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The Food and Drug Administration has alerted healthcare providers to the recommendations for expanded safety warnings associated with the tumor necrosis factor alpha blockers (TNF-alpha blockers) adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), and infliximab (Remicade). These drugs suppress the immune system and are approved to treat a wide variety of conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and Crohn’s disease.

The heightened warnings were prompted by increased reports of serious opportunistic fungal infection development associated with their use. Healthcare providers have reported difficulty recognizing fungal infections among TNF-alpha blocker users, especially histoplasmosis, coccidioidomycosis, blastomycosis, and other invasive fungal infections, often causing delays in treatment with adverse outcomes. Some patients with invasive fungal infections have died. Living in or visiting certain U.S. geographical areas, including the Ohio River and Mississippi River valleys, can increase the risk for fungal infections

Patient teaching: Patients should immediately seek medical attention if they develop a persistent fever, cough, shortness of breath, and fatigue. To assist in the diagnosis of fungal infections, remind patients to inform their healthcare providers of areas they have recently visited that may increase their risk of contracting fungal infections. Patients who develop a fungal infection may be advised to stop their medication until they recover.

Caution: Review current drug information before administering and monitoring medications.

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Drug News is compiled by Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, CRRN, who maintains a private practice in Plantation, Fla., and is professor and area chair for nursing at the University of Phoenix, Fort Lauderdale.