All About Enbrel

What is Enbrel?

If you have certain types of arthritis or plaque psoriasis, your doctor may prescribe Enbrel. It’s used to treat the following conditions:

• rheumatoid arthritis in adults
• juvenile idiopathic arthritis in some children
• psoriatic arthritis in adults
• ankylosing spondylitis in adults
• plaque psoriasis in adults and some children

To learn more about these conditions, see the “What is Enbrel used for?” section below.

Enbrel contains the active drug etanercept, which is a biologic medication. A biologic is made from parts of living organisms. Enbrel is available in two biosimilar forms:

• Eticovo, which contains the active biosimilar drug etanercept-ykro
• Erelzi, which contains the active biosimilar drug etanercept-szzs

(Biosimilars are like generic drugs. But unlike generics, which are made for non-biologic drugs, biosimilars are made for biologic drugs.)

Enbrel comes as a solution and as a powder that’s mixed into a solution.

You’ll receive Enbrel as an injection under your skin. Your doctor can show you how to inject Enbrel at home, or you can receive your injections at their office.

If you’d like to know about Enbrel’s side effects, cost, and more, read on.

What are Enbrel’s side effects?

Like most drugs, Enbrel may cause mild or serious side effects. The lists below describe some of the more common side effects that Enbrel may cause. These lists don’t include all possible side effects.

Your doctor or pharmacist can tell you more about the potential side effects of Enbrel. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Enbrel can cause. To learn about other mild side effects, talk with your doctor or pharmacist or read Enbrel’s medication guide.

Mild side effects of Enbrel can include:

• infections caused by viruses, bacteria, parasites, and fungi
• skin reaction at the injection site, which may cause redness, itchiness, pain, swelling, bleeding, and bruising
• diarrhea
• rash
• itchiness
• fever

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Enbrel can occur, but they aren’t common. If you have serious side effects from Enbrel, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects can include:

• boxed warnings: serious infections and cancer (see “Side effect focus” below)
• eye-related side effects (see “Side effect focus” below)
• reactions of the nervous system*
• congestive heart failure*
• blood disorders such as pancytopenia (low level of all your blood cells)
• reactivation of hepatitis B and tuberculosis (TB) in people who’ve had these conditions in the past*
• allergic reaction (see “Side effect focus” below)

* For more information about these side effects, see the “What to consider before taking Enbrel” section below.

Side effect focus

Learn more about some of the side effects Enbrel may cause.

Boxed warnings

Enbrel has boxed warnings about serious infections and cancer. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

Serious infections. Taking Enbrel can increase your risk for serious infections. These include bacterial infections, such as TB, and invasive fungal infections. You may also be at risk for viral and parasitic infections. If you have any symptoms of infection while taking Enbrel, it’s important to tell your doctor right away.

Taking Enbrel can increase your risk for serious bacterial, viral, parasitic, and fungal infections. Some serious infections include TB and invasive fungal infections. If you have any symptoms of infection while taking Enbrel, it’s important to tell your doctor right away. Before you start taking Enbrel, your doctor will check to see if you have TB. And they’ll continue to monitor you for this infection while you’re taking this drug.

Your doctor may not have you start taking Enbrel if you have an infection. If you develop an infection that worsens while taking Enbrel, your doctor may stop Enbrel for a short time. But don’t stop taking Enbrel without talking with your doctor. Before you start taking Enbrel, your doctor will check to see if you have TB. And they’ll continue to monitor you for this infection while you’re taking this drug.

Some serious infections may cause hospitalization or death. You have a higher risk for infection when you’re taking Enbrel if you:

• are age 65 years and older
• have other medical conditions
• take other immunosuppressants, such as methotrexate or glucocorticoids

Cancer. Enbrel can increase your risk for blood cancers, such as lymphoma and leukemia, and for skin cancer. Some children who take Enbrel also have an increased risk for certain cancers, including lymphoma. Some people have died from cancers that occurred while taking Enbrel.

What might help

If you develop an infection while you’re taking Enbrel, tell your doctor. They may monitor your symptoms to make sure the infection is not getting worse. And they’ll treat your infection if needed.

If you have a serious infection while taking Enbrel, your doctor will tell you to stop taking Enbrel. But don’t stop taking the drug without talking with your doctor.

If you’re at risk for certain fungal infections, you may need to take antifungal medications to help prevent a fungal infection with Enbrel. For example, if you’re traveling to an area where you have a high risk for getting certain infections, talk with your doctor. They can recommend whether you should take medication to help lower your risk for infection.

And if you have any questions about your risk for cancer while taking Enbrel, talk with your doctor. In clinical studies, researchers noted increases in the rates of certain cancers like blood cancers (lymphoma and leukemia) and skin cancer.

Your doctor may recommend that you check your skin regularly for changes or new growths. If you have risk factors for skin cancer, your doctor will monitor your skin regularly.

Eye-related side effects

It’s possible that you’ll develop eye-related side effects when you’re taking Enbrel. Rarely, inflammation of the nerves of your eyes can occur. This condition is called optic neuritis. And it’s one of several nervous system disorders that may occur when you’re taking Enbrel.

Your doctor will help you manage your eye condition if needed. Once you’ve received treatment, your doctor will decide if it’s safe for you to continue taking Enbrel.

What might help

Talk with your doctor if you have any symptoms of a nervous system problem while you’re taking Enbrel. These symptoms may include:

• numbness or tingling in any part of your body
• changes in your vision
• loss of vision
• weakness in your arms and legs
• dizziness
• pain in the eye, especially when moving it

Long-term side effects

While taking Enbrel, you may experience mild side effects of the drug that don’t go away. These are long-lasting side effects, and they may only disappear if you stop taking Enbrel.

Possible long-term side effects of Enbrel include:

• infections
• skin reaction at the injection site
• diarrhea
• rash
• itchiness
• fever

What might help

If you’re concerned about the long-term side effects of Enbrel, talk with your doctor. But don’t stop taking Enbrel without discussing doing so with your doctor.

Allergic reaction

Some people may have an allergic reaction to Enbrel.

Symptoms of a mild allergic reaction can include:

• rash
• itchiness
• flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Enbrel. But if you think you’re having a medical emergency, call 911 or your local emergency number.

How much does Enbrel cost?

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for Enbrel in your area, visit GoodRx.com.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Enbrel manufacturer’s website to see if it offers any support options.

How is Enbrel injected?

Your doctor can give you instructions and show you how to inject Enbrel at home. They will also explain how much to take and how often. Be sure to follow your doctor’s instructions. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Injecting Enbrel

Enbrel comes as a solution and as a powder that’s mixed into a solution.

You’ll receive Enbrel as an injection under your skin. Your doctor may give you instructions on how to inject Enbrel yourself.

Enbrel comes in these five forms, which can each be self-injected:

• single-dose prefilled syringes
• single-dose, single-use, prefilled SureClick autoinjectors
• single-dose, reusable, prefilled AutoTouch autoinjectors
• single-use vials
• multiple-dose vials

The instructions you’ll follow to inject your doses depend on the Enbrel form your doctor prescribes for you.

You can inject Enbrel under the skin of:

• your thigh
• your belly, staying 2 inches away from the belly button
• the outer part of your arm

Dosage

The dose of Enbrel you’ll inject under your skin depends on several factors. For example, Enbrel doses vary depending on your age and the condition you’re using the drug to treat. And in children, Enbrel doses also depend on body weight.

For adults with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, Enbrel is given weekly.

For adults with plaque psoriasis, Enbrel is given as a starting dose and as a maintenance dose. For the starting dose, over the first 3 months, you’ll likely receive Enbrel twice weekly. Then, for the maintenance dose going forward, you’ll receive Enbrel once weekly.

Children also receive weekly doses of Enbrel for juvenile idiopathic arthritis and plaque psoriasis.

Taking Enbrel with other drugs

Your doctor may recommend that you take other drugs together with Enbrel.

If you’re an adult receiving Enbrel for rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, your doctor may also prescribe the following drugs:

• methotrexate
• prednisone or other glucocorticoids
• salicylates, like aspirin
• nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen
• other pain relievers

For children with juvenile idiopathic arthritis who take Enbrel, doctors may prescribe the following medications:

• prednisone or other glucocorticoids
• NSAIDs
• other pain relievers

Questions about taking Enbrel

• What if I miss a dose of Enbrel? If you forget to take your dose of Enbrel, inject the medication as soon as you remember. Then, take your next dose at your regularly scheduled time. If you’re unsure when you should inject Enbrel next, talk with your doctor or pharmacist.
• Will I need to use Enbrel long term? The conditions that Enbrel treats are long-lasting. So, you may need to take Enbrel for a long time. Talk with your doctor about how long you need to take Enbrel for.
• Should I take Enbrel with food? Since Enbrel is an injection, you can take it with or without food. Eating doesn’t affect how your body absorbs the drug.
• How long does Enbrel take to work? Everyone will have a different experience with Enbrel. And how long it takes Enbrel to work may depend on the condition it’s being used to treat. For rheumatoid arthritis, two studies showed benefits after 1 to 2 weeks of treatment. But talk with your doctor to find out how long it should take for Enbrel to work for your condition.

Questions for your doctor

You may have questions about Enbrel and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

• Before your appointment, write down questions like:
  • How will Enbrel affect my body, mood, or lifestyle?
• Bring someone with you to your appointment if doing so will help you feel more comfortable.
• If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

What are some frequently asked questions about Enbrel?

Find answers to some commonly asked questions about Enbrel.

How are Enbrel and Humira alike and different?

Both Enbrel and Humira are biologic medications. Biologic medications are made from living cells. Enbrel and Humira are also both injections. And they work by lowering the activity of your immune system.

These two drugs target the same part of your immune system. They both block the activity of a protein called tumor necrosis factor (TNF).

These drugs also share the same side effects. And both have boxed warnings for serious infections and cancer. Boxed warnings alert people to serious side effects of a drug. These are the most serious warnings about a drug’s side effects.

Both Enbrel and Humira can be used to treat:

• rheumatoid arthritis
• juvenile idiopathic arthritis
• psoriatic arthritis
• ankylosing spondylitis

But doctors can also prescribe Humira for other conditions, such as:

• Crohn’s disease
• ulcerative colitis
• uveitis
• hidradenitis suppurativa

Doctors can prescribe Enbrel for adults and some children with plaque psoriasis. But Humira can only be used to treat plaque psoriasis in adults.

If you’d like to know more about the differences and similarities of these two drugs, talk with your doctor.

Does Enbrel cause weight gain or weight loss?

No, Enbrel doesn’t cause weight gain or weight loss.

But if you have or develop congestive heart failure while using Enbrel, you may gain weight. This is because with congestive heart failure, your body may retain too much water.

On the other hand, if you have unexplained weight loss, it could be a sign of a serious infection caused by Enbrel. Examples of serious infections related to Enbrel use include hepatitis B and tuberculosis.

If your weight is changing while you’re taking Enbrel, talk with your doctor right away. Aside from heart failure or infection, other health conditions could be causing your weight to change.

How does Enbrel work?

Enbrel works by lowering the activity of your immune system. It’s a type of drug called a TNF blocker.

TNF is a protein that causes inflammation in the body. It plays a role in several immune conditions, including rheumatoid arthritis and psoriatic arthritis.

Enbrel blocks the action of TNF in your body. Experts believe that blocking TNF lowers inflammation in the body. This is how Enbrel helps manage certain conditions related to TNF.

What is Enbrel used for?

Enbrel is used to treat the following long-lasting conditions:

• Rheumatoid arthritis (RA): Enbrel may be prescribed for people ages 18 years and older with RA. RA is a condition that affects your joints. If you have RA, you may have swelling and stiffness in the joints of your hands, wrists, elbows, shoulders, hips, knees, and ankles.
• Juvenile idiopathic arthritis (JIA): Enbrel may be prescribed for people ages 2 years and older with JIA. JIA is one of the most common long-lasting conditions in children. It causes inflamed and painful joints.
• Psoriatic arthritis (PsA): Enbrel may be prescribed for people ages 18 years and older with PsA. With PsA, you may have swollen joints and a skin condition called psoriasis. Psoriasis causes plaques on your skin that may be darker in color or look scaly.
• Ankylosing spondylitis (AS): Enbrel may be prescribed for people ages 18 years and older with AS. AS and RA share many common features, but they’re two different conditions that affect your joints. With AS, you may have severe back or hip pain.
• Plaque psoriasis (PsO): Enbrel may be prescribed for people ages 4 years and older with PsO. PsO causes plaques on your skin that may be darker in color or look scaly.

With each of these conditions, your immune system damages certain cells in your body. Enbrel manages the symptoms of these conditions by lowering the activity of the immune system. For more information about how Enbrel works, see the “What are some frequently asked questions about Enbrel?” section above.

What should be considered before taking Enbrel?

Before taking Enbrel, talk with your doctor about your overall health and any medical conditions you may have. You’ll also need to tell your doctor about any drugs you’re taking. If you’re pregnant or breastfeeding, tell your doctor before taking Enbrel.

Before taking Enbrel, you should also let your doctor know if you:

• have any allergies to latex or rubber
• have been in contact with someone with chickenpox
• are planning to have surgery
• have heart failure or have had it in the past
• have a nervous system problem (such as multiple sclerosis or Guillain-Barré syndrome) or have had one in the past
• have recently gotten any live vaccines

Interactions

Using medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.

Before taking Enbrel, be sure to tell your doctor about all medications you take (including prescription and over-the-counter types). Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Enbrel.

Interactions with drugs or supplements

Enbrel can interact with several types of drugs. These drugs include:

• biologic medications, including anakinra (Kineret) and abatacept (Orencia)
• the cancer drug cyclophosphamide

Combining Enbrel with anakinra or abatacept can increase your risk for serious infection. Taking cyclophosphamide and Enbrel together can increase your risk for developing cancer. (For more information about the risks of infection and cancer with Enbrel, see the “What are Enbrel’s side effects?” section above.)

This list does not contain all types of drugs that may interact with Enbrel. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Enbrel.

Other interactions

Enbrel can interact with certain vaccines. So, you shouldn’t get any live vaccines while you’re taking Enbrel. (Live vaccines are made from living germs.)

Examples of live vaccines include those for yellow fever, smallpox, and chickenpox.

Because Enbrel lowers the activity of your immune system, the live germs in a vaccine could make you sick. Talk with your doctor about vaccines that are safe to receive while taking Enbrel.

Keep in mind that Enbrel is used in children with certain conditions. It’s recommended that children be up to date on their vaccinations, especially live vaccines, before they start Enbrel.

In addition, it isn’t known whether Enbrel affects how well certain pneumonia vaccines work. So, be sure to talk with your doctor before receiving a pneumonia vaccine.

Boxed warnings

Enbrel has boxed warnings. These are serious warnings from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Serious infections. Taking Enbrel can increase your risk for serious bacterial, viral, parasitic, and fungal infections. Some serious infections include tuberculosis (TB) and invasive fungal infections. If you have any symptoms of infection while taking Enbrel, it’s important to tell your doctor right away. Before you start taking Enbrel, your doctor will check to see if you have TB. And they’ll continue to monitor you for this infection while you’re taking this drug.

Cancer. Enbrel can increase your risk for blood cancers, such as lymphoma and leukemia, and for skin cancer. Some children who take Enbrel also have an increased risk for certain cancers, including lymphoma. If you have any questions about your risk for cancer while taking Enbrel, talk with your doctor.

For more information, see the “What are Enbrel’s side effects?” section above.

Other warnings

Enbrel may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Enbrel. Factors to consider include those in the list below.

Reactivation of TB or hepatitis B. If you have TB, you shouldn’t take Enbrel. Your doctor will check to see if you have TB before you start taking Enbrel. It’s possible to have latent TB, which means that you have the infection in your body, but it’s not causing symptoms. Enbrel may make latent TB flare up and cause symptoms. This condition is called reactivation. If needed, your doctor will treat your TB before having you start Enbrel treatment.

Enbrel can also reactivate hepatitis B if it’s in your body. If you had hepatitis B in the past, the inactive virus may flare up with Enbrel treatment. If this reactivation of hepatitis B occurs, your doctor will stop Enbrel and treat the infection.

Diabetes. If you have diabetes and you’re taking Enbrel, you may notice that your blood sugar levels are lower than usual. Be sure to talk with your doctor about your blood sugar levels while taking Enbrel.

Your doctor may recommend lowering your doses of certain diabetes medications. But don’t stop taking your diabetes medications without talking with your doctor.

Congestive heart failure. Some people may develop congestive heart failure while taking Enbrel, but this is rare. If you have congestive heart failure, the condition may worsen while you’re taking Enbrel. So, your doctor may closely monitor your heart function during treatment.

Talk with your doctor if you notice any weight gain that you can’t explain.Changes in your weight can be a sign that your body is retaining fluid. This could indicate that your heart function may be getting worse.

Conditions of the nervous system. Rarely, conditions of the nervous system may develop while you’re taking Enbrel. If you already have a nervous system condition, such as optic neuritis, a seizure disorder, multiple sclerosis, or Guillain-Barré syndrome, taking Enbrel can worsen it. Tell your doctor if you have a nervous system disorder before taking Enbrel.

If you notice any changes in your mood, changes in how your body moves, or changes in your eyesight, talk with your doctor right away.

Allergic reaction. If you’ve had an allergic reaction to Enbrel or any of its ingredients, you shouldn’t take this drug. Ask your doctor about which other medications are better options for you.

Tell your doctor if you have a rubber or latex allergy. The needle cover of Enbrel prefilled syringes, autoinjectors, and mini cartridges contains rubber. If you have a sensitivity to latex, you may develop an allergic reaction while using these products.

Alcoholic hepatitis. A study showed that people with alcoholic hepatitis had a higher death rate if they were taking Enbrel. With alcoholic hepatitis, you have inflammation in your liver that’s caused by heavy alcohol intake. If you drink large amounts of alcohol regularly, you may develop alcoholic hepatitis.

Before taking Enbrel, tell your doctor if you have alcoholic hepatitis.

Use with alcohol

It isn’t known whether alcohol interacts with Enbrel. But in one study of people with alcoholic hepatitis, the death rate was higher in those taking Enbrel than in those not taking it.

With alcoholic hepatitis, you have inflammation in your liver that’s caused by heavy alcohol intake. If you drink large amounts of alcohol regularly, you may develop alcoholic hepatitis.

If you have alcoholic hepatitis, talk with your doctor before taking Enbrel. They can discuss the benefits and risks of using this drug.

Pregnancy and breastfeeding

There’s not enough information available about the safety of using Enbrel in pregnancy. Information from a pregnancy registry showed no increased risk in minor birth defects when Enbrel was taken during pregnancy. But a higher risk of major birth defects was seen in some cases.

If you want to get pregnant or do become pregnant while taking Enbrel, tell your doctor. They can discuss the benefits and risks of taking Enbrel during pregnancy.

It’s unknown whether Enbrel passes into breast milk and, if so, if it’s harmful to a breastfed child. Talk with your doctor about the safety of breastfeeding while using Enbrel.

What should be done in case of overdose?

Don’t take more Enbrel than your doctor prescribes. Doing so can lead to serious side effects. If you inject too much Enbrel, your doctor will check you for possible overdose symptoms.

What to do in case you take too much Enbrel

Call your doctor if you think you’ve taken too much Enbrel. You can also call 800-222-1222 to reach the American Association of Poison Control Centers, or you can use their online resource. But if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.

Ask your doctor

If you have questions about taking Enbrel, talk with your doctor or pharmacist before starting treatment. Some questions to ask your doctor about Enbrel include:

• How should I store Enbrel at home?
• If I had hepatitis B in the past, can I still take Enbrel?
• Can I get the seasonal flu shot while taking Enbrel?
• How should I store Enbrel when I’m traveling on a plane?
• Can I continue taking Enbrel if I’m having surgery?

You should also talk with your doctor about other possible treatments for your condition. Here’s a list of articles that may help you:

• Doctor Discussion Guide: Is Your RA Treatment Working?
• Rheumatoid Arthritis Medication List
• Treatment Options for Moderate to Severe Psoriatic Arthritis
• Treatment for Ankylosing Spondylitis
• All You Need to Know About the Latest Psoriasis Treatments

You can also learn more about rheumatoid arthritis and psoriasis and their treatment options by subscribing to Healthline’s Rheumatoid Arthritis and Psoriasis newsletters.