Certolizumab Pegol (Subcutaneous Route)
Original Article: http://www.mayoclinic.com/health/drug-information/DR602647
US Brand Names
Certolizumab pegol is a monoclonal antibody. It is used to decrease signs and symptoms of moderately to severely active Crohn's disease in adult patients who have not been helped by other medicines. It is also used to treat the symptoms of moderately to severely active rheumatoid arthritis.
This medicine is available only with your doctor's prescription.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of certolizumab pegol in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of certolizumab pegol in the elderly. However, this medicine may cause more serious infections in the elderly, which may require caution in patients receiving certolizumab pegol.
|All Trimesters||B||Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine Type 4, Live
- Adenovirus Vaccine Type 7, Live
- Bacillus of Calmette and Guerin Vaccine, Live
- Influenza Virus Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine
- Varicella Virus Vaccine
- Yellow Fever Vaccine
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Bleeding problems or
- Blood or bone marrow problems (e.g., aplastic anemia, leukopenia, pancytopenia, thrombocytopenia), or history of or
- Coccidioidomycosis (fungus infection), history of or
- Congestive heart failure or
- Demyelinating disease (e.g., multiple sclerosis), history of or
- Diabetes or
- Histoplasmosis (fungus infection), history of or
- Lupus-like syndrome or
- Optic neuritis (eye problem) or
- Peripheral neuropathy (nerve problem) or
- Psoriasis (skin disease) or
- Seizures, history of—Use with caution. May make these conditions worse.
- Cancer, active or history of or
- Hepatitis B, history of or
- Tuberculosis, history of—Patients with these conditions may have an increased chance for side effects.
- Infection, active or recurring or
- Tuberculosis, active—Should not be used in patients with these conditions.
- Tuberculosis, inactive—Should be treated before starting therapy with this medicine.
A nurse or other trained health professional will give you this medicine. This medicine is given as a shot under your skin, usually on the abdomen or thigh.
Certolizumab pegol may sometimes be given at home to patients who do not need to be in the hospital or clinic. If you are using this medicine at home, your doctor or nurse will teach you how to prepare and inject the medicine. Be sure that you understand how to use the medicine.
This medicine comes with a medication guide and patient information insert. Read and follow the instructions carefully. Ask your doctor if you have any questions.
If you use this medicine at home, you will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. This will help prevent skin problems.
To use the prefilled syringe:
- First, gather the items you will need on a clean, flat surface using a cloth or towel in a well-lighted area.
- Remove the carton with the syringe from the refrigerator and place it on the clean cloth.
- Allow 30 minutes for the syringe to warm up to room temperature. Do not warm this medicine in any other way.
- Wash your hands with soap and water before and after using this medicine.
- Choose an injection site on your body (e.g., abdomen or stomach area, or thigh). Clean the injection site with an alcohol swab, and do not touch the area until you are ready for injection.
- Remove the needle cover when you are ready to inject.
- Hold the syringe with one hand between the thumb and index fingers. Do not to touch the needle or let it touch any surface.
- Use your free hand to pinch and hold the skin at the injection site.
- Inject the medicine in a dart-like motion into the pinched skin at a 45-degree angle.
- Use your thumb to push the plunger and inject the full dose of the medicine. Pull the needle out of the skin.
If the medicine in the vial or syringe has changed color, or if you see particles in it, do not use it.
Do not inject this medicine if blood enters the syringe. If you notice blood inside the syringe, pull the needle out and throw away the syringe and needle in a hard-closed container.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For injection dosage form (prefilled syringe):
- For Crohn's disease:
- Adults—At first, 400 milligrams (mg) (given as two 200 mg) injected under the skin and at weeks 2 and 4. The recommended maintenance dose is 400 mg every four weeks.
- Children—Use and dose must be determined by your doctor.
- For rheumatoid arthritis:
- Adults—At first, 400 milligrams (mg) (given as two 200 mg) injected under the skin and at weeks 2 and 4, followed by 200 mg every other week. The recommended maintenance dose is 400 mg every four weeks.
- Children—Use and dose must be determined by your doctor.
- For Crohn's disease:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store in the refrigerator. Do not freeze.
Protect the medicine from direct light. Keep your medicine in the original package until you are ready to use it.
Throw away used syringes in a hard, closed container (puncture-resistant) that the needles cannot poke through. Keep this container away from children and pets.
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Certolizumab pegol can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
- If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
- Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
- Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
- Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
- Avoid contact sports or other situations where bruising or injury could occur.
Your risk of getting an infection increases when you travel to places where certain organisms (such as fungi, bacteria, viruses, or parasites) are more common. Tell your doctor where you live and if you have any history of travel if you start having any signs of infection.
You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.
Do not have any live vaccines (immunizations) while you are being treated with certolizumab pegol. Check with your doctor before having any vaccines.
Check with your doctor right away if you have any symptoms of liver problems including skin and eyes turning yellow, dark brown-colored urine, right-sided abdominal or stomach pain, fever, or severe tiredness.
This medicine may cause other unwanted effects that may not occur until months or years after this medicine is used. A small number of people (including children and teenagers) who have used this type of medicine have developed certain types of cancer (eg, leukemia). Some patients developed a rare type of cancer called lymphoma. Talk with your doctor if you have unusual bleeding, bruising, or weakness; swollen lymph nodes in the neck, underarms, or groin; or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.
Check with your doctor right away if you have more than one of these symptoms: chest pain; decreased urine output; dilated neck veins; extreme fatigue; irregular breathing; irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; tightness in the chest; trouble with breathing; weight gain; or wheezing. These may be signs of a heart condition called congestive heart failure (CHF).
Certolizumab pegol may cause serious allergic reactions. Check with your doctor right away if you have a rash; itching; dizziness, fainting, or lightheadedness; swelling of the face, throat, legs, or feet; or troubled breathing after you receive the medicine.
Some people who have used this medicine developed lupus-like symptoms during treatment and got better after this medicine was stopped. Make sure your doctor knows if you start having chest pains, shortness of breath, joint pain, or a rash on your cheeks or arms that is sensitive to the sun.
Do not change or stop using this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are using before stopping it completely.
Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.
Do not take other medicines unless they have been discussed with your doctor. Your doctor will discuss with you any changes in your medicine.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- Bladder pain
- Bloody or cloudy urine
- Body aches or pain
- Cough or hoarseness
- Difficult, burning, or painful urination
- Difficulty with breathing
- Ear congestion
- Frequent urge to urinate
- Loss of voice
- Lower back or side pain
- Nasal congestion
- Runny nose
- Sore throat
- Unusual tiredness or weakness
- Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- Bloating or swelling of the face, arms, hands, lower legs, or feet
- Chest pain
- Colds or flu-like symptoms
- Frequent urination
- Pain in the ankles or knees
- Pain in the arms or legs
- Painful, red lumps under the skin, mostly on the legs
- Rapid weight gain
- Shortness of breath
- Stomach pain
- Tingling of the hands or feet
- Tightness in the chest
- Troubled breathing
- Unusual weight gain or loss
- Blurred vision
- Coughing or spitting up blood
- Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Feeling of warmth
- General feeling of discomfort, illness, or weakness
- Inflammation of the joints
- Joint pain
- Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- Loss of appetite
- Muscle aches
- Night sweats
- Redness of the face, neck, arms and occasionally, upper chest
- Skin rash
- Sudden high fever or low-grade fever for months
- Swelling of the lymph glands
- Blistering, peeling, or loosening of the skin
- Red skin lesions, often with a purple center
- Red, irritated eyes
- Red, scaling, or crusted skin
- Sores, ulcers, or white spots in the mouth or on the lips
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Difficulty with moving
- Muscle pain or stiffness
- Stuffy or runny nose
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.