Learn about Hadlima drug interactions, including medications to avoid, supplements to watch, and what to tell your doctor before starting treatment.
If you're starting Hadlima (Adalimumab-bwwd) or already taking it, understanding how it interacts with other medications is essential for your safety. Hadlima is a biologic TNF blocker that works by suppressing part of your immune system, which means combining it with certain drugs can increase your risk of serious infections or other complications.
This guide covers the major and moderate drug interactions, supplements and OTC medications to be aware of, and what information your doctor needs before you begin treatment.
Unlike many medications that are processed through the liver using enzymes (like the CYP450 system), Hadlima is a biologic — a large protein molecule that your body breaks down differently. Its interactions aren't about competing for liver enzymes. Instead, the risks come from additive immunosuppression: combining Hadlima with other drugs that also suppress your immune system can push your defenses too low, making you vulnerable to serious infections.
There's also a unique consideration: TNF-alpha (the protein Hadlima blocks) normally helps regulate the levels of certain liver enzymes called CYP450 enzymes. When you start Hadlima and TNF-alpha levels drop, those enzyme levels can change — potentially affecting how your body processes other medications metabolized by CYP450. Your doctor may need to monitor levels of those drugs.
These combinations should be avoided or used only with extreme caution under close medical supervision:
Abatacept is another biologic used for rheumatoid arthritis. Combining it with Hadlima significantly increases the risk of serious infections without adding meaningful therapeutic benefit. Clinical studies showed the combination was more dangerous and no more effective than either drug alone. Do not take these together.
Anakinra is an interleukin-1 (IL-1) receptor antagonist used for rheumatoid arthritis and other inflammatory conditions. Like the Abatacept combination, using Anakinra with Hadlima raises the risk of serious infections substantially. This combination is not recommended.
Because Hadlima suppresses your immune system, live vaccines should be avoided during treatment. Live vaccines contain weakened but active viruses or bacteria, and your suppressed immune system may not be able to handle them safely. Examples of live vaccines include:
If possible, get any needed live vaccines before starting Hadlima treatment.
Combining Hadlima with other biologic disease-modifying antirheumatic drugs (DMARDs) — such as Rituximab (Rituxan), Tocilizumab (Actemra), or Sarilumab (Kevzara) — increases the risk of immunosuppression and serious infections. Biologics should generally not be combined with one another.
These combinations may be used together but require monitoring:
Methotrexate is actually one of the most common medications used alongside Hadlima, particularly for rheumatoid arthritis. It can improve Hadlima's effectiveness and reduce the formation of anti-drug antibodies. However, Methotrexate also affects your immune system, so your doctor will monitor you for signs of infection and check your blood work regularly.
These immunosuppressants are sometimes used for Crohn's disease and ulcerative colitis. When combined with TNF blockers like Hadlima, there is an increased risk of hepatosplenic T-cell lymphoma (HSTCL), a rare but often fatal type of cancer. This risk is most notable in adolescents and young adult males. Your doctor will carefully weigh the benefits against this risk.
Some medications are processed by CYP450 liver enzymes, and their levels in your body may be affected when you start or stop Hadlima. Medications that may be affected include:
If you take any of these, your doctor may monitor drug levels more closely after you start Hadlima.
While Hadlima has fewer direct interactions with over-the-counter products than many medications, there are still some things to keep in mind:
The good news: Hadlima has no specific food interactions. You don't need to take it with food or avoid any particular foods. Since it's an injection rather than an oral medication, food doesn't affect how your body absorbs it.
That said, general healthy eating supports your immune system, which is especially important when you're on an immunosuppressive medication. And while alcohol isn't a direct interaction, heavy drinking can weaken your immune system further — something to be mindful of while taking Hadlima.
Before your first dose, give your doctor a complete picture of everything you take:
Don't assume something is too minor to mention. Even "harmless" supplements can affect your treatment.
Hadlima's drug interaction profile is relatively straightforward compared to many oral medications. The biggest risks come from combining it with other immunosuppressive drugs, which can lower your infection defenses too much. Live vaccines are off-limits, and a few specific medications require closer monitoring.
The best thing you can do is keep your doctor informed about every medication and supplement you take. Bring a list to every appointment, and don't start or stop anything without checking first.
For more about Hadlima, including side effects and savings options, explore our other Hadlima guides. Ready to fill your prescription? Use Medfinder to find Hadlima in stock near you.
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