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Enbrel vs. Trexall

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Enbrel (etanercept) and Trexall (methotrexate) are both used to treat rheumatoid arthritis (RA) and other autoimmune conditions, but they have some key differences. Enbrel is a biologic DMARD that you inject under the skin, while Trexall is an antimetabolite that you take by mouth. Enbrel works by blocking a protein called tumore necrosis factor (TNF) to reduce inflammation, whereas Trexall's exact mechanism for treating non-cancer conditions is not fully understood, though it is known to suppress the immune system. Enbrel is available as rand-name and biosimilar products, but it can be expensive. Trexall is available in generic form, making it more affordable. Enbrel is typically taken once a week, but Trexall's dosing can vary depending on the condition being treated. Both medications can increase your risk of infections, but Trexall also has a higher risk of causing liver damage and other serious side effects. Additionally, Enbrel is not recommended for people with a history of hepatitis B, while Trexall should be avoided during pregnancy for non-cancer conditions.

Enbrel

(etanercept)

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Methotrexate

(Trexall)

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Summary for Enbrel

Prescription only

Enbrel (etanercept) is used for certain autoimmune conditions in adults and children. This includes rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis. It works as a tumor necrosis factor (TNF) blocker to reduce inflammation in the body. Enbrel (etanercept) is given as an injection under the skin, typically once a week. It comes as vials and prefilled syringes. There are also Enbrel SureClick autoinjectors, as well as Enbrel Mini prefilled cartridges for AutoTouch autoinjectors. Side effects include infections and injection site reactions.

Indications for Enbrel

Pros and Cons for Enbrel

Pros

  • Available in many options for at-home injections (e.g., prefilled syringes, autoinjectors)
  • Can be used for children age 2 and older with certain kinds of juvenile arthritis
  • Can be used for both adults and children 4 years and up for plaque psoriasis

Cons

  • Must be given as an injection under the skin
  • Must give injection every week
  • Raises the risk of serious infections

Common Side Effects for Enbrel

  • Infection (27%)
  • Injection site reaction (15%)

Warnings for Enbrel

  • Risk of serious infections
  • Risk of cancers
  • Problems with the nervous system
  • Heart failure
  • Low blood cell counts
  • Serious allergic reaction
  • Not recommended for certain people with granulomatosis with polyangiitis (GPA)
  • Not recommended with Kineret (anakinra) or Orencia (abatacept)
  • Caution use in people with moderate or severe liver damage from alcohol use

Summary for Trexall

Prescription only

Methotrexate (Trexall) belongs to a drug class called antimetabolites. It’s used as chemotherapy at high doses to kill cancer cells and treat different cancers, such as acute lymphoblastic leukemia (ALL). At lower doses, methotrexate (Trexall) is considered a disease-modifying antirheumatic drug (DMARD) that treats certain non-cancer conditions, such as rheumatoid arthritis (RA). This medication is a tablet that you take by mouth. For most conditions, it’s taken once a week, but for some, it’s taken more often than that. Methotrexate (Trexall) side effects include mouth sores, nausea, and stomach upset.

Indications for Trexall

Cancer:

Non-cancer conditions:

Pros and Cons for Trexall

Pros

  • Taken by mouth, so a good option for people who don’t like needles
  • A non-steroidal option for autoimmune conditions (e.g., rheumatoid arthritis, psoriasis)
  • Doesn’t typically cause hair loss or weight gain

Cons

  • Might cause nausea and mouth sores
  • Can raise your risk for infection
  • Requires regular office visits and lab tests to check for serious side effects

Common Side Effects for Trexall

  • Mouth sores
  • Nausea or vomiting
  • Diarrhea
  • Stomach upset
  • Dizziness
  • Tiredness
  • Chills
  • Fever
  • Infection
  • Higher liver enzyme levels in the blood
  • Low white blood cells
  • Low platelet levels

Warnings for Trexall

  • Harm to unborn baby
  • Allergic reaction
  • Low blood cell counts
  • Damage to the digestive tract
  • Liver damage
  • Lung problems
  • Serious skin problems (including skin burns)
  • Kidney damage
  • Risk of serious side effects with dosing errors
  • Effect on folic acid levels in the body
  • Serious infections
  • Serious nervous system problems
  • Risk for new cancers
  • Tumor lysis syndrome
  • Changes to your ability to have children (infertility)
  • Higher risk for side effects if you have extra body fluid

Prices with our coupons for Enbrel vs. Trexall

Price Card Drug Icon
Enbrel1 carton / 4 sureclicks of 50mg
$3,353.53$10,463.30
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Trexall4 tablets / 10mg
$200.03$244.25
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