Adult Dosing
Treatment of adult rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis
- 50 mg SC qwk; doses higher than 50 mg per week are not recommended
Treatment of adult plaque psoriasis
- Initial dose: 50 mg SC twice weekly (3-4 days apart) x 3 months; alt: 25 or 50 mg SC qwk
- Maintenance dose: 50mg SC qwk
TNF-Receptor associated periodic syndrome [Not FDA Approved]
- 50 mg SC given weekly or 25 mg twice weekly;Separate individual doses by 72–96 hours
Notes:- When administering as two injections, give them either on the same day or 3 or 4 days apart
- Injection sites (upper arm, abdomen, or thigh) should be rotated; avoid injecting into areas where the skin is red, bruised, tender, or hard
Pediatric Dosing
Juvenile idiopathic arthritis
- 2-17 yrs, <63 kgs (138 pounds): 0.8 mg/kg SC qwk; Max: 50 mg SC qwk
- 2-17 yrs,
63 kgs (138 pounds): 50 mg SC qwk
Notes:- Avoid 25 mg prefilled syringe for pediatric patients weighing <31 kg (68 pounds)
- When administering as two injections, give them either on the same day or 3 or 4 days apart
- Injection sites (upper arm, abdomen, or thigh) should be rotated; avoid injecting into areas where the skin is red, bruised, tender, or hard
TNF-Receptor associated periodic syndrome (4–17 yrs) [Not FDA Approved]
- Once-weekly dosing: 0.8 mg/kg SC (not to exceed 50 mg/dose)
- Twice-weekly dosing: 0.4 mg/kg SC (not to exceed 25 mg/dose)
- Separate individual doses by 72–96 hours
Kawasaki Diseases [Non-FDA Approved]
- 0.8 mg/kg/dose IV given immediately after immune globulin infusion and then weekly x 2 additional doses
[Outline]
See Supplemental Patient Information
- Invasive fungal infections such as histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis have been reported in patients receiving etanercept therapy [US Black Box Warning]
- Patients receiving TNF-blocking agents have reported serious and fatal infections. Patients have presented with disseminated rather than localized disease, and are often taking concomitant immunosuppressants such as methotrexate or corticosteroids with etanercept
- Avoid therapy in patients with an active infection, including clinically important localized infections
- Consider the risks and benefits of etanercept treatment prior to initiating therapy in patients with chronic or recurrent infection; those who have been exposed to tuberculosis; resided or traveled in areas of endemic tuberculosis or endemic mycoses; or those with underlying conditions that may predispose to infections, such as advanced or poorly controlled diabetes
- Monitor patients for the development of signs and symptoms of infection, during and after treatment with etanercept
- Patients should be evaluated for tuberculosis risk factors and be tested for latent tuberculosis infection prior to and during treatment [US Black Box Warning]
- New onset or exacerbation of CNS demyelinating disorders, some presenting with mental status changes and others with permanent disability, have been reported with etanercept and other TNF blockers
- Cases of transverse myelitis, optic neuritis, multiple sclerosis, and new onset or exacerbation of seizure disorders have been reported in patients on etanercept therapy
- Patients receiving TNF-blocking agents are at increased risk of lymphomas when compared to controls in clinical trials. Acute and chronic leukemia have been reported with TNF-blocker use in rheumatoid arthritis and other indications
- Hodgkin’s and non-Hodgkin’s lymphoma and a variety of different malignancies have occurred in children, adolescents, and young adults who received TNF-blocking agents, including etanercept
- Post-marketing reports of worsening of CHF, with and without identifiable precipitating factors, and rare reports of new onset of CHF, including CHF in patients without known preexisting cardiovascular disease have been reported in patients receiving etanercept. Monitor patients with heart failure carefully while on therapy
- Pancytopenia including aplastic anemia have been reported rarely with etanercept therapy. Advise patients to seek immediate medical attention if signs and symptoms of blood dyscrasias or infection develop. Consider discontinuation of therapy in patients with confirmed significant hematologic abnormalities
- Reactivation of hepatitis B virus (HBV) infection in patients who are chronic carriers of this virus has been reported with use of TNF blockers. Monitor such patients for clinical and laboratory signs of active HBV infection throughout therapy and for several months following termination of therapy
- Discontinue therapy immediately, if an anaphylactic reaction or other serious allergic reaction occurs and institute appropriate therapy
- Avoid administration of live vaccines while on therapy
- Formation of autoantibodies and rarely development of a lupus-like syndrome or autoimmune hepatitis have been reported in patients receiving therapy. Discontinue therapy and evaluate the patient in case of such events
- TNF blockers including etanercept affect host defenses against malignancies and infections
- Concurrent use of therapy with cyclophosphamide is not recommended; co-administration with anakinra may cause neutropenia
Cautions: Use cautiously in
- History of significant hematologic abnormalities
- Elderly patients
- Latex allergy
- Moderate to severe alcoholic hepatitis
- Malignancy history and malignancy risk
- Concurrent use of immunosuppressants
- Myelosuppression
Supplemental Patient Information
- Instruct patients to inform their physicians if they experience any symptoms suggesting infection such as fever, cough, flu-like symptoms, diarrhea or stomach pain, weight loss, shortness or breath, or any open sores on their body
Pregnancy Category:B
Breastfeeding: Safety unknown. Preliminary data indicate that minimal amount of etanercept is excreted into breastmilk; it is unlikely to adversely affect the breastfed infant over 1 month of age. However, an alternative drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 18 February 2011). According to the manufacturer's data, it is unknown whether etanercept is excreted in breast milk. Because many drugs are excreted in human milk, a decision has to be made whether to discontinue the drug or to discontinue nursing.
Pricing data from www.DrugStore.com in U.S.A.
- Enbrel 25 MG/0.5ML SOLN [Syringe] (AMGEN)
0.51 0.5ml = $260.99
1.53 0.5ml = $760.97 - Enbrel 50 MG/ML SOLN [Box] (AMGEN)
3.92 ml = $1903.07
7.84 ml = $3760.97 - Enbrel 25 MG KIT [Box] (AMGEN)
4 mg = $979.01
8 mg = $1940.87 - Enbrel SureClick 50 MG/ML SOLN [Box] (AMGEN)
3.92 ml = $2030.98
11.76 ml = $5827.13
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
