Brand names: Enbrel
Enbrel is used to relieve the symptoms and slow the progress of moderate to severe rheumatoid arthritis. It's also prescribed to relieve the symptoms of psoriatic arthritis. It can be added to methotrexate therapy when methotrexate fails to provide adequate relief. Prescribed alone, it is also used for juvenile rheumatoid arthritis when other drugs have failed.
Enbrel is the first in a class of drugs designed to block the action of tumor necrosis factor (TNF), a naturally occurring protein responsible for much of the joint inflammation that plagues the victims of rheumatoid arthritis. In clinical trials, Enbrel provided the majority of patients with significant relief.
Enbrel is also used to reduce the symptoms of active ankylosing spondylitis, an inflammatory condition that results in stiffness and immobility and can sometimes cause joints and bones to fuse together.
In addition, Enbrel is used to treat chronic, moderate-to-severe plaque psoriasis, a condition where the skin is red and covered with silvery scales and inflammation (patches of round or oval red plaques that itch or burn).
TNF plays a significant role in the immune system, so blocking its action can lower your resistance to infection. Serious—and even fatal—infections have been known to occur, especially in people whose immune systems have already been weakened by advancing age, conditions such as heart failure or diabetes, or drugs such as azathioprine, cyclosporine, mycophenolate mofetil, and tacrolimus. Due to the possibility of lowered resistance, children with juvenile rheumatoid arthritis should be brought up to date with all immunizations before starting Enbrel therapy.
Enbrel is given by injection under the skin of the thigh, abdomen, or upper arm. Your doctor will instruct you in the proper drug preparation and injection technique and supervise your first injection in the office. You should rotate injection sites and make each new injection at least 1 inch from an older one. Never inject into areas where the skin is tender, bruised, red, or hard.
Do not shake Enbrel solution. Avoid handling the needle cover if you have a latex allergy. Never reuse a syringe. Throw it away in a puncture-proof container immediately after using it.
Side effects cannot be anticipated. If any develop or change in intensity inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Enbrel.
If Enbrel gives you an allergic reaction, you will not be able to continue using it. Do not start taking it during any kind of infection.
Think carefully about using Etanercept if you are prone to repeated infections or have a condition that encourages infections, such as diabetes. Be cautious, too, if you have a disease of the nervous system such as multiple sclerosis or a seizure disorder; such problems have been known to develop or get worse during Enbrel therapy. Enbrel should also be used with caution if you are prone to blood disorders, since they have occasionally appeared during treatment with Enbrel.
If you develop an infection, stop taking Enbrel and call your doctor immediately. Children exposed to chickenpox during Enbrel therapy may have to temporarily discontinue the drug and get preventive treatments.
Enbrel may worsen congestive heart failure. If you have this condition, make sure the doctor knows about it; Enbrel should be used with caution.
Enbrel has been known to trigger a condition similar to lupus. If you develop warning signs such as raised patches of red skin, see the doctor immediately. Enbrel therapy may have to be stopped.
Also check with your doctor immediately if you develop warning signs of a blood disorder, including such symptoms as persistent fever, bruising, bleeding, or paleness. You may have to stop taking Enbrel.
The immune system blocking action of Enbrel can lower your resistance to infection. Combining Enbrel with other rheumatoid arthritis drugs, such as anakinra, can lower your resistance even more, possibly leading to a severe infection. Make sure your doctor is aware of any drugs you are taking.
You should also avoid getting vaccinations that contain active, live viruses while taking Enbrel. However, other types of vaccines (such as those with inactive viruses) may be given during treatment with Enbrel.
The effects of Enbrel during pregnancy have not been studied. If you are pregnant or plan to become pregnant, inform your doctor immediately.
It is not known whether Enbrel appears in breast milk, but because there is a possible risk to the infant, you should either give up nursing while taking Enbrel or discontinue the drug. Discuss the problem with your doctor.
ADULTS 18 YEARS AND OLDER
The total dose is 50 milligrams per week, given as one 50-milligram injection at separate sites. The injections are given under the skin either on the same day or 3 to 4 days apart.
The recommended dose is one 50-milligram injection given under the skin twice weekly (3 or 4 days apart) for 3 months. The medication will be reduced to one 50-milligram dose once a week.
CHILDREN 4 TO 17 YEARS OLD
The recommended dose is 0.8 milligrams per 2.2 pounds of body weight, up to a maximum of 50 milligrams, injected under the skin twice a week. The safety of Enbrel has not been studied in children less than 4 years old.
High doses of Enbrel do not appear to have any toxic effects. Nevertheless, if you suspect an overdose, you should notify your doctor.