthritis

Ankylosing spondylitis

Plaque psoriasis

Crohn’s disease

Ulcerative colitis

Hidradenitis suppurativa

When do Humira’s side effects start?

The most common side effect of Humira is an injection site reaction, and this can occur almost immediately after the injection. This typically presents as redness and swelling, and it may itch or be painful. Other side effects, such as liver damage, take months to develop.

How long do Humira side effects last?

Injection site reactions for most patients will last for a few minutes up to an hour or two, and typically will self-resolve without intervention. The rare but more serious adverse events such as liver damage or  life-threatening infections can have life-long consequences even if you stop Humira treatment.

What are the long term effects of Humira?

Heart damage, liver disease, and blood irregularities are potential long term effects of Humira, and unfortunately they aren’t typically visible to the naked eye. In order to reduce the risk of long term side effects, it is important to maintain your regular visits to your physician and perform routine blood tests and screenings as your prescriber orders them.

Will Humira make you gain weight?

Humira does not directly cause weight loss or weight gain. If you experience involuntary weight changes while taking Humira, check in with your doctor immediately as this could be a symptom of something more serious.

Can you drink alcohol while taking Humira?

Alcohol consumption can be damaging to the liver, as can Humira. Consuming alcohol while on Humira increases the risk of liver damage and the long term effects related to this damage. It is best to refrain from drinking alcohol while receiving Humira treatment.

Related resources to Humira side effects:

• Adalimumab, StatPearls
• Biologic response modifiers, StatPearls
• Breaking old habits: moving away from commonly used buffers in pharmaceuticals, European Pharmaceutical Review
• Humira, Epocrates
• Humira for healthcare professionals, AbbVie
• Humira medication guide, AbbVie
• Humira prescribing information, AbbVie
• Tumor necrosis factor inhibitors, StatPearls
• Tumor necrosis factor inhibitors: a clinical primer, Practical Pain Management