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Anti-Tumor Necrosis Factor alpha

Drug Class: Commonly Known As: Category:

Anti-Tumor Necrosis Factor alpha - What is it for

  • ​Anti-TNF is a type of medicine called biologic agent. Anti-TNF targets substance called TNF.
  • When TNF is present in excessive concentrations, is responsible for the destructive inflammatory process. .
  • Anti-TNF  acts   by  blocking  the   effect  of   TNF.  Thus,  reduce inflammation and stop disease progression.
  • It  is  reserved  for  moderate  to  severe  disorders  that  have  not responded to one or more of the traditional disease modifying anti- rheumatic drugs (DMARDs) such as methotrexate.
  • There are five anti-TNF drugs available including Inflixamab, Adalimumab, Etanercept, Certolizumab, Golimumab

Anti-Tumor Necrosis Factor alpha - Side Effects, Precautions, and Contraindications

What side effects can Anti-Tumor Necrosis Factor alpha cause?

​Common side-effects:

  1. Infection  (colds,  sinusitis,  urinary  tract  infections  and  skin infections)
  2. Injection  site  reactions  (bleeding,  bruising,  redness,  itching, pain and swelling)
  3. Infusion reactions of infliximab: Flushing, chills, chest tightness, shortness of breath, hypotension or hypertension (pre- medication may be given to prevent infusion reactions)
  4. Headache
  5. Rash
Uncommon side-effects:
  1. Severe  infections  (pneumonia,  joint  infection,  activation  of tuberculosis)
  2. Low blood platelet count
  3. Localized swelling of the skin or hives
  4. Lung inflammation

Rare side-effects:

  1. Combined low platelet, red and white blood cell count
  2. Severe muscle weakness
  3. Seizures
Long term use of anti-TNF may increase the risk of lymphoma and other cancers. You may be more at risk if you are also taking immunosuppressant such as methotrexate and azathioprine.

Before taking Anti-Tumor Necrosis Factor alpha, what precautions must I follow?

  • ​Patient should be tested for tuberculosis before starting anti-TNF therapy.​
  • Hepatitis B and C testing may be done. Hepatitis B and C infection may get worse during the anti-TNF therapy.
  • If you have heart problems, as anti-TNF could make your symptoms worse, therefore your heart will need to be monitored closely before and after the treatment. 
  • Come back to the hospital for regular blood test as instructed by your doctor.
  • Because adverse effects can happen at any time during the course of treatment and some side effects may not cause symptoms, it is really important  that  you  have  your  regular blood test.  This  can monitor the side-effects of anti-TNF.
  • Move the injection site where you give the shot each time.​


What food or medicine must I avoid when I take Anti-Tumor Necrosis Factor alpha?

Anti-Tumor Necrosis Factor alpha - Dosage and How to Use

How should Anti-Tumor Necrosis Factor alpha be used?

  • ​It  may  be  given  by  injection  under  the  skin,  e.g.  Adalimumab, Etanercept, Certolizumab and Golimumab (administer at home) or by infusion, e.g.: Infliximab (administer in hospital up to 2-4 hours)
  • Injection under the skin can be injected into the abdomen or thigh.
  • Starting, maintenance dose and time to effect :
​Drug​Usual Dosing Regimen​Time to effect
​Infliximab​ Initial : 3-5mg/kg (Week 0,2,6)
Maintain : 8 weekly
​2-3 weeks
​Adalimumab​40mg every other week​2-3 weeks
​Etanercept​50mg once a week​1-2 weeks
​Certolizumab​Initial : 400mg (Week 0,2,4)
Maintain : 200mg every other week
​1-2 weeks
​Golimumab​50mg once a month​1-2 weeks

What should I do if I miss a dose?

  • ​Take the missed dose as soon as you remember.
  • Then take your next injection as you would have on your originally scheduled day.
  • If it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule
  • Do not take a double dose to make up a missed dose.

What should I do if I overdose?

Anti-Tumor Necrosis Factor alpha - Handling and Storage

How should I handle Anti-Tumor Necrosis Factor alpha safely?

How should I store Anti-Tumor Necrosis Factor alpha?

​After injection, dispose needles in a sharp disposal box. When the box is full, return it to pharmacy or clinic.

How should I dispose of Anti-Tumor Necrosis Factor alpha safely?

Anti-Tumor Necrosis Factor alpha - Additional Information

In SUMMARY… what you need to know about anti-TNF?​​

  • ​Inject anti-TNF following the scheduled interval at home.
  • Infliximab infusion is administered in hospital at scheduled interval.
  • Always come for your BLOOD TESTS on the scheduled date.
  • Beware of the SIDE EFFECTS and when to seek immediate medical attention.
  •  Never take medicines, supplements or herbal medicines OVER-THE- COUNTER without checking with your doctor or pharmacist first.
  • If you intent to start a family, please inform your doctor as anti-TNF may not be appropriate in pregnancy.
  •  If  you  have  any  questions  about  your  anti-TNF  therapy,  please discuss with your doctor or Advanced Practice Nurse at 65762418 or pharmacist at 63265077.​


Updated on Tuesday, October 31, 2023

This article is contributed by PSS National Medication Information Workgroup PSS National Medication Information Workgroup

    The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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