7 Orencia Side Effects and How to Manage Them

Orencia (abatacept) is a valuable resource for people managing a variety of autoimmune conditions. This injectable biologic medication is FDA approved to treat rheumatoid arthritis (RA), polyarticular juvenile idiopathic arthritis, and psoriatic arthritis. It can even help prevent acute graft versus host disease from a bone marrow or stem cell transplant. 

Orencia is a versatile treatment because of how it affects T cells, a type of immune system cell. While it’s beneficial for many people, like with all medications, it’s also linked to certain risks and side effects. Some of these side effects can be mitigated with at-home management strategies, while others warrant prompt attention from a healthcare provider.

Below, we’ll review seven notable Orencia side effects and how to manage them.

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Orencia side effects at a glance

Orencia is most often associated with relatively mild side effects. These include:

• Headache

• Upper respiratory tract infections, which usually resemble the common cold

• Nausea

• Elevated blood pressure

Rare but serious Orencia side effects include:

• Serious infections, sometimes resulting in hospitalization or death

• Hepatitis B reactivation

• COPD-related breathing problems

• Allergic reactions

Let’s review some of these side effects in more detail.

1. Headache

Headache is the most common side effect people experienced with Orencia in clinical studies. Approximately 20% of people in clinical studies of the medication as a treatment for RA had headaches.

There are a few things you can try if you develop headaches while taking Orencia. Over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), can help in the short term. But it’s also important to prioritize your water intake, maintain optimal sleep hygiene, and avoid excessive alcohol consumption.

2. Cold-like symptoms

Some people in clinical studies of Orencia developed upper respiratory tract infections. This included illnesses such as the common cold, sinus infections, and more. 

Upper respiratory tract infections can lead to symptoms such as:

• Fever

• Fatigue

• Stuffy nose

• Sore throat

• Cough

If you experience any of these symptoms, it’s a good idea to reach out to your healthcare provider. They can tell you if you can self-treat your infection with OTC medications or home remedies, or if you need further intervention to prevent more serious issues.

If your provider says that OTC medications should be sufficient, there are several options to choose from. Acetaminophen and ibuprofen can help reduce a fever. A cough suppressant like dextromethorphan (Delsym) may be useful if you have a dry, persistent cough. And a decongestant like pseudoephedrine (Sudafed) can treat a stuffy nose. Your pharmacist can make more specific recommendations, too.

3. Dizziness

Some people experience mild dizziness with Orencia. Though, this may or may not be related to the medication. Dizziness is a complex symptom that has many possible causes.

If you’re feeling dizzy, sit or lie down in a safe location, as dizziness can place you at a greater risk of fall or injury. (This risk is higher if you’re taking other medications that can also cause dizziness or drowsiness.) Don’t drive or perform other attention-oriented tasks if you’re feeling dizzy, either.

Let your healthcare provider know if you experience frequent or severe spells of dizziness. They may be able to adjust your Orencia dosage or your other medications to improve your symptoms, depending on the severity.

4. Back pain

Back pain is occasionally reported by people taking Orencia.

If your back is feeling sore, a number of non-medication interventions can have a positive impact. Applying heat packs, receiving gentle massages, and trying certain at-home exercises can all help alleviate back pain, for example. If needed, you can also ask your pharmacist about trying an OTC pain medication, such as acetaminophen or naproxen (Aleve), or look into prescription medication options.

Let your healthcare provider know if you’re experiencing severe or persistent back pain. While they may be able to adjust your medication dosage to help improve your symptoms, back pain can also be a symptom of another health issue. So it’s important to be evaluated.

5. Elevated blood pressure

Orencia is occasionally associated with high blood pressure. The likelihood you’ll experience high blood pressure while taking Orencia depends on what other medications you’re taking and any other health conditions you have.

As a standard precaution, your healthcare provider will likely keep an eye on your blood pressure while you’re taking Orencia. But you can also monitor your blood pressure at home. As another option, many community pharmacies and health clinics offer self-serve blood pressure machines.

If you take blood pressure medication, your healthcare provider may adjust your dosage if your blood pressure rises above your target level. They may also recommend that you try non-medication strategies, like exercising and reducing your salt intake, to manage your blood pressure.

6. Serious infections

There's a small risk of developing serious infections while taking Orencia. These infections can lead to hospitalization and be life-threatening. In initial studies of Orencia, most serious infections occurred in people who were taking multiple medications that suppressed their immune system.

Before you start treatment with Orencia, let your healthcare provider know if you currently have an infection or have an infection that keeps coming back. They’ll want to treat the infection before you receive your first dose of Orencia. They may also screen you for tuberculosis and viral hepatitis as an added measure. In rare cases, medications like Orencia have the potential to reactivate conditions like hepatitis B.

Also, let your provider know if you develop symptoms of an infection after starting treatment with Orencia. Symptoms to keep an eye out for include fever, tiredness, and other bothersome cold-like symptoms. The severity of these symptoms can be tough to evaluate on your own, so it’s important that your provider evaluates you to prevent anything more serious from developing.

7. COPD exacerbations

You may experience lung-related side effects with Orencia if you have chronic obstructive pulmonary disease (COPD). Possible side effects include:

• New or worsening cough

• Strange airway sounds (rhonchi)

• Labored or difficult breathing

• Pneumonia

Tell your healthcare provider if you have COPD before starting treatment with Orencia. (This is especially important if the provider who prescribed you Orencia is different from the one who helps you manage your COPD.) You’ll likely have your breathing checked from time to time, though you should still flag any new or worsening COPD symptoms without delay.

When to contact a healthcare provider about Orencia side effects

You should feel empowered to contact your healthcare provider or pharmacist for help any time you’re experiencing side effects — even if they feel minor. They can recommend medications or other interventions to help you feel better.

However, if you’re experiencing any signs of an infection — such as fever, sudden fatigue, or a persistent cough — a call to your provider is a more urgent matter. Because of how Orencia affects your immune system, even a minor infection should be taken seriously. It’s important to get ahead of an infection before it can become a larger issue.

And if you have COPD or high blood pressure, you should contact your provider immediately if your condition becomes harder to manage. If you have COPD, this will likely mean breathing exacerbations. With high blood pressure, you’ll likely see elevated blood pressure readings.

While rare, it’s also possible to experience a severe allergic reaction while taking Orencia. Call 911 or go to the nearest ER if you experience symptoms of a severe allergic reaction, such as hives, a swollen face, or difficulty breathing. These symptoms may be a sign of anaphylaxis.

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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