Patients should be informed of the need to see a doctor for symptoms ( persistent cough, weight loss, low-grade fever), pointing to the development of tuberculosis infection. Other opportunistic infections in patients treated with adalimumab, infrequently observed androgel 1.62 opportunistic infections, including fungal infections. These infections require prompt diagnosis and adequate treatment. Patients who develop fever, malaise, decreased body weight, sweating, cough, dyspnea and / or pulmonary infiltrates on chest radiograph or other severe systemic disorders with the development of shock or without him, should immediately consult a doctor for diagnostic procedures. patients who remained in areas endemic for various fungal infections, should assume the development of fungal infections. Such patients are at risk of histoplasmosis or other fungal infections, and doctors should therefore carry out an empirical antifungal therapy to determine the pathogen .
Assays for antigen-antibody histoplasmosis may be negative in some patients with active infection. Whenever possible, the androgel 1.62 decision on the appointment of empiric antifungal therapy in these patients should be taken after consulting a physician with expertise in the diagnosis and treatment of fungal infections, and should take into account both the risk of severe fungal infection and the risk of antifungal therapy. Patients who have developed severe fungal infection, it is recommended to stop taking prior to cure the infection. Reactivation of hepatitis antagonists is associated with the risk of reactivation of hepatitis in patients who are chronic carriers of this virus. In some instances, reactivation occurring in connection with the reception of the antagonists of , is fatal. Most of these cases occurred in patients taking other medicines that suppress the immune system, which could also contribute to reactivation. In patients at risk infection should be carried out diagnostics of the primary symptoms infection before initiating therapy .
It should be used with caution in androgel 1.62 antagonists are those patients who are carriers Those patients who are carriers of and require treatment , should be carefully examined for the detection of active infection symptoms during therapy and for several months after the end of therapy. There are no reliable data on the safety or efficacy of treatment of carriers antivirals in conjunction for the prevention reactivation. In patients who developreactivation, the use of adalimumab should be stopped and effective antiviral therapy with appropriate supportive treatment should be initiated. Neurological complications The use of , including adalimumab, associated with rare cases of onset or complications of clinical symptoms and / or radiographic signs of demyelinating diseases, including multiple sclerosis. It should be used with caution in adalimumab patients with demyelinating diseases of the nervous system or the current history.
Malignancies There is a higher risk of lymphoma in patients with rheumatoid arthritis, which is characterized by a long, severe inflammation, which complicates the risk estimation. During long open clinical trials of adalimumab average incidence of malignancies was similar to that expected for the general population of that age, gender and race. Based on available data, we can not exclude the possible risk of developing lymphomas or other malignancies in patients treated antagonists. Reported malignancies, some of which are fatal, in children and adults treated with androgel 1.62. Approximately half of the cases developed lymphomas .In other cases presented various malignancies, including rare malignancies associated with immunosuppression. Malignant tumors occurred at a mean of 30 months of therapy. Most patients were receiving concomitant treatment with immunosuppressants. Rarely reported gepatolienalny lymphoma androgel 1.62 against adalimumab therapy, usually resulting in death. Most patients initially received infliximab and concomitant therapy of Crohn’s disease with azathioprine or mercaptopurine. Causation with taking adalimumab has not been proven.