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Autoimmune processes treatment with adalimumab may result in the formation of autoimmune antibodies. The effect of long-term treatment on the development of autoimmune diseases is not known. If a patient develops symptoms suggestive of a lupus-like syndrome as a result of treatment with adalimumab, discontinue use of the drug.

Elderly patients occurrence frequency serious infections in patients older than 65 years who received adalimumab was andro gel higher in patients younger than 65 years. 12% of patients treated with adalimumab was 65 years and approximately 2.5% were older than 75. Adalimumab should be used with caution in elderly patients due to the high probability of occurrence of infectious diseases.No differences in efficacy in this patient group compared with younger patients have been identified, a dose adjustment is required. children Adalimumab has not been studied in children under 4 years, data on the use of the drug in children weighing  is limited. Efficacy and safety of adalimumab in children proved only for the treatment of juvenile idiopathic arthritis in patients from 13 to 17 years. SurgerySafety data of the drug Humira for surgical interventions are limited. When planning for the surgery must take into account the long period of elimination of adalimumab. Patients receiving adalimumab during surgery should be closely monitored for the emergence of infections. Obstruction of the small intestine insufficient response to treatment disease may signal the presence of a fixed fibrotic stricture (stenosis), which may require surgical treatment. According andro gel to reports adalimumab is not conducive to the formation or worsening of strictures.

Pregnancy and lactation
In animal studies at doses up to 100 mg / kg of adalimumab signs damaging effect on the fetus have been identified. However, adequate controlled studies in pregnant women the drug has not been studied.
Animal studies do not always make it possible to predict the effect of the drug on humans, so during pregnancy, use of Humira drug is contraindicated.
Women of reproductive age should avoid pregnancy during treatment with Humira.
Data on excretion of adalimumab in breast milk or no suction.
Many drugs and immunoglobulins into breast milk. Given the risk of developing serious adverse reactions in the newborn, it is advisable to discontinue breast-feeding or stop the drug, taking into account its importance to the mother. The birth effects of andro gel in the generic activities and childbirth are unknown.

DOSAGE AND ADMINISTRATION
The recommended  testosterone gel dose of Humira in adult patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is 40 mg subcutaneously once every two weeks. In the appointment of Humira therapy of corticosteroids, non-steroidal anti-inflammatory drugs (including salicylates), analgesics (narcotic and non-narcotic), methotrexate and other basic antirheumatic drugs can be continued.
In some patients not receiving methotrexate, an additive effect with an increase can be achieved Humira multiplicity application to 40 mg once a week. Crohn’s disease . In the appointment of Humira therapy aminosalicylates, glyukokortiko steroids, and / or anti-metabolites (such as mercaptopurine and azathioprine) may be continued. The patients, the observed decrease in response to drug treatment, can obtain an additional effect of increasing the dose to 40 mg of Humira in the week. Some patients may not respond to therapy Humira during the first 4 weeks, however, treatment should continue as positive effect can be achieved within 12 weeks. The decision to discontinue therapy may be taken if the patient does not receive the effect from the treatment during this period. Chronic plaque psoriasis . The starting dose for adults is 80 mg. The maintenance dose – 40 mg every two weeks, starting one week after the . starting dose of juvenile idiopathic arthritis . Children from andro gel 13 to 17 years -. 40 mg biweekly clinical response is usually achieved within 12 weeks of treatment. The decision on termination of therapy may be taken if the patient does not receive the effects of the treatment during this period. The use of Humira Treatment with Humira is held under the supervision of a physician. If the doctor thinks it is possible, after appropriate training techniques subcutaneous injection, patients may self-administer the drug themselves. The drug Humira administered subcutaneously in the thigh or abdomen. The solution should be inspected before administration to determine the presence of foreign particles and discoloration. Adalimumab should not be mixed in the same syringe or vial with any other drugs. The remains of the solution and the material used should be destroyed.