Cyltezo Drug Interactions: What You Need to Know

When you're taking a biologic like the Cyltezo Pen 40 Mg/0.4 Ml Starter Pack (adalimumab-dbll), understanding drug interactions is critical. Cyltezo works by suppressing part of your immune system, which means combining it with certain other medications can increase your risk of serious infections or reduce how well your treatments work.

This guide covers the most important interactions to be aware of — from prescription medications to vaccines, supplements, and over-the-counter products.

How Drug Interactions Work with Cyltezo

Cyltezo is a TNF-alpha inhibitor — it blocks a key inflammatory protein in your immune system. Most of its drug interactions fall into two categories:

1. Additive immunosuppression — Combining Cyltezo with other drugs that suppress the immune system can increase your risk of serious infections and certain cancers.
2. CYP450 effects — TNF-alpha normally affects how your liver processes certain drugs. When Cyltezo blocks TNF-alpha, it can change the way your liver metabolizes those medications, potentially altering their effectiveness or side effects.

Medications That Interact with Cyltezo

Major Interactions — Avoid or Use with Extreme Caution

Other Biologic Immunosuppressants

This is the most important category. Do not combine Cyltezo with other biologic medications, including:

• Anakinra (Kineret) — An interleukin-1 receptor antagonist. Combining it with Cyltezo significantly increases the risk of serious infections and neutropenia (dangerously low white blood cells). This combination is specifically warned against in Cyltezo's labeling.
• Abatacept (Orencia) — A T-cell co-stimulation blocker. Using it with any TNF inhibitor, including Cyltezo, increases infection risk without adding clinical benefit.
• Other TNF inhibitors — You should not take Cyltezo alongside Enbrel (etanercept), Remicade (infliximab), Cimzia (certolizumab), Simponi (golimumab), or any other adalimumab product (Humira, Hadlima, Hyrimoz, Amjevita, etc.).
• Rituximab (Rituxan) — A B-cell depleting biologic. Concurrent use increases immunosuppression significantly.

Live Vaccines

You must avoid live vaccines while taking Cyltezo. Because Cyltezo suppresses your immune system, a live vaccine could potentially cause the infection it's meant to prevent. Live vaccines to avoid include:

• MMR (measles, mumps, rubella)
• Varicella (chickenpox)
• Yellow fever
• BCG (tuberculosis vaccine)
• Live influenza (nasal spray — FluMist)
• Live shingles vaccine (Zostavax) — Note: Shingrix (recombinant, not live) is generally considered safe

Important: Get all recommended vaccinations before starting Cyltezo if possible. Inactivated vaccines (flu shot, COVID-19 vaccines, pneumococcal vaccines) are generally safe to receive during treatment. Discuss timing with your doctor.

Moderate Interactions — Use with Monitoring

Methotrexate

Methotrexate is actually commonly prescribed alongside Cyltezo, particularly for rheumatoid arthritis. The combination can be more effective than either drug alone. However, both drugs suppress the immune system, so your doctor will monitor you more closely for infections and check your blood counts and liver function regularly.

If you're taking Cyltezo without methotrexate for rheumatoid arthritis, your doctor may increase your dose to 40 mg weekly instead of every other week.

Other Immunosuppressants

Non-biologic immunosuppressants are sometimes used alongside Cyltezo but require monitoring:

• Azathioprine (Imuran) — Used in Crohn's disease and ulcerative colitis. Combined use increases infection risk and has been associated with a higher risk of hepatosplenic T-cell lymphoma, particularly in younger patients.
• 6-Mercaptopurine — Similar concerns as azathioprine.
• Cyclosporine — Additional immunosuppression; requires close monitoring.
• Corticosteroids (Prednisone, etc.) — Often used during Cyltezo initiation and tapered over time. Long-term use of both increases infection risk.

CYP450 Substrates

This is a less obvious interaction. TNF-alpha can suppress the activity of certain liver enzymes (CYP450 enzymes). When Cyltezo blocks TNF-alpha, those enzymes may return to normal activity, which can change the blood levels of drugs processed by those enzymes.

Medications that may be affected include:

• Warfarin (Coumadin) — Blood thinner; dose adjustments may be needed
• Cyclosporine — Immunosuppressant used in transplant patients
• Theophylline — Used for asthma and COPD

If you take any of these, your doctor may check blood levels more frequently when starting or stopping Cyltezo.

Supplements and Over-the-Counter Products to Watch

While Cyltezo doesn't have as many OTC interactions as some medications, there are a few things to keep in mind:

• Echinacea — This popular immune-boosting supplement could theoretically work against Cyltezo's mechanism. While there's no strong clinical evidence of a direct interaction, most doctors advise avoiding immune-stimulating supplements.
• Elderberry and other immune boosters — Same concern as echinacea. They aim to stimulate the immune system, while Cyltezo works to calm it down.
• NSAIDs (ibuprofen, naproxen) — These are generally safe to use with Cyltezo for additional pain relief, but long-term use can affect your kidneys and stomach. Discuss with your doctor.
• Acetaminophen (Tylenol) — Safe to use with Cyltezo for pain or fever management.

Food and Drink Interactions

Cyltezo does not have significant food interactions. However:

• Alcohol — There's no direct interaction between alcohol and Cyltezo, but both can affect your liver. If you're also taking methotrexate (which is liver-toxic), alcohol should be limited or avoided. Discuss your alcohol consumption with your doctor.
• Grapefruit — Not a concern with Cyltezo. Grapefruit interactions primarily affect CYP3A4-metabolized oral medications, and Cyltezo is a biologic that is not processed this way.

What to Tell Your Doctor

Before starting the Cyltezo Pen 40 Mg/0.4 Ml Starter Pack, give your doctor a complete list of:

• All prescription medications — especially other biologics, immunosuppressants, and blood thinners
• Over-the-counter medications — including NSAIDs, cold medicines, and allergy medications
• Supplements and vitamins — particularly immune-stimulating herbs like echinacea
• Recent or planned vaccinations — your doctor needs to know about any live vaccines you've had recently or plan to get
• Other health conditions — especially active infections, heart failure, hepatitis B, or a history of cancer

Also tell your doctor if you're pregnant, planning to become pregnant, or breastfeeding. For more on Cyltezo safety in these populations, see our side effects guide.

Final Thoughts

The most critical Cyltezo drug interactions involve other biologic immunosuppressants and live vaccines — both should be avoided. Methotrexate and other non-biologic immunosuppressants can be used alongside Cyltezo with appropriate monitoring. Always keep your doctor informed about every medication and supplement you take.

For more on how Cyltezo works, read our mechanism of action guide. If you need help finding Cyltezo at a pharmacy, Medfinder can help you check availability.