Cimzia (certolizumab) is a prescription drug used to treat some types of arthritis and other conditions. Cimzia can cause side effects that range from mild to serious. Examples include infection and injection site reaction.

Specifically, Cimzia is a biologic drug that’s used to treat the following conditions in adults:

Keep reading to learn about the common, mild, and serious side effects Cimzia can cause. To learn more about this medication, see this Cimzia overview article.

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). For details, see the “Side effects explained” section.

Some people may experience mild to serious side effects during Cimzia treatment. Side effects of this drug may vary depending on the condition it’s being used to treat.

In general, Cimzia’s common side effects include:

Talk with your doctor if you have questions about your risk of side effects with this medication.

Cimzia may cause mild side effects in some people. Side effects may vary depending on the condition the drug is being used to treat.

Mild side effects may include:

  • injection site reaction, such as bruising, pain, swelling, redness or deepening of skin color
  • skin rash
  • upper respiratory infection, such as the common cold
  • urinary tract infection, such as a bladder infection
  • cough
  • headache, in people with psoriasis or arthritis
  • herpes infection (such as cold sores, genital herpes, or chickenpox) in people with psoriasis who have been exposed to the herpes virus
  • fatigue when used with methotrexate (Trexall, Rasuvo, Otrexup) to treat RA
  • joint pain in people with Crohn’s disease

Usually, these side effects are temporary. And some may be easily manageable. But if you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop Cimzia treatment unless your doctor recommends it.

Cimzia may also cause other mild side effects. See the drug’s prescribing information for more details.

Cimzia may cause serious side effects. These are typically rare, but some people have an increased risk of certain serious side effects.

Serious side effects of Cimzia can include:

  • immune system reactions, such as:
    • lupus-like syndrome (which can cause joint pain or a cheek rash that worsens with sun exposure)
  • nervous system disorders, such as:
  • blood disorders, such as
  • eye-related disorders, such as:
    • retinal hemorrhage (bleeding in the back of the eye)
    • uveitis (inflammation of the middle layer of the eye)
  • heart failure
  • hair loss
  • hepatitis B reactivation, if you carry the virus*
  • boxed warning: serious or fatal infection*
  • boxed warning: risk of certain cancers*
  • allergic reaction*

Call your doctor right away if you have any new or worsening symptoms. If your symptoms feel life threatening, call 911 or your local emergency phone number to get medical care right away.

Before starting treatment, talk with your doctor about your risk of serious side effects from Cimzia.

* To learn more, see the “Side effects explained” section.

Cimzia helps treat certain autoimmune and inflammatory conditions. The goal of treatment is to reach remission, which means your condition isn’t causing symptoms.

When you stop Cimzia treatment, you may experience a flare up. This means your condition may become active again and cause symptoms.

There’s also a chance Cimzia won’t work as well if you start using it again after stopping treatment. This is because your body may consider Cimzia a foreign object and make antibodies against it. The antibodies work in different ways to neutralize Cimzia, making it less effective.

In clinical trials of Cimzia, people who developed antibodies against the drug had much lower blood concentrations of Cimzia than those who didn’t. This made the drug less effective. Rarely, this process may increase your risk of other serious side effects, such as lupus-like syndrome.

You should not stop or change your Cimzia treatment without your doctor’s recommendation. Talk with them if you have questions about how long you should expect to take this medication and how long you can expect any particular Cimzia side effects to last.

Get answers to some frequently asked questions about Cimzia’s side effects.

Can Cimzia affect my eyes or eyesight?

It’s possible. Rarely, Cimzia has caused eye disorders, including:

  • optic neuritis (inflammation in the nerves of the eyes)
  • retinal hemorrhage (bleeding in the back of the eye)
  • uveitis (inflammation of the middle layer of the eye)

Talk with your doctor if you’re concerned about your eye health during Cimzia treatment. And call them right away if you have eye redness, pain, blurred vision, or other vision changes.

Is eye twitching a side effect of Cimzia?

No, Cimzia shouldn’t cause eye twitching. This side effect wasn’t seen in the drug’s clinical trials.

But Cimzia can cause rare but serious nervous system problems which can include new or worsening multiple sclerosis (MS). And eye twitching is a common MS symptom.

Rarely, Cimzia has caused other eye problems. See the “Can Cimzia affect my eyes or eyesight?” FAQ for more information.

If you have new or worsening eye twitching or other vision concerns, visit your eye doctor.

Does Cimzia cause weight gain or weight loss?

No, Cimzia isn’t known to cause weight changes. Weight loss and weight gain weren’t seen in the drug’s clinical trials, but they may be symptoms of other serious side effects of Cimzia.

Weight gain due to fluid retention could be a sign of heart failure. Rarely, Cimzia has caused heart failure and made existing heart failure worse.

Sometimes, weight loss can be a symptom of a serious infection caused by Cimzia, such as hepatitis B reactivation or tuberculosis (TB).

Lastly, weight changes can be caused by the autoimmune or inflammatory condition you’re using Cimzia to treat. For example, many people with RA or Crohn’s disease experience unintentional weight loss.

If you have unexplained weight changes during your Cimzia treatment, talk with your doctor right away.

Does Cimzia cause hair loss?

Yes, it’s possible to have hair loss from Cimzia treatment. This side effect occurred in some people who had an immune system flare-up during the drug’s clinical trials. The type of hair loss reported is called alopecia totalis, which is a complete loss of hair on the head.

Studies showed that hair loss is a rare side effect of tumor necrosis factor (TNF) blocking drugs such as Cimzia.

If you’re concerned about hair loss from Cimzia, talk with your doctor. And check out these tips on how to help prevent hair loss.

Does Cimzia cause itching?

Yes, itchiness can occur with Cimzia. Itching is a symptom of various side effects of this medication, such as:

It’s important to note that skin rash and hives could also be symptoms of an allergic reaction. Allergic reactions are typically mild, but can be serious in rare cases.

The Cimzia prefilled syringe has a cap that contains latex. Allergic reactions have occurreed with Cimzia, but they are rare, and it’s unclear if any of these reactions were due to latex. If you have a latex allergy, talk with your doctor before using this form of the drug. They may suggest you use the other form of Cimzia (single-dose vial) instead.

If you have an itchy rash, hives, or irritated skin that bothers you or gets worse while using Cimzia, call your doctor. If you experience side effects that feel serious or life threatening, call 911 or your local emergency phone number to get emergency medical care.

Can Cimzia cause other side effects that affect the skin?

Yes. Severe skin reactions have been seen with Cimzia. Examples include new or worsening psoriasis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

But it’s important to note that these skin reactions weren’t seen in clinical trials of Cimzia. There have been reports of severe skin reactions in people using this medication, but it’s unclear how often this has happened or if Cimzia was the cause.

Rarely, Cimzia may also cause an inflammatory skin disorder called erythema nodosum. This condition causes painful lumps to form in the fatty layer under your skin.

To learn more about itchy skin with Cimzia, see the previous “Does Cimzia cause itching?” FAQ.

Talk with your doctor if you have questions or concerns about side effects that may affect your skin.

Learn more about some of the side effects Cimzia may cause.

Upper respiratory infection

Upper respiratory infections are a common side effect of Cimzia. These are bacterial or viral infections that affect your upper airways (the sinuses, nose, throat, and lungs). Examples include:

What might help

You can take steps to avoid germs that can cause upper respiratory infection:

  • Wash or sanitize your hands often.
  • Avoid crowds of people and people who are sick during cold and flu season.
  • Stay up to date on vaccines. (See note below for details.)
  • Eat a balanced diet and drink enough water to stay hydrated.
  • Keep all doctor and lab appointments.
  • Contact your doctor if you feel sick.
  • Take and finish antibiotics as prescribed by your doctor.

Call your doctor if you have any symptoms of an infection, even if they seem mild. Examples of infection symptoms include fever, cough, sore throat, and congestion.

Your doctor will check for infection and, if needed, prescribe treatment to clear it up. In some cases, they may stop your Cimzia treatment until your infection has cleared. But do not stop or change your Cimzia treatment unless your doctor tells you to.

Note: Because Cimzia may reduce the activity of your immune system, you should not get live vaccines during your treatment. Live vaccines contain a weakened form of a virus or bacterium and could cause infection in someone with reduced immune system activity (a weakened immune system). Examples of live vaccines include those for smallpox, chickenpox, and measles, mumps, and rubella (MMR). Before starting Cimzia, talk with your doctor about any vaccines you may need.

Urinary tract infection (UTI)

UTI is a common side effect of Cimzia. It’s a bacterial infection that affects your ureters, urethra, bladder, or kidneys.

What might help

If you have a UTI, you’ll need an antibiotic to clear the infection. Without treatment, a UTI can become serious. Contact your doctor right away if you have symptoms such as:

Hepatitis B reactivation

Hepatitis B is a serious liver infection. If you have a chronic (ongoing) hepatitis B infection or have had hepatitis B in the past, Cimzia could reactivate the virus in your body. This could cause severe illness and even lead to death.

Rarely, Cimzia has caused increased liver enzymes, which can be a sign of liver damage and hepatitis B.

What might help

Tell your doctor about any liver problems you’ve had, including a current or past hepatitis B infection. They’ll order hepatitis B tests for you before and during your treatment with Cimzia. If you test positive, they’ll decide if Cimzia is right for you.

During treatment with Cimzia, watch for any symptoms of liver damage. Call your doctor if you notice any new or worsening symptoms, such as:

  • jaundice (yellowing of your skin or the whites of your eyes)
  • weight loss or reduced appetite
  • pain in your upper-right abdomen
  • nausea or vomiting
  • weakness or extreme fatigue
  • itchiness
  • dark urine or pale stool
  • joint pain

Boxed warning: Other serious infections

Cimzia has a boxed warning about the risk of serious infection. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Cimzia can make it more difficult for your immune system to protect against germs, which puts you at greater risk of serious or fatal infections. These infections may be bacterial (such as TB), or they may be fungal, parasitic, or viral.

Your risk of serious infection with Cimzia may be higher if you:

  • live in or travel to places where these infections are common
  • use Cimzia with drugs that suppress the immune system
  • have certain other conditions, such as diabetes or HIV
  • are over the age of 65 years

What might help

Before starting Cimzia, your doctor will test you for TB and other infections, especially if you live in or have traveled to certain places.

Tell your doctor if you’re sick or have frequent or recurring infections. Before starting Cimzia, you’ll need to receive treatment to clear any infection you currently have.

During your Cimzia treatment, tell your doctor about any infection symptoms you have, such as:

  • fever or chills
  • lasting fatigue
  • cough
  • unexplained weight loss
  • body aches or malaise (an overall feeling of discomfort)

Talk with your doctor about your risk of serious infection with Cimzia.

Boxed warning: Certain cancers

Cimzia has a boxed warning about the risk of certain cancers. A boxed warning is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

Rarely, drugs such as Cimzia have been linked with certain cancers including:

Rare cancers and lymphoma have occurred in children and teens using tumor necrosis factor (TNF) blocker drugs.

What might help

Talk with your doctor about your cancer risk with Cimzia. Tell them if you’ve had cancer in the past or if you’re currently undergoing cancer treatment.

While taking Cimzia, tell your doctor right away about any new or worsening symptoms, such as:

  • changes in your skin, including new or growing marks, moles, or lesions
  • swollen glands
  • fever or chills
  • lasting fatigue
  • unexplained weight loss
  • bruising or bleeding

These symptoms could indicate cancer. If you experience any of them, call your doctor right away.

Allergic reaction

Like most drugs, Cimzia can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

  • skin rash or hives
  • itchiness
  • flushing (warmth, swelling, redness or discoloration in your skin)
  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an over-the-counter oral antihistamine, such as diphenhydramine (Benadryl), or a product you apply to your skin, such as hydrocortisone cream, to help manage your symptoms.

If your doctor confirms you’ve had a mild allergic reaction to Cimzia, they’ll decide if you should continue treatment.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

Keeping track of side effects

During Cimzia treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start a new drug or combination of treatments.

Your side effect notes can include things such as:

  • what Cimzia dosage you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how your symptoms affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Sharing notes with your doctor will help them learn more about how Cimzia affects you. They can then use this information to adjust your treatment plan if needed.

Cimzia has several warnings that may affect whether or not you can safely take this medication.

Boxed warnings

Cimzia has boxed warnings. A boxed warning is the most serious warning from the FDA. For details, see the “Side effects explained” section.

Other warnings

Cimzia may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before starting Cimzia. Factors to consider include those listed here.

  • current or past hepatitis B infection
  • heart failure
  • nervous system disorders
  • blood disorders
  • allergy to Cimzia or another TNF blocker
  • latex allergy
  • lymphoma or other cancers
  • active infection (one that’s causing symptoms)
  • pregnancy
  • breastfeeding
  • alcohol consumption

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.