Anti-Tumor Necrosis Factor alpha

What is Anti-Tumor Necrosis Factor (Anti-TNF) for?

 Anti-Tumor Necrosis Factor alpha (anti-TNFα) belongs to a class of medications called biologics or more specifically, biological disease modifying anti-rheumatic drugs (bDMARD). 

Biologics work by blocking targeted parts of the immune system that cause inflammation in the body. 

How should I take or use Anti-Tumor Necrosis Factor (Anti-TNF)?

• It may be given as 
  o subcutaneous injection (inject under the skin, into areas like the abdomen or thigh) such as adalimumab and golimumab. This can be injected  by yourself or a caregiver at home. 
  o intravenous infusion (inject into the blood vessel) such as infliximab. This has to be done in the hospital for typically 2 to 4 hours.
  
• Do not stop using your medication without checking with your healthcare professional.
  
• Other medications such as corticosteroids (e.g. prednisolone) or disease modifying anti-rheumatic drugs (DMARDs) may be taken with anti-TNFα.
  

What should I do if I forget to take or use Anti-Tumor Necrosis Factor (Anti-TNF)?

Different biologics have different intervals between doses. If you forget to inject a dose, do it as soon as you remember. Then inject your next dose at the usual time. Do not administer two doses to make up for the missed dose. DO check with your healthcare professional if unsure. 

What precautions should I take when taking or using Anti-Tumor Necrosis Factor (Anti-TNF)?

What food or medication should I avoid when I take or use Anti-Tumor Necrosis Factor (Anti-TNF)?

What are some common side effects of Anti-Tumor Necrosis Factor (Anti-TNF)?

Common side effects include:

• Infection (common cold, sinusitis, urinary tract infections and skin infections)

• If you develop a fever, sore throat, pain on urination or feel generally unwell, see a doctor immediately. Tell the doctor whom you consult that you are on anti-TNFα.

• Injection site reactions: symptoms include bruising, redness, itching, pain and swelling

• If you are using subcutaneous injection, rotate the injection site each time. You may also apply a cold pack to the injection site after injection.

• These symptoms are temporary and usually go away within 3 to 5 days.

• Infusion reactions: symptoms include flushing, chills, chest tightness, shortness of breath, hypotension or hypertension

• Medications may be given before the infusion to prevent these reactions.

• You will be monitored closely in the ward during and after the infusion

• Inform the nurse immediately if you experience any of these symptoms.

• Your infusion may be slowed down or stopped if the symptoms are severe.

• Headache

• Rash

It is important to monitor the effects of your new treatment, particularly during the first few months of treatment. If the symptoms persist or are severe, consult your doctor. You may need to have regular blood tests to monitor your blood counts while on this medication.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Some rare but serious side effects include:

Severe infections such as pneumonia, fungal infection, reactivation of tuberculosis and hepatitis B

• Combined low blood cell count (symptoms include infection, persistent fever, feeling very tired or weak, bleeding/bruising very easily, looking pale)
• Lung inflammation
• Severe muscle weakness/numbness/tingling sensation
• Seizures
• Heart problems (symptoms include shortness of breath with exertion or on lying down, swelling of feet)

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

Long term use of anti-TNFα may increase the risk of lymphoma and other cancers. However, this is very rare. You may also be at higher risk if you are also taking certain medications that suppress the immune system. Your doctor will monitor/manage this risk closely.

How should I store Anti-Tumor Necrosis Factor (Anti-TNF)?

• Store in the refrigerator between 2-8 ^oC and protected from light. Do not freeze. Keep this medication away from children

How do I throw away Anti-Tumor Necrosis Factor (Anti-TNF) safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. Dispose needles in a sharps box or tightly closed container to avoid needle prick injury.