Enbrel is a biologic medication primarily used for managing and reducing the symptoms of certain autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis.

Enbrel works by blocking the action of tumor necrosis factor (TNF), a substance in the body that causes inflammation. By doing so, it can alleviate the painful and debilitating symptoms that come with these conditions.

Warnings and Precautions

While Enbrel can be effective in managing these conditions, it is important to be aware of the potential warnings and precautions associated with its use.

Allergies and Hypersensitivity Reactions

Enbrel is contraindicated in individuals who are allergic to etanercept or any of its components. If you have a known hypersensitivity to Enbrel or similar medications, it is crucial to inform your healthcare provider. Allergic reactions to Enbrel can range from mild skin rashes to more severe symptoms such as difficulty breathing, chest tightness, or swelling of the face, lips, tongue, or throat. Immediate medical attention should be sought if any signs of an allergic reaction occur.

Infections and Vaccinations

Enbrel can suppress the immune system, making individuals more susceptible to infections. Before starting Enbrel, it is essential to inform your healthcare provider about any ongoing infections or recent vaccinations. Certain live vaccines should be avoided while on Enbrel treatment due to the risk of infection. Your healthcare provider will guide you on the appropriate timing of vaccinations and may recommend getting up-to-date with immunizations before initiating Enbrel therapy.

Tuberculosis (TB) Screening

Prior to starting Enbrel, your healthcare provider will assess your risk of tuberculosis (TB) and may perform a TB skin test or other diagnostic tests. Enbrel can reactivate latent TB infections, leading to serious complications. If you have a history of TB or have been in close contact with individuals who have active TB, it is crucial to discuss this with your healthcare provider.

Hepatitis B Virus (HBV) Infection

Enbrel can increase the risk of hepatitis B virus (HBV) reactivation in individuals who are chronic carriers of the virus. It is important to inform your healthcare provider if you have a history of HBV infection or if you test positive for HBV surface antigen. Regular monitoring of liver function tests may be necessary during Enbrel treatment to detect any signs of HBV reactivation.

Heart Failure

Patients with pre-existing heart failure may experience worsening of symptoms while on Enbrel. It is important to notify your healthcare provider if you have a history of heart failure or any other cardiovascular conditions. Regular monitoring of heart function may be recommended during treatment with Enbrel.

Neurologic Conditions

Enbrel has been associated with rare cases of central nervous system (CNS) demyelinating disorders, such as multiple sclerosis and optic neuritis. If you have a history of these conditions or experience new neurologic symptoms while on Enbrel, it is crucial to seek immediate medical attention.

Side Effects

While Enbrel can be highly effective in managing these conditions, it is important to be aware of the potential side effects that may occur.

Common Side Effects

Enbrel, like any medication, can cause certain side effects that are relatively common and generally not life-threatening. These side effects may include:

  • Injection site reactions: It is not uncommon to experience redness, swelling, or pain at the site of injection when using Enbrel. These reactions are usually mild and tend to improve over time.
  • Headache: Some individuals may experience headaches as a common side effect of Enbrel. These headaches are typically mild and can be managed with over-the-counter pain relievers.
  • Nausea: Nausea is another common side effect of Enbrel. If you experience persistent nausea, it is advisable to speak with your healthcare provider, as they may be able to recommend strategies to alleviate this symptom.
  • Upper respiratory tract infections: Enbrel may slightly increase the risk of developing upper respiratory tract infections, such as the common cold. These infections are generally mild and self-limiting.
  • Fatigue: Fatigue or tiredness is a common side effect that has been reported by some individuals using Enbrel. If you find that your fatigue is interfering with your daily activities, it is important to consult your healthcare provider.
  • Diarrhea: Enbrel can occasionally cause diarrhea as a side effect. Staying hydrated and eating a balanced diet can help manage this symptom. If the diarrhea persists or becomes severe, medical attention should be sought.

Rare Side Effects

While rare, some individuals may experience less common side effects while taking Enbrel. It is important to note that the occurrence of these side effects is generally low, but they should still be monitored. Rare side effects of Enbrel may include:

  • Allergic reactions: In rare cases, individuals may develop allergic reactions to Enbrel. These reactions may manifest as hives, itching, difficulty breathing, or swelling of the face, lips, tongue, or throat. If you experience any signs of an allergic reaction, seek immediate medical attention.
  • Liver problems: Rarely, Enbrel may affect liver function, leading to abnormalities in liver enzymes. Monitoring liver function through regular blood tests is important when taking Enbrel.
  • Blood disorders: Some individuals may experience changes in their blood cell counts, such as a decrease in white blood cells, red blood cells, or platelets. Regular blood tests can help detect these changes and ensure appropriate management.
  • Neurological symptoms: In rare cases, Enbrel has been associated with neurological symptoms, including seizures, multiple sclerosis-like symptoms, or optic neuritis. If you experience any neurological symptoms while taking Enbrel, it is crucial to consult your healthcare provider promptly.
  • Skin reactions: Although uncommon, Enbrel may cause skin reactions such as rash, hives, or other dermatological issues. It is essential to report any unusual skin changes to your healthcare provider.

Severe Side Effects

While severe side effects are rare, they are important to be aware of, as they may require immediate medical attention. Severe side effects associated with Enbrel may include:

  • Serious infections: Enbrel can increase the risk of developing serious infections, including bacterial, viral, or fungal infections. These infections may affect various parts of the body and can be life-threatening. Contact your healthcare provider immediately if you develop signs of infection, such as fever, persistent cough, or flu-like symptoms.
  • Cancer: Although the risk is extremely low, there have been reports of cancer in individuals treated with Enbrel. It is essential to discuss any concerns regarding the risk of cancer with your healthcare provider.
  • Heart failure: In rare cases, Enbrel may exacerbate or contribute to the development of heart failure. If you experience symptoms such as shortness of breath, rapid weight gain, or swelling in the legs, contact your healthcare provider promptly.
  • Blood disorders: While rare, Enbrel has been associated with blood disorders, including aplastic anemia or pancytopenia. If you experience symptoms such as persistent fatigue, pale skin, or unusual bleeding or bruising, seek immediate medical attention.
  • Injection site reactions: Although usually mild, some individuals may experience severe injection site reactions, including skin necrosis or ulceration. If you notice any unusual or concerning changes at the injection site, contact your healthcare provider.

Drug Interactions

Understanding the potential interactions between Enbrel and other medications is crucial to avoid any adverse effects or reduced efficacy.

Methotrexate

Enbrel is often prescribed in combination with methotrexate to enhance its effectiveness. The combination of these medications has been shown to slow down the progression of rheumatoid arthritis. However, it is important to monitor patients closely for any signs of toxicity, as both Enbrel and methotrexate can suppress the immune system.

Corticosteroids

Corticosteroids, such as prednisone, are commonly used to manage the symptoms of autoimmune diseases. When used concurrently with Enbrel, corticosteroids can enhance the anti-inflammatory effects. However, long-term use of corticosteroids may increase the risk of certain side effects. It is advisable to work closely with a healthcare provider to find the right balance and minimize potential risks.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs, including Celebrex and Voltaren, are commonly used to relieve pain and inflammation. While they can be used alongside Enbrel, caution should be exercised, as NSAIDs may increase the risk of gastrointestinal complications. Patients should discuss the use of NSAIDs with their healthcare provider to determine the most suitable approach.

Vaccines

It is important to consult with a healthcare provider before receiving any vaccines while taking Enbrel. Since Enbrel suppresses the immune system, certain live vaccines may be contraindicated. However, non-live vaccines, such as the flu vaccine, can usually be administered safely. It is crucial to discuss vaccination plans with a healthcare professional to ensure proper immunization without compromising safety.

Anticoagulants

Enbrel has been associated with an increased risk of bleeding when used concomitantly with anticoagulant medications, such as Xarelto or Lixiana. Close monitoring of blood clotting parameters is essential when combining Enbrel with anticoagulants. Any signs of abnormal bleeding should be promptly reported to a healthcare provider.

Biologic Agents

Enbrel belongs to a class of medications known as biologic agents. When considering the use of other biologic agents alongside Enbrel, caution should be exercised due to the potential for increased immunosuppression and the risk of infections. Any decisions regarding the combination of biologic agents should be made by a healthcare provider based on the individual patient’s condition.

How To Use

If you have been prescribed Enbrel by your healthcare provider, it is important to follow their instructions carefully.

  1. Preparation: Wash your hands thoroughly with soap and water. Select an injection site, such as the thigh or abdomen, and clean the area with an alcohol swab. If you are using a pre-filled syringe, remove the cap and let the syringe sit for a few minutes to allow any air bubbles to rise to the top. Gently tap the syringe to remove the bubbles. If you are using a pre-filled pen, remove the cap and do not remove the needle cover until you are ready to inject.
  2. Injection: Hold the syringe or pen in one hand like a pencil or a dart, with the needle pointing downwards. With your other hand, pinch the skin at the injection site. Insert the needle into the pinched skin at a 45-degree angle (or as instructed by your healthcare provider). Slowly push the plunger on the syringe or press the injection button on the pen until the medication is fully injected. Hold the syringe or pen in place for a few seconds before removing it. Do not rub the injection site after removal.

Dosing

Understanding the proper dosing of Enbrel is essential for its safe and effective use. It is important to work closely with a healthcare provider who can provide personalized guidance and monitor the response to treatment. With the proper dosing and administration of Enbrel, patients can improve their quality of life and manage their autoimmune conditions more effectively.

Starting Dose

When initiating Enbrel treatment, the recommended starting dose varies depending on the condition being treated. For rheumatoid arthritis, the initial dose is usually 50 milligrams (mg) administered once weekly. For psoriasis and ankylosing spondylitis, the starting dose is typically 50 mg administered twice a week for the first three months. After this initial period, the dosage is adjusted.

Maintenance Dose

After the initial phase of treatment, the maintenance dose of Enbrel is generally 50 mg once a week for rheumatoid arthritis and 50 mg twice a week for psoriasis and ankylosing spondylitis. However, the specific dosage may vary depending on individual factors, such as disease severity and response to treatment. It is important to follow the dosage instructions provided by your healthcare provider.

Pediatric Dosing

For pediatric patients, the dosing of Enbrel is determined based on the child’s weight. The recommended dosage is 0.8 mg per kilogram (kg) of body weight for moderate to severe juvenile idiopathic arthritis. The maximum weekly dose should not exceed 50 mg. Children under the age of four may require a reduced dosage.

Dosing Adjustments

In some cases, dosage adjustments may be necessary to optimize the therapeutic effect of Enbrel. If a patient does not adequately respond to the initial dose, the healthcare provider may consider increasing the dosage. Conversely, if a patient experiences significant side effects, the dosage may be reduced or the treatment discontinued. Any changes in dosing should be done under the supervision of a healthcare professional.

Storage

Proper storage of Enbrel is essential to maintain its effectiveness and ensure patient safety. If Enbrel is not stored correctly, it may lose its effectiveness, putting patients at risk of inadequate treatment. Therefore, it is crucial to adhere to the recommended storage guidelines to ensure that Enbrel remains potent.

Recommended Storage Temperature for Enbrel

Enbrel should be stored in the refrigerator between 36°F (2°C) and 46°F (8°C). It is important to note that Enbrel should not be frozen. Freezing can denature the proteins in the medication, rendering it ineffective. Therefore, it is essential to avoid storing Enbrel in the freezer.

Protecting Enbrel from Light Exposure

Enbrel should be stored in its original packaging to protect it from light exposure. The packaging is designed to block out harmful UV rays that can degrade the medication. Avoid transferring Enbrel to alternative containers, as they may not provide adequate protection against light.

Keeping Enbrel Away from Heat and Moisture

In addition to temperature and light, it is important to keep Enbrel away from heat and moisture. Store the medication in a dry place, away from direct sunlight, stoves, heaters, and humid environments like bathrooms. Exposing Enbrel to excessive heat or moisture can compromise its potency.

Disposal

While it provides immense relief to patients, it is essential to understand the proper methods of disposing of Enbrel to ensure environmental safety and prevent any potential risks.

  1. Store Unused Enbrel Properly: If you have any unused Enbrel, ensure it is stored at the appropriate temperature and in a secure location away from children and pets. Follow the storage instructions provided by your healthcare provider or pharmacist.
  2. Do Not Share or Reuse: Enbrel is a medication that should only be used by the individual it is prescribed for. Do not share your Enbrel with others, and do not reuse any leftover medication.
  3. Dispose of Sharps Properly: Enbrel is typically administered using a syringe or autoinjector, which contains a sharp needle. After use, place the used syringe or autoinjector in a puncture-resistant container designated for sharps disposal. Check with your local pharmacy or healthcare provider for instructions on how to safely dispose of sharps in your area.
  4. Follow Local Regulations: Different regions may have specific regulations regarding the disposal of medications. Familiarize yourself with the local guidelines and regulations to ensure you comply with the proper disposal methods.
  5. Ask Your Pharmacist: If you are unsure about the proper disposal methods for Enbrel or have any questions, consult your pharmacist. They are knowledgeable about medication disposal and can provide you with the necessary guidance.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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