Generic Name: etanercept, Injectable Solution

Generic Name:

etanercept, Injectable Solution

Enbrel

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SECTION 1 of 5

Highlights for etanercept

Injectable Solution
1

Etanercept is an injected drug used to treat rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaques psoriasis.

2

Your dose of etanercept depends on what disease you’re treating. For adults, the dose may be 50 mg injected under the skin once a week.

3

Etanercept can lower your immune system and put you at risk for serious infections.

4

Common side effects include injection site reactions, upper respiratory infections, and headaches.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Risk of infection. Etanercept can lower the ability of your immune system to fight infections. Some people develop serious infections while taking etanercept. These include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria. Some people have died from these infections.

Your doctor may test you for TB before starting etanercept. They may monitor you closely for symptoms of TB during treatment, even if you tested negative for TB.

Your doctor may check you for symptoms of any type of infection before, during, and after your treatment with etanercept. Don’t start taking etanercept if you have any kind of infection, unless your doctor says it’s okay.

Risk of cancer. There have been cases of unusual cancers in people who started using this type of medication when they were younger than 18 years old.

Etanercept may increase the risk of lymphoma or other cancers. People with rheumatoid arthritis or psoriasis, especially those with very active disease, may be more likely to get lymphoma.

Hepatitis B warning

If you carry the hepatitis B virus, it can become active when you use etanercept. Your doctor may do blood tests before you start treatment, while you’re using etanercept, and for several months after you stop.

Heart failure warning

Heart failure is one of the serious side effects that can occur with this medication. It can cause new heart failure or make existing heart failure worse. Call your doctor right away if you get new or worsening symptoms of heart failure while taking etanercept. These include shortness of breath, swelling of your ankles or feet, and sudden weight gain.

Diabetes warning

This medication may affect your body’s ability to control blood sugar. If you’re taking etanercept with diabetes medications, your doctor may adjust your diabetes medications. Tell your doctor if you have diabetes.

Drug Features

Etanercept is a self-injected prescription medication. It comes in a variety of injected forms, including single-use prefilled syringe, autoinjector, and multiple-use vial.

This drug may be used as part of a combination therapy. That means you may need to take it with other drugs.

Why It's Used

Etanercept is used to treat:

  • rheumatoid arthritis
  • severe juvenile rheumatoid arthritis in children aged 2 years and older
  • psoriatic arthritis
  • ankylosing spondylitis
  • moderate to severe plaque psoriasis when you can’t use other therapies

How It Works

Etanercept works to block a substance in your body that causes inflammation due to an immune system response. It belongs to a class of drugs called tumor necrosis factor (TNF) blockers.

TNF is normally found in your body and causes inflammation. However, if you have a disease that causes your body to make too much TNF, this can result in too much inflammation, which can be harmful.  Etanercept works to lower the levels of TNF in your body, which helps to control excess inflammation.

SECTION 2 of 5

etanercept Side Effects

Injectable Solution

Most Common Side Effects

The most common side effects that occur with etanercept include:

  • injection site reactions, such as:

    • redness
    • swelling
    • itching
    • pain
  • upper respiratory infections

  • headaches

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  • infections. Symptoms may include:

    • cough that doesn’t go away
    • fever
    • unexplained weight loss
    • sweats or chills
    • blood in your phlegm
    • pain or burning with urination
    • diarrhea or stomach pain
    • skin sores or red, painful areas on your skin
    • loss of body fat and muscle
  • hepatitis B infection. Symptoms may include:

    • muscle aches
    • clay-colored stools
    • feeling very tired
    • fever
    • dark urine
    • chills
    • yellowing of your skin or whites of your eyes
    • stomach pain
    • little or no appetite
    • skin rash
    • vomiting
  • nervous system problems. Symptoms may include:

    • numbness or tingling in any part of your body
    • vision changes
    • weakness in your arms and legs
    • dizziness
  • blood problems. Symptoms may include:

    • fever
    • bruising or bleeding very easily
    • looking pale
  • heart failure. Symptoms may include: 

    • shortness of breath
    • swelling of your lower legs or feet
    • sudden weight gain
  • psoriasis. Symptoms may include:

    • red scaly patches
    • raised bumps that may be filled with pus
  • allergic reactions. Symptoms may include:

    • severe rash
    • swollen face
    • trouble breathing
  • lupus-like syndrome. Symptoms may include:

    • rash on your face and arms that gets worse in the sun
  • liver problems. Symptoms may include:

    • excessive tiredness
    • yellowing of your skin or whites of your eyes
    • poor appetite or vomiting
    • pain on the right side of your stomach
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Etanercept does not cause drowsiness.

Injection site reactions are common after an injected dose. Call your doctor right away if you have an injection site reaction that doesn’t go away within a few days or gets worse.

Mild side effects may go away within a few days or a couple of weeks. Talk to your doctor or pharmacist if they’re more severe or don’t go away.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

etanercept May Interact with Other Medications

Injectable Solution

Etanercept can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Medications That Might Interact with This Drug

Biologic drugs

These drugs are created from natural sources. They may include vaccines, gene therapy, and blood components. Etanercept is a biologic drug. Other examples are:

  • abatacept (Orencia)
  • anakinra (Kineret)
  • rilonacept (Arcalyst)

You may have a higher chance of getting a serious infection if you take etanercept with other biologics.

Live vaccines

Examples are:

  • nasal spray flu vaccine
  • measles, mumps, and rubella vaccine
  • chickenpox vaccine

Don’t receive a live vaccine while taking etanercept and for at least 3 months after stopping the medication. The vaccine may not fully protect you from disease while you’re taking etanercept.

Cancer drug
  • cyclophosphamide

Don’t take cyclophosphamide while using etanercept. Combining these drugs may increase your risk of certain types of cancers.

Ulcerative colitis and rheumatoid arthritis drug
  • sulfasalazine 

Tell your doctor if you’re currently taking sulfasalazine or have taken it recently. Combining these drugs may cause a decrease in your white blood cell count.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with infections

Tell your doctor if you have any kind of infection. These include small infections, such as an open cut or sore; or an infection that’s in your whole body, such as the flu. If you have an infection when taking etanercept, you may have a higher risk of serious side effects.

People with tuberculosis

If you previously had a tuberculosis (TB) infection treated, your TB infection could come back while you are taking this medication.  Be sure to contact your doctor right away if the symptoms you had during your TB infection return.

People with hepatitis B virus infection

If you carry the hepatitis B virus, it can become active while you use etanercept and damage your liver. Your doctor may do blood tests before you start treatment, while you’re using etanercept, and for several months after you stop.

People with nervous system problems

Etanercept can make symptoms of some nervous system problems worse. Use etanercept with caution if you have: 

  • transverse myelitis
  • optic neuritis
  • multiple sclerosis
  • Guillain-Barre syndrome

People with heart failure

This medication can make heart failure worse. Call your doctor right away if you have symptoms of worsening heart failure. These include shortness of breath, swelling of your ankles or feet, and sudden weight gain.

People with diabetes

Etanercept may impact your body’s ability to regulate blood sugar. If you have diabetes, your doctor may need to adjust your diabetes medication while taking etanercept. Tell your doctor if you have a history of diabetes.

People with latex allergy

Tell your doctor if you are allergic to rubber or latex. The inner needle cover on the prefilled syringe and the needle cap on the prefilled autoinjectors contain latex. Don’t handle the needle cover if you’re allergic to latex.

Pregnant women

Etanercept is a pregnancy category B drug. That means two things: 

  1. Studies of the drug in pregnant animals have not shown risk to the fetus.
  2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Etanercept should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are nursing

Data suggests this medication is present in low amounts in human milk and can be passed to a breastfed infant. You and your doctor may decide whether you’ll take etanercept or breastfeed.

For Seniors

If you’re over the age of 65 years, you may be at higher risk for a serious infection or certain types of cancers while taking etanercept.

For Children

Etanercept hasn’t been studied in children younger than 2 years old with juvenile rheumatoid arthritis. The safety and effectiveness of etanercept in children with psoriasis isn’t known.

Syringes and needles are used to inject this medicine. Keep them away from children. Don’t throw out individual needles into trashcans or recycling bins. Never flush them down the toilet. Ask your pharmacist for a needle clipper and container for throwing away used needles and syringes. Your community may have a program for disposing needles and syringes. If you’re putting the container in the trash, label it “do not recycle”.

When to call the doctor

Call your doctor right away if you:

  • have an infection, a history of infections that keep coming back, or other problems that can increase your risk of infections.
  • are scheduled to receive any vaccines. People using etanercept shouldn’t receive live vaccines.

Allergies

Etanercept can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Tell your doctor if you’re allergic to rubber or latex. The inner needle cover on the prefilled syringe and the needle cap on prefilled autoinjectors contain latex. Don’t handle the needle if you’re allergic.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

SECTION 4 of 5

How to Take etanercept (Dosage)

Injectable Solution

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Rheumatoid arthritis
Form: Single-use prefilled syringe
Strengths:
  • 50 mg: 0.98 mL of a 50 mg/ml solution
  • 25 mg: 0.51 mL of a 50 mg/mL solution
Form: SureClick autoinjector
Strengths: 50 mg: 0.98 mL of a 50 mg/mL solution
Form: Multiple-use vial
Strengths: 25 mg
Adult Dosage (ages 18 years and older)

The dose is 50 mg once per week.

Juvenile rheumatoid arthritis
Form: Single-use prefilled syringe
Strengths:
  • 50 mg: 0.98 mL of a 50 mg/ml solution
  • 25 mg: 0.51 mL of a 50 mg/mL solution
Form: SureClick autoinjector
Strengths: 50 mg: 0.98 mL of a 50 mg/mL solution
Form: Multiple-use vial
Strengths: 25 mg
Child Dosage (ages 2-17 years)
  • The dose is based on your child’s weight.
  • The dose for children weighing 138 pounds or more is 50 mg once per week.
  • The dose for children who weigh less than 138 pounds is 0.8 mg per 2.2 pounds of bodyweight once per week.
Child Dosage (ages 0-1 year)

A safe and effective dose hasn’t been established for this age group.

Psoriatic arthritis
Form: Single-use prefilled syringe
Strengths:
  • 50 mg: 0.98 mL of a 50 mg/ml solution
  • 25 mg: 0.51 mL of a 50 mg/mL solution
Form: SureClick autoinjector
Strengths: 50 mg: 0.98 mL of a 50 mg/mL solution
Form: Multiple-use vial
Strengths: 25 mg
Adult Dosage (ages 18 years and older)

The dose is 50 mg once per week.

Child Dosage (ages 0-17 years)

A safe and effective dose hasn’t been established for this age group.

Ankylosing spondylitis
Form: Single-use prefilled syringe
Strengths:
  • 50 mg: 0.98 mL of a 50 mg/ml solution
  • 25 mg: 0.51 mL of a 50 mg/mL solution
Form: SureClick autoinjector
Strengths: 50 mg: 0.98 mL of a 50 mg/mL solution
Form: Multiple-use vial
Strengths: 25 mg
Adult Dosage (ages 18 years and older)

The dose is 50 mg once per week.

Child Dosage (ages 0-17 years)

A safe and effective dose hasn’t been established for this age group.

Plaque psoriasis
Form: Single-use prefilled syringe
Strengths:
  • 50 mg: 0.98 mL of a 50 mg/ml solution
  • 25 mg: 0.51 mL of a 50 mg/mL solution
Form: SureClick autoinjector
Strengths: 50 mg: 0.98 mL of a 50 mg/mL solution
Form: Multiple-use vial
Strengths: 25 mg
Adult Dosage (ages 18 years and older)
  • The starting dose is 50 mg taken twice per week for 3 months.
  • The maintenance dose is 50 mg once per week.
Child Dosage (ages 0-17 years)

A safe and effective dose hasn’t been established for this age group.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Etanercept comes with risks if you don’t take it as prescribed.

If You Don’t Take It at All

If you don’t take etanercept, your condition won’t improve and it could get worse.

If You Stop Taking It

Your condition may get worse if you stop taking etanercept.

If You Take Too Much

No serious side effects have been seen in people who have taken up to twice the recommended dose. But you should call your doctor if you’ve taken too much or think you’ve taken too much.

What to Do If You Miss a Dose

This medicine is used once a week. If you miss a dose, take it as soon as you can. Never try to catch up by giving two injections at the same time. This could result in toxic side effects. If you’re not sure when to take your next dose, contact your doctor.

How to Tell If the Drug Is Working

You may be able to tell if this medication is working for arthritis and ankylosing spondylitis if you have less joint pain and are able to move better.

You may be able to tell if it’s working for plaque psoriasis if your skin lesions get smaller and your skin improves.

This is a long-term medication.

Important Considerations for Taking Etanercept

Store etanercept in the refrigerator

Keep it in temperatures from 36–46°F (2.2–7.7°C). If you can’t refrigerate it, you can store it in temperatures up to 77°F (25°C) for up to 14 days.

Once you’ve stored the syringe at room temperature, don’t put it back into the refrigerator. If you don’t use it within 14 days at room temperature, throw it away properly. Mixed etanercept powder should be used right away or kept in the refrigerator for up to 14 days.

Don’t freeze etanercept. Don’t use it if it was frozen and then thawed. Make sure not to shake the medication.

Keep it in its original carton until you use it to protect it from light. Keep it away from extreme heat or cold. Don’t use it after the expiration date printed on the label.

Disposal:

  • Don’t throw used needles or syringes away in your household trash.
  • Put them in a FDA-approved needle disposal container.
  • When the container is almost full, follow your community guidelines for the right way to throw it away.
  • Don’t throw the container in your household trash or recycle it.
  • Your state may have local laws on how to throw away needles and syringes.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled box with you when traveling.
  • This medication normally needs to be refrigerated. When traveling, you can store it at temperatures up to 77°F (25°C) for up to 14 days.
  • Needles and syringes need to be used to take this medicine. Check for special rules about traveling with needles and syringes.
  • Be sure you have enough medication before you start your trip. It may be difficult to get this medication at a pharmacy while you’re traveling.

Self-Management

If your healthcare provider decides that you or a caregiver can give your injections at home, you or your caregiver should receive training on the right way to do the injection. Don’t try to inject etanercept until you’ve been shown the right way to give the injections by your healthcare provider.

There are 3 different ways to administer etanercept. Your doctor or nurse will tell you which one you’re using and show you how to give it.

Single-use prefilled syringe:

  • Carefully take it out of the box. Make sure not to shake it.
  • Don’t use it if the needle cover is missing.
  • Leave the prefilled syringe at room temperature for about 15–30 minutes before injecting. Don’t warm it up any other way.
  • Hold the prefilled syringe with the covered needle pointing down. If you see bubbles in it, very gently tap the syringe so the bubbles rise to the top.
  • Turn the syringe so the purple horizontal lines on the barrel are facing you. Check to see if the amount of liquid in the syringe falls between the purple lines. The top of the liquid might be curved. If the liquid isn’t in that range, don’t use the syringe.
  • Gather your alcohol swab, a cotton ball or gauze, and a safe needle disposal container.
  • Wash your hands with soap and warm water.
  • Make sure the solution in the prefilled syringe is clear and colorless. White particles are okay. Don’t use the solution if it’s cloudy or discolored.

Sure Click autoinjector:

  • Remove one autoinjector from the carton. Make sure not to shake it.
  • If you drop it onto a hard surface, don’t use it. Use a new one instead.
  • Do NOT use the autoinjector if the white needle cap is missing or not securely attached.
  • Look at etanercept through the inspection window. It should be clear and colorless or may have small white particles. Don’t use it if it looks cloudy, discolored, or has large lumps, flakes or colored particles.
  • Leave the autoinjector at room temperature for about 15–30 minutes before injecting. Leave the white cap on during this time. Don’t warm it up any other way.
  • Wash your hands well.
  • Don’t remove the white needle cap from the autoinjector until you’re ready to inject.

Multiple-use vials:

  • Check to make sure the dose tray has these four items:
    • one prefilled diluent syringe containing 1 mL of diluent (liquid) with attached adapter and twist-off cap
    • one plunger
    • one 27-gauge ½ inch needle in hard plastic cover
    • one vial adapter
  • Leave the dose tray at room temperature for about 15–30 minutes before injecting.
  • Wash your hands with soap and warm water.
  • Peel the paper seal off the dose tray and remove all the items.
  • Inspect the volume of liquid in the syringe with the twist-off cap pointing down. Use the unit markings on the side of the syringe to make sure there’s at least 1 mL of liquid in the syringe. If the level of liquid is below the 1 mL mark, don’t use it.
  • Don’t use it if the twist-off cap is missing or not securely attached.

To inject this drug you will need:

  • alcohol wipes
  • dry sterile gauze or tissue
  • a puncture-resistant needle disposal container

Clinical Monitoring

Tuberculosis (TB) test: Your doctor may test you for TB before starting etanercept and check you closely for signs and symptoms of TB during treatment.

Hepatitis B virus test: If you carry the hepatitis B virus, your doctor may do blood tests before you start treatment, while you’re using etanercept, and for several months after you stop.

Hidden Costs

Besides the medicine, you’ll need to buy sterile alcohol wipes, gauze, and a container for safe disposal of needles and syringes.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for etanercept.

Are There Any Alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

SECTION 5 of 5

How Much Does etanercept Cost?

Injectable Solution
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Lowest price for etanercept

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Publix $3,254.13
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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on May 26, 2015

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.

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