etanercept
Enbrel (etanercept) is a weekly injection used for many autoimmune conditions. Currently, it's only available as a brand-name product and can be expensive.
What is Enbrel (etanercept)?
What is Enbrel (etanercept) used for?
- Rheumatoid arthritis (RA)
- Plaque psoriasis (PsO) and psoriatic arthritis (PsA)
- Ankylosing spondylitis (AS)
- Childhood arthritis (polyarticular juvenile idiopathic arthritis, JIA)
How Enbrel (etanercept) works
Enbrel (etanercept) is a monoclonal antibody. It binds to a protein called TNF and blocks inflammation to help with symptoms of certain types of arthritis and skin conditions.
Drug facts
Side effects of Enbrel (etanercept)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Infection (including common cold/flu) (50%)
- Injection site reaction (37%)
- Diarrhea (8%)
Less Common Side Effects
- Rash or hives
- Itching
- Fever
Enbrel (etanercept) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infections: High fever, difficulty breathing, cough that won't go away, night sweats, confusion
- Allergic reactions: Difficulty breathing, face swelling, fast heartbeat, severe rash
The following Enbrel (etanercept) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Congestion in the chest
fast heartbeat
frequent or painful urination
itching, pain, redness, or swelling on the skin
joint or muscle stiffness, tightness, or rigidity
stomach discomfort or pain
Incidence not known
Bladder pain
blistering, peeling, or loosening of the skin
bloody, black, or tarry stools
blue-yellow color blindness
blurred vision
chest discomfort or pain
cloudy or bloody urine
confusion
dark urine
decreased urine output
decreased vision
difficult, irregular, troubled, or labored breathing (or difficulty with breathing gets worse)
difficulty with moving
dilated neck veins
double vision
extreme fatigue
feeling sad or empty
fruit-like breath odor
general feeling of discomfort, illness, or weakness
generalized pain
inability to move the arms, legs, or facial muscles
indigestion
irregular heartbeat
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lightheadedness
loss of consciousness
muscle tenderness
pain or discomfort in the arms, jaw, back, or neck
pain, redness, or swelling in the arm or leg
problems with bowel or bladder function
red skin lesions, often with a purple center
red, scaling, or crusted skin
seizures
severe and continuing nausea
severe numbness, especially on one side of the face or body
sores, ulcers, or white spots on the lips or in the mouth
swelling of the face, fingers, feet, or lower legs
tenderness
tightness in the chest
trouble concentrating
trouble sleeping
unexplained weight loss
unusual bleeding or bruising
unusual tiredness or weakness
vomiting of blood or material that looks like coffee grounds
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Loss of energy or weakness
pain or burning in the throat
redness or itching, pain, or swelling at the injection site (under the skin)
runny or stuffy nose
stomach pain
vomiting
Less common
Bumps below the skin
hair loss or thinning
irritation or soreness of the mouth
itching, redness, or tearing of the eye
skin rash
Incidence not known
Altered sense of taste
burning, crawling, itching, numb, prickling, “pins and needles”, or tingling feelings
feeling faint, dizzy, or lightheaded
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
loss of appetite
sweating
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Enbrel (etanercept)
Pros
- Available in a prefilled syringe or autoinjector for easy-at-home injections
- Can be used in children age 2 and older for certain indications (JIA)
- Can be kept at room temperature for up to 14 days
- Manufacturer offers copay card for people with commercial insurance
- Not many side effects other than infection and redness and irritation at the injection site
Cons
- Raises risk of serious infections
- Can cause the hepatitis B virus to reappear if you have a history of infection
- Lymphoma and other cancers have been reported in people taking Enbrel (etanercept)
- Available only as a brand medication so it can be expensive and isn't always covered by insurance
- Needs to be given every week, unlike Humira (adalimumab), which is given every other week
Pharmacist tips for Enbrel (etanercept)
- Don't try to inject Enbrel (etanercept) unless you've been properly trained. Follow up with your healthcare provider or pharmacist if you have any questions.
- This medication needs to be refrigerated. Don't freeze it. If you're traveling or don't have access to a fridge, the medication can stay at room temperature for 14 days. After 14 days, it should be thrown away. Don't put it back in the fridge after it's been left at room temperature.
- Take your pen, syringe, or vial out of the fridge 15 to 30 minutes before you plan on doing your injection. Injecting cold medication can cause more discomfort.
- This medication is clear and colorless. Always check the solution before each injection. Don't use it if it's cloudy, discolored, or has particles. Don't shake the medication.
- Let your provider know if you have a latex allergy. The medication might have latex in the cap or needle cover.
- It's safe to get vaccines while you're taking Enbrel (etanercept), but avoid getting live vaccines, such as the nasal spray flu vaccine.
Common questions about Enbrel (etanercept)
Enbrel (etanercept) and Humira (adalimumab) are both monoclonal antibodies and work very similarly. They are both used to treat the same conditions, but Humira (adalimumab) can also be used for Crohn's disease, ulcerative colitis, a skin condition called hidradenitis suppurativa, and an eye condition called uveitis. The medications have different doses and side effects, but both are given as an injection under the skin. See the bottom of this page for a full side-by-side comparison.
Enbrel (etanercept) can raise your risk of infections and other serious conditions. In some cases, your provider might tell you to stop taking Enbrel (etanercept) if they think the risk outweighs the possible benefit. Make sure you keep your regular appointments and lab visits so they can monitor your health and assess your risk.
While drinking in moderation might be okay while you're taking Enbrel (etanercept), heavy alcohol use can damage your liver. Also, taking Enbrel (etanercept) might put you at higher risk for death if you have liver damage related to alcohol use. It’s best to check with your provider before you combine alcohol and Enbrel (etanercept).
Enbrel (etanercept) can be injected into the abdomen, thigh, and outer area of the upper arm. The vials, syringes, and autoinjectors are all slightly different, so make sure you receive proper training before trying any new device. After you've had your training, you can always check the instructions for use if you forget your injection directions.
Some people have mild pain or discomfort (e.g., itching, swelling, bruising) with Enbrel (etanercept) injections. For the most part, the pain and discomfort do not keep people from using the medication. Letting the solution warm up to room temperature before you inject the medication can decrease the pain.
Both Eticovo (etanercept) and Enbrel (etanercept) are biologics, which means that they are made from living cells. Eticovo (etanercept) is considered as a biosimilar to Enbrel (etanercept). This means that both medications are highly similar, with studies showing similarities in safety and efficacy. Although Eticovo (etanercept) and Enbrel (etanercept) are not the same medication, they are similar enough to be used interchangeably. Currently, Eticovo (etanercept) has been FDA approved, but is not yet available on the market due to legal problems.
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Risks and warnings for Enbrel (etanercept)
Enbrel (etanercept) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious infections
- Risk factors: Taking other immunosuppressing medications | Older adults | Active, chronic, or recurrent infection | Comorbidities
Enbrel (etanercept) can raise your risk of serious or life-threatening infections. Serious infections are more common in older adults, people taking other immune-suppressing medications, and people with other chronic conditions. Make sure your provider knows your past medical history before starting Enbrel (etanercept), especially if you've ever had tuberculosis or hepatitis B. They will assess your risk before starting the medication, as certain infections can reappear after starting Enbrel (etanercept). If you develop any symptoms of an infection, such as fever, difficulty breathing, a cough that won't go away, night sweats, or confusion, contact your provider right away. Don't take Enbrel (etanercept) if you have an active infection.
Cancers
- Risk factors: Taking other immunosuppressants at the same time as Enbrel (etanercept) | History of cancer | COPD with significant smoking history
In clinical trials, there was a higher number of malignancies and cancers, such as lymphatic cancer (lymphoma), blood cancer (leukemia), and skin cancer (melanoma), in people taking Enbrel (etanercept) when compared to people who were not taking the medication. There are also reports of children and teens using medications like Enbrel (etanercept) having lymphomas and other potentially fatal cancers. Your provider will assess your risk before starting Enbrel (etanercept) and monitor you while you're taking the medication.
Nervous system effects
- Risk factors: Current or recently acquired neurologic condition
Although rare, Enbrel (etanercept) can cause new nervous system conditions such as multiple sclerosis and Guillain-Barré syndrome. If you currently have nerve problems, let your provider know. They'll want to monitor you closely while your taking Enbrel (etanercept) since it can make them worse. Let your provider know right away if you notice numbness or tingling, weakness in arms or legs, vision problems, or dizziness. Nerve problems can become serious and permanent. It's best to have it evaluated by a healthcare provider as soon as possible.
Heart failure
People taking Enbrel (etanercept) have had new or worsening cases of heart failure. Let your provider know if you currently have heart failure. They will weigh the benefits and risks to determine if Enbrel (etanercept) is right for you.
Bleeding and infections
It's rare, but there have been reports of people having a lower number of blood cells while taking Enbrel (etanercept). This can lower your body's ability to fight infections and put you at risk for bleeding. Contact your provider if you develop a fever that doesn't go away, easy bruising, pale skin, or bleeding.
Enbrel (etanercept) dosage
Typical dosage for Enbrel (etanercept)
Adults
- Rheumatoid and psoriatic arthritis, ankylosing spondylitis: The typical dose is 50 mg injected under the skin once a week.
- Plaque psoriasis: The starting dose is 50 mg injected under the skin twice a week for 3 months. Afterwards, your provider will lower your dose to 50 mg per week.
Children
Plaque psoriasis and polyarticular juvenile idiopathic arthritis: The dose will be based on the child's weight.
- 63 kg (138 lbs) or more: The typical dose is 50 mg injected under the skin once per week.
- Less than 63 kg (138 lbs): The typical dose is 0.8 mg/kg injected under the skin once per week.
Interactions between Enbrel (etanercept) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abatacept
- Adenovirus Vaccine
- Anakinra
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Cyclophosphamide
- Dengue Tetravalent Vaccine, Live
- Infliximab
- Influenza Virus Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Rilonacept
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Vaccine
- Tofacitinib
- Typhoid Vaccine, Live
- Varicella Virus Vaccine, Live
- Yellow Fever Vaccine
- Zoster Vaccine, Live
How much does Enbrel (etanercept) cost?
$852.17
Enbrel (etanercept) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Enbrel (etanercept) will not be safe for you to take.
- Serious infection in the blood (sepsis)
What are alternatives to Enbrel (etanercept)?
