Formulary
Etanercept: Indications, Dosing, Side Effects and Interactions
Etanercept clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Etanercept: Indications, Dosing, Side Effects and Interactions
Etanercept clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Rheumatoid arthritis (initiated by a specialist),Psoriatic arthritis (initiated by a specialist),Ankylosing spondylitis (initiated by a specialist),Non-radiographic axial spondyloarthritis (initiated by a specialist)**
- **Adult** (By Subcutaneous Injection): 25 mg twice weekly, alternatively 50 mg once weekly, review treatment if no response within 12 weeks of initial dose.
**Plaque psoriasis (initiated by a specialist)**
- **Adult** (By Subcutaneous Injection): 25 mg twice weekly, alternatively 50 mg once weekly, alternatively 50 mg twice weekly for up to 12 weeks, followed by 25 mg twice weekly, alternatively 50 mg once weekly if required for up to 24 weeks-continuous therapy beyond 24 weeks may be appropriate in some patients (consult product literature), discontinue if no response after 12 weeks.
**Plaque psoriasis (initiated by a specialist) for etanercept**
- **Child 6-17 years** (By subcutaneous injection): 800 micrograms/kg once weekly (max. per dose 50 mg) for up to 24 weeks, discontinue if no response after 12 weeks.
**Polyarthritis (initiated by a specialist), Oligoarthritis (initiated by a specialist) for etanercept**
- **Child 2-17 years** (By subcutaneous injection): 400 micrograms/kg twice weekly (max. per dose 25 mg), to be given at an interval of 3-4 days between doses, alternatively 800 micrograms/kg once weekly (max. per dose 50 mg), consider discontinuation if no response after 4 months.
**Psoriatic arthritis (initiated by a specialist), Enthesitis-related arthritis (initiated by a specialist) for etanercept**
- **Child 12-17 years** (By subcutaneous injection): 400 micrograms/kg twice weekly (max. per dose 25 mg), to be given at an interval of 3-4 days between doses, alternatively 800 micrograms/kg once weekly (max. per dose 50 mg), consider discontinuation if no response after 4 months.
Cautions
Development of malignancy; diabetes mellitus; heart failure (risk of exacerbation); hepatitis B virus-monitor for active infection; hepatitis C infection (monitor for worsening infection); history of blood disorders; history of malignancy; history or increased risk of demyelinating disorders; predisposition to infection (avoid if predisposition to septicaemia); significant exposure to herpes zoster virus-interrupt treatment and consider varicella-zoster immunoglobulin Cautions, further information Tuberculosis Active tuberculosis should be treated with standard treatment for at least 2 months before starting etanercept. Patients who have previously received adequate treatment for tuberculosis can start etanercept but should be monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not treated adequately, chemoprophylaxis should ideally be completed before starting etanercept. In patients at high risk of tuberculosis who cannot be assessed by tuberculin skin test, chemoprophylaxis can be given concurrently with etanercept.
Contraindications
Active infection
Side effects
Common or very common Cystitis; fever; headache; hypersensitivity; increased risk of infection; skin reactions Uncommon Abscess; anaemia; angioedema; bursitis; cholecystitis; diarrhoea; endocarditis; eye inflammation; gastritis; heart failure; hepatic disorders; inflammatory bowel disease; leucopenia; myositis; neoplasms; neutropenia; sepsis; skin ulcers; thrombocytopenia; vasculitis Rare or very rare Bone marrow disorders; cutaneous lupus erythematosus; demyelination; interstitial lung disease; lupus-like syndrome; nerve disorders; pulmonary fibrosis; sarcoidosis; seizure; severe cutaneous adverse reactions (SCARs); transverse myelitis Frequency not known Dermatomyositis exacerbated; hepatitis B reactivation Side-effects, further information Associated with infections, sometimes severe, including tuberculosis, septicaemia, and hepatitis B reactivation.
Interactions
**Severe interactions:**
- Concurrent treatment with anakinra Adult patients treated with etanercept and anakinra were observed to have a higher rate of serious infection when compared with patients treated with either...
- In addition, in a double-blind, placebo-controlled trial in adult patients receiving background methotrexate, patients treated with etanercept and anakinra were observed to have a higher rate of...
- Concurrent treatment with abatacept In clinical studies, concurrent administration of abatacept and etanercept resulted in increased incidences of serious adverse events.
- Concurrent treatment with sulfasalazine In a clinical study of adult patients who were receiving established doses of sulfasalazine, to which etanercept was added, patients in the combination group...
- No clinically significant pharmacokinetic drug-drug interactions were observed in studies with methotrexate, digoxin or warfarin.
**Other interactions (3):**
- The combination etanercept and anakinra has not demonstrated increased clinical benefit and is therefore not recommended.
- Physicians should use caution when considering combination therapy with sulfasalazine.
- Non-interactions In clinical trials, no interactions have been observed when etanercept was administered with glucocorticoids, salicylates (except sulfasalazine), nonsteroidal anti-inflammatory...
Pregnancy
Use only if essential. M
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises caution in moderate to severe alcoholic hepatitis.
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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