4 Enbrel Interactions You Should Know

Enbrel (etanercept) is an injectable medication that’s approved to treat various autoimmune conditions, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis. These conditions happen when your immune system becomes overactive and starts attacking your body. Enbrel helps stop the inflammation caused by an overactive immune system.

Enbrel doesn’t interact with very many medications, but there are a few Enbrel interactions you should know about. Below, we’ll discuss four of the most notable interactions. This isn’t a complete list, so make sure to review your current medication list with your healthcare provider or pharmacist before starting Enbrel. They can check for any other potential interactions.

1. Medications that weaken your immune system

Enbrel works by blocking a protein called tumor necrosis factor (TNF). In conditions where your immune system is overactive, high levels of TNF can cause inflammation and pain. Enbrel blocks TNF to reduce these symptoms.  

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While blocking TNF relieves your symptoms, it can also weaken your immune system. So your immune system can’t fight off germs as well as it could before starting Enbrel. This can increase your risk of infections.

Other medications can also weaken your immune system. If you take them along with Enbrel , you have a higher risk of developing infections. These infections can be serious or even life-threatening in some cases.

Medications that can weaken your immune system include:

• Methotrexate

• Immune-modulating biologic medications like abatacept (Orencia) or anakinra (Kineret)

• Corticosteroids like prednisone or dexamethasone

• Azathioprine (Imuran)

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Sometimes, your healthcare provider may want you to take Enbrel with another medication that can weaken your immune system. That’s not uncommon, and may be preferred for your specific condition. 

Make sure to pay attention to your body, and contact your healthcare provider if you develop any signs or symptoms of an infection. These include:

• Fever

• Night sweats

• Trouble breathing

• Cough that won’t go away

• Loss of appetite

• Feeling tired

2. Live vaccines

After you receive a vaccine, your immune system responds by building antibodies that will protect you against future infection. There are two main types of vaccines — inactivated and live. In general, inactivated vaccines are safe for those with a weakened immune system. But it’s best to avoid live vaccines while taking Enbrel and for 4 weeks after stopping it.

This is because live vaccines contain a living, weaker version of a bacteria or virus. Enbrel weakens your immune system, so your body might not be able to fight off the infection from a live vaccine the way it normally would. This could allow the infection to spread.

Examples of live vaccines include:

• Yellow fever

• Measles, mumps, rubella (MMR)

• Cholera

• Nasal influenza mist (FluMist)

• Rotavirus

• Varicella (chicken pox)

• Smallpox

• Oral typhoid

It’s fine to receive a live vaccine before you start taking Enbrel, so it’s a good idea to make sure all of your vaccines are up to date before you do. If you have concerns about receiving a vaccine while taking Enbrel, talk to your pharmacist or healthcare provider. They’ll be able to tell you if a vaccine is safe for you or not.

3. Cyclophosphamide

Cyclophosphamide (Cytoxan) is a medication used to treat certain types of cancer. When taken with Enbrel, there’s a higher risk of cancerous tumors.

It’s recommended to avoid Enbrel if you’re receiving cyclophosphamide treatment.

4. Medications that lower blood glucose

Enbrel may lower blood glucose (sugar) levels in some people. If you’re living with diabetes, you may already be taking a medication that lowers your blood glucose. This includes medications like insulin, metformin, and glipizide (Glucotrol). If you take Enbrel with these medications, your blood glucose may drop too low. This is called hypoglycemia, and it can be serious if left untreated.

Symptoms of hypoglycemia to be on the lookout for include:

• Confusion

• Shaking

• Dizziness

• Hunger

• Feeling weak

• Sweating

• Fast heartbeat

It’s a good idea to keep glucose tablets or gel on hand, as you can use them to treat low blood glucose when it happens. If you’re noticing low blood glucose levels after starting Enbrel, make sure to let your healthcare provider know. They may want to make changes to your diabetes medication dosage.

When should I contact my healthcare provider about an Enbrel interaction?

If you’re noticing side effects that you think might be related to a drug interaction with Enbrel, let your healthcare provider know. This includes symptoms of an infection, such as a fever or persistent cough. Or symptoms of low blood sugar, such as shaking and sweating. Your provider can help decide on the best course of action.

Be sure your pharmacist and healthcare provider have an updated list of medications you take. Don’t forget to include any over-the-counter medications or supplements as well. This will help your provider look for any possible interactions before they happen.

If at any point you’re experiencing symptoms that are severe, don’t hesitate to call 911 or go to the nearest urgent care.

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Written by:

Emilie White, PharmD

Emilie White is a clinical pharmacist with over a decade of hospital pharmacy experience. Her professional areas of interest include critical care as well as infectious and autoimmune diseases.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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