etanercept

(ee tah ner' sept)

Enbrel

Pregnancy Category B

Drug classes
Antiarthritic
Disease-modifying antirheumatic drug (DMARD)

Therapeutic actions
Genetically engineered tumor necrosis factor receptors from Chinese hamster ovary cells;
keep inflammatory response to autoimmune disease in check by reacting with and
deactivating free-floating tumor necrosis factor released by active leukocytes.

Indications
• Reduction of the signs and symptoms of moderately to severely active rheumatoid
arthritis; to delay the structural damage associated with rheumatoid arthritis, or
may be used in combination with methotrexate when patients do not respond to
methotrexate alone
• Polyarticular-course juvenile rheumatoid arthritis in patients who have not had an
adequate response to one or more antirheumatic drugs
• Reduction of signs and symptoms of psoriatic arthritis; may be used alone or in
combination with methotrexate
• Treatment of ankylosing spondylitis
• Treatment of psoriatic arthritis

Contraindications and cautions

• Contraindicated with allergy to etanercept or Chinese hamster products, lactation,
pregnancy, cancer, severe infection including sepsis, CNS demyelinating
disorders, myelosuppression.
• Use cautiously with renal or hepatic disorders, any infection, CHF.

Available forms
Powder for injection—25 mg

Dosages
ADULTS
25 mg SC twice weekly with 72–96 hr between doses or 50 mg SC once weekly.
PEDIATRIC PATIENTS
< 4 yr: Safety and efficacy not established.
4–17 yr: 0.4 mg/kg SC twice weekly with 72–96 hr between doses to a max 25 mg/dose
or 0.8 mg/kg SC once weekly.

Pharmacokinetics
Route Onset Peak
SC Slow 72 hr
Metabolism: Tissue; T1/2: 115 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Tissues

Adverse effects
• CNS: CNS demyelinating disorders (multiple sclerosis, myelitis, optic
neuritis)
• GI: Abdominal pain, dyspepsia
• Hematologic: Pancytopenia
• Respiratory: URIs, congestion, rhinitis, cough, pharyngitis
• Other: Irritation at injection site; increased risk of infections, cancers; ANA
development; headache; autoimmune diseases

Nursing considerations
Assessment
• History: Allergy to etanercept or Chinese hamster products; pregnancy, lactation;
serious infections; cancer; CNS demyelinating disorders, myelosuppression
• Physical: Skin lesions, color; R, adventitious sounds; injection site evaluation;
ROM to monitor drug effectiveness; CNS—neurologic evaluation, reflexes; CBC

Interventions
• Obtain a baseline and periodic CBC; discontinue drug at signs of severe bone
marrow suppression.
• Obtain baseline values of neurologic function; discontinue drug at any sign of
CNS demyelinating disorders.
• Advise patient that this drug does not cure the disease and appropriate therapies
for rheumatoid arthritis should be used.
• Reconstitute for injection by slowly injecting 1 mL sterile bacteriostatic water
provided with powder into the vial; swirl gently, do not shake; avoid foaming;
liquid should be clear and free of particulate matter; use within 6 hr of
reconstitution. Do not mix with any other medications.
• Rotate injection sites between abdomen, thigh, and upper arm. Maintain a chart to
ensure that sites are rotated regularly.
• Teach patient and a significant other how to reconstitute and administer SC
injections; observe the process periodically.
• Monitor patient for any sign of infection; discontinue drug if infection occurs.
• Evaluate drug effectiveness periodically; 1–2 wk may be required before any
change is noted; if no response has occurred within 3 mo, discontinue drug.
• Do not administer drug with any vaccinations; allow at least 2–3 wk between
starting this drug and a vaccination.
• Protect patient from exposure to infections and ensure routine physical
examinations and monitoring for potential cancers and autoimmune diseases.

Teaching points
 • Take this drug exactly as prescribed. Note that this drug does not cure rheumatoid
arthritis and appropriate therapies to deal with the disease should be followed.
You and a significant other should learn how to prepare the drug and to administer
SC injections. Prepare a chart of injection sites to ensure that sites are rotated on a
regular basis. Consult with your health care provider about proper disposal of
needles and syringes.
• Arrange for frequent, regular medical follow-up, including blood tests to follow
the effects of the drug on your body.
• These side effects may occur: Signs and symptoms of upper respiratory
infections, cough, sore throat (consult with your health care provider for potential
treatment if this becomes severe); headache (analgesics may be available to help);
increased susceptibility to infections (avoid crowded areas and people who might
have infections; use strict handwashing and good hygiene).
• Report fever, chills, lethargy; rash, difficulty breathing; swelling; worsening of
arthritis; severe diarrhea.

Adverse effects in Italic are most common; those in Bold are life-threatening.