If you have a certain type of arthritis, your doctor may prescribe Orencia (abatacept) for you. Orencia is a prescription drug that’s used to treat the following conditions:

Orencia is a biologic drug, which means it’s made from living cells. Orencia can be given in two ways: by subcutaneous injection (an injection under the skin) or by intravenous (IV) infusion (an injection into a vein). An IV infusion is given over a period of time.

Orencia is usually a long-term treatment. For more information about it, see this in-depth article.

Like all drugs, Orencia can cause mild or serious side effects. Keep reading to learn more about the possible side effects of Orencia.

Orencia may cause mild or serious side effects in some people. The following list contains some common side effects that could occur.

The more common side effects of Orencia may include:

This list does not include all the possible side effects. If you have concerns about side effects of Orencia, talk with your doctor. They’ll only prescribe Orencia if they feel that the possible benefits outweigh your risk for side effects.

Orencia may cause mild side effects. These may include:

For details on headaches and upper respiratory infections, see the “Side effects explained” section below.

The list above doesn’t include all the mild side effects that Orencia may cause. To learn about all the possible side effects of Orencia, see the drug’s medication guide.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews the side effects. If you’d like to notify the FDA about a side effect you’ve had with Orencia, visit MedWatch.

Serious side effects of Orencia are rare, but they can occur. These may include:

For more information about the side effects in this list, see “Side effects explained” below.

* Orencia’s role in the risk of cancer is not fully known.

Below are answers to commonly asked questions about Orencia’s side effects. If you have other questions, talk with your doctor or pharmacist.

How do Orencia side effects differ when given by infusion vs. injection?

You may experience different side effects of Orencia depending on how you receive the drug.

Orencia can be given in two ways: by subcutaneous injection (an injection under the skin) or by intravenous (IV) infusion (an injection into a vein). An IV infusion is administered over time.

If you receive Orencia infusions, you’ll get your treatment at your doctor’s office. Orencia infusions last about 30 minutes each.

Side effects are more common when Orencia is given by IV infusion than by subcutaneous injection. Infusion-related side effects generally occur within 1 hour of the start of the infusion and may include:

If you receive Orencia by subcutaneous injection, you or your caregiver will be trained on how to inject the medication. If you give yourself the injections, you can inject into your thigh or certain areas of your abdomen (belly). A caregiver may inject into your upper arm.

Injection-site reactions are more common when Orencia is given by subcutaneous injection than by infusion. These side effects can be mild to moderate and may include:

  • pain
  • swelling
  • skin discoloration
  • itching

Your doctor will talk with you about which form of Orencia best fits your needs.

Does Orencia cause hair loss?

No, Orencia shouldn’t cause hair loss. In clinical studies of the drug, hair loss wasn’t a reported side effect. However, hair loss may happen in people with certain kinds of arthritis, including those that Orencia treats.

If you’re concerned about hair loss while taking Orencia, talk with your doctor. They may suggest testing to find the reason for it. They may also recommend ways to help reduce it.

Is depression a side effect of Orencia?

No, Orencia shouldn’t cause depression. This side effect wasn’t seen during clinical studies of the drug. However, people with certain kinds of arthritis, including those that Orencia treats, may be at risk for depression.

If you think you have untreated depression or another mental health condition, talk with your doctor about your treatment options.

Could using Orencia make me gain weight?

No, Orencia doesn’t cause weight gain. This side effect wasn’t seen during clinical studies of the drug.

In fact, nausea is a common side effect of Orencia, and it may reduce your appetite. This could lead to weight loss.

If you have unexplained weight changes during your Orencia treatment that concern you, talk with your doctor. They may be able to recommend tips for maintaining a healthy weight.

Does Orencia cause neurological side effects?

No, Orencia shouldn’t cause neurological (brain and nervous system) side effects. Neurological side effects weren’t seen in clinical studies of Orencia.

During your Orencia treatment, call your doctor right away if you experience seizures, changes in vision or hearing, or feelings of numbness or weakness. Your doctor may order tests to find the cause.

Are there any long-term side effects of Orencia?

Orencia, like most medications, can cause short- or long-term side effects. Serious long-term side effects are rare but may include:

Talk with your doctor if you’re concerned about long-term side effects of Orencia. And to learn more about those in this list, see the “Side effects explained” section below.

* Orencia’s role in the risk of cancer is not fully known.

In clinical studies, children with juvenile idiopathic arthritis who used Orencia were more likely to experience certain side effects than adults using the drug. These side effects included:

  • diarrhea
  • cough
  • fever
  • abdominal (belly) pain

Other side effects seen in children during clinical studies were similar to those seen in adults. To learn more, see the sections above that describe the mild and serious side effects of Orencia.

Learn more about some of the side effects that Orencia may cause.

Infection

Taking Orencia might raise your risk for an infection. This is because Orencia may make it harder for your immune system to protect against germs.

Infections seen with Orencia are usually mild. Examples include a sinus infection or the common cold. In rare cases, Orencia may cause a serious infection, such as sepsis or pneumonia.

Symptoms of an infection can include:

  • fever
  • fatigue (lack of energy)
  • cough
  • skin changes (warmth, pain, or pus)

What might help

Let your doctor know if you have any symptoms of an infection. They may want to do tests to find out what kind of infection you have. They may also prescribe medication to treat it.

If necessary, your doctor may stop the Orencia treatment until your infection is gone. This is because Orencia may make serious infections harder to treat.

One way to help prevent getting infections during your treatment is to avoid people who may be sick. Also, washing or sanitizing your hands often can help prevent the spread of infection.

You can help support your immune system and possibly lower your risk for infection by:

For other suggestions on preventing infections during your treatment, talk with your doctor.

Reactivation of hepatitis B virus

If you have hepatitis B, or have had it in the past, taking Orencia could cause the virus to reactivate (flare up and cause symptoms again).

Hepatitis B is a viral infection that causes inflammation (swelling and damage) in the liver. People diagnosed with it usually take medications to control the infection and relieve its symptoms. But in most cases, the virus doesn’t get completely cleared from the body.

Orencia can lower your immune system’s ability to protect against infections. So if the virus is already in your system, it’s more likely to reactivate during your Orencia treatment. If this happens, your hepatitis B symptoms could return or get worse.

Symptoms of hepatitis B may include:

  • a fever
  • joint pain
  • fatigue (lack of energy)
  • nausea or vomiting
  • loss of appetite
  • abdominal (belly) pain
  • dark urine
  • light-colored stools
  • jaundice (yellowing of the skin and whites of the eyes)

What might help

Before you start Orencia, your doctor may test you for hepatitis B. If you do have the infection, they probably won’t prescribe Orencia until it is treated. Your doctor may prescribe hepatitis B treatment to help relieve your symptoms.

If you notice any symptoms of hepatitis B during your treatment, tell your doctor right away so they can test for it if needed. If the result is positive, you may have to stop using Orencia until the infection has been treated.

Headache

A headache is one of the most common side effects of Orencia. In most cases, headaches caused by Orencia are mild.

What might help

If you get headaches from Orencia, there are several natural headache remedies you can try to help get rid of them. A few examples include:

  • drinking plenty of water each day
  • using a cold or warm compress
  • massaging the painful area

Over-the-counter pain relievers are another option. These include acetaminophen (Tylenol) or anti-inflammatory drugs such as ibuprofen (Motrin). If you’re not sure whether you can safely take over-the-counter pain relievers, talk with your doctor.

Possible risk of cancer

Orencia may affect how your cells function and grow, which could possibly lead to cancer. In rare cases, certain kinds of cancer were seen in people using Orencia in clinical studies.

However, it’s not known if Orencia was the cause of cancer in people using this drug. And people who received a placebo (a treatment with no active drug) in these studies had similar rates of cancer as people using Orencia.

Symptoms of cancer can vary, depending on the area of your body that’s affected. They may include:

  • changes to your senses (vision or hearing problems, feelings of numbness)
  • headaches
  • fatigue (lack of energy)
  • lumps, growths, or other changes in the appearance of your skin
  • unexplained weight loss or gain

What might help

Talk with your doctor right away if you think you have symptoms of cancer. Also, keep up with your routine blood tests and preventive screenings (like mammograms and colonoscopies). If you develop cancer, your doctor will prescribe treatment for it. They’ll also discuss whether you should continue taking Orencia.

Allergic reaction

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

  • a skin rash
  • itchiness
  • flushing (warmth, swelling, or redness 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 topical product, like hydrocortisone cream, to manage your symptoms.

If your doctor confirms that you had a mild allergic reaction to Orencia, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble 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 your Orencia treatment, consider keeping notes about any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things like:

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

Keeping notes and sharing them with your doctor will help them learn more about how Orencia affects you. Your doctor can use this information to adjust your treatment plan if needed.

Orencia 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 you use Orencia. Factors to consider include those in the list below.

Use of TNF blockers. You shouldn’t use Orencia if you’re also using a tumor necrosis factor (TNF) blocker, such as Enbrel, Humira, or Remicade. Using these drugs with Orencia can lower your immune system’s ability to protect against infections, which raises your risk for serious (and possibly life threatening) infections. Tell your doctor about all the medications you’re taking before starting Orencia.

Infection. If you currently have an infection or have had one recently, talk with your doctor before starting Orencia. You should even report small infections, such as an open sore or cut that hasn’t healed yet. If you have an infection while taking Orencia, your risk for serious side effects may be higher.

Allergic reaction. If you’ve had an allergic reaction to Orencia or any of its ingredients, you shouldn’t use this drug. Ask your doctor what other medications might be better.

Hepatitis B virus. Be sure to tell your doctor if you’ve had inflammation (swelling or damage) in your liver due to hepatitis B. Your doctor may test for the virus before you start Orencia. This is because using Orencia may cause the virus to reactivate (flare up and cause symptoms again).

Tuberculosis (TB). Before using Orencia, tell your doctor if you have TB or have had it in the past. If you develop TB while taking Orencia, your risk for serious side effects may be higher. Your doctor will likely screen you for a latent TB infection (with a resting virus that causes no symptoms) before you can start Orencia.

Vaccines (recent or upcoming). Ask your doctor if you need to get any vaccines before starting Orencia treatment. This drug can weaken your immune system, so you shouldn’t get live vaccines while using it. Live vaccines contain a weakened form of a virus or bacterium, and they could cause infection in people with weakened immune systems. Examples of live vaccines include chickenpox and measles, mumps, and rubella. Check with your doctor or pharmacist before getting any vaccines while using Orencia.

Chronic obstructive pulmonary disease (COPD). If you have COPD, Orencia could make your symptoms worse. Because of this, your doctor may need to monitor you more closely during your treatment. If you have COPD, talk with your doctor about whether Orencia is right for you.

Alcohol use and Orencia

It should be safe to drink alcohol during Orencia treatment. However, excessive alcohol use may make your arthritis worse. Also, alcohol may interact with other drugs you’re taking.

If you drink alcohol, talk with your doctor about how much is safe, considering your condition and treatment plan.

Pregnancy and breastfeeding while using Orencia

It isn’t known if Orencia is safe to use during pregnancy. Before starting the treatment, talk with your doctor if you’re pregnant or planning to become pregnant. They’ll discuss your options with you.

If you do use Orencia during pregnancy, consider joining the company’s pregnancy registry. This gathers information about how Orencia may affect pregnancy. To learn more or sign up, call 877-311-8972.

It also isn’t known if Orencia is safe to use while breastfeeding. If you’re currently breastfeeding or plan to breastfeed during your treatment, talk with your doctor about the risks and benefits of using Orencia.

Orencia can be an effective treatment option for rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. However, this drug may cause side effects in some people. The most common side effects of Orencia are usually mild, but serious side effects can occur. If you have questions about the side effects of Orencia, talk with your doctor or pharmacist.

Here are some questions to get your discussion with your doctor started:

  • What other steps should I take to prevent infection during my Orencia treatment?
  • Will Orencia put me at risk for COPD?
  • What tests do I need before I start Orencia?

If you use Orencia to treat rheumatoid arthritis, subscribe to our rheumatoid arthritis newsletter for pain management tips, treatment information, and more.

Q:

Is it safe for me to receive vaccines, such as the flu shot or COVID-19 vaccine, while using Orencia?

Anonymous patient

A:

Yes, it should be safe for you to get the flu shot and either of the currently available COVID-19 vaccines (Pfizer-BioNTech or Moderna). That’s because they’re not live vaccines, so they won’t raise your risk for infection. (Live vaccines contain a weakened form of the virus or bacteria.)

In some cases, if you get non-live vaccines during your Orencia treatment, they may not be as effective. However, you may still benefit from these vaccines even if you’re already using Orencia. Talk with your doctor to learn more.

You shouldn’t get any live vaccines during your Orencia treatment. They could cause infections in people with a weakened immune system, such as someone using Orencia. Examples of live vaccines include chickenpox, measles, mumps, and rubella, and the intranasal (nasal spray) version of the flu vaccine.

Check with your doctor or pharmacist before getting any vaccines while using Orencia.

Dena Westphalen, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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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 another 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.