Home Drug Guide Etanercept

Drug Guide

Generic Name

Etanercept

Brand Names Enbrel

Classification

Therapeutic: Antirheumatic, Disease-modifying

Pharmacological: Tumor necrosis factor (TNF) inhibitor

FDA Approved Indications

  • Moderate to severe rheumatoid arthritis
  • Juvenile idiopathic arthritis
  • Psoriasis (plaque psoriasis)
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Plaque psoriasis

Mechanism of Action

Etanercept is a fusion protein that acts as a decoy receptor for TNF-α, binding to it and preventing it from activating TNF receptors on cell surfaces, thereby reducing inflammation and immune response.

Dosage and Administration

Adult: Typically 50 mg once weekly by subcutaneous injection. Dose adjustments may be necessary based on the condition.

Pediatric: Dose varies based on weight and indication; for juvenile idiopathic arthritis, usually 0.8 mg/kg once weekly, up to a maximum of 50 mg.

Geriatric: No specific dosing adjustments, but monitor for increased risk of infections.

Renal Impairment: No specific adjustment required; caution advised.

Hepatic Impairment: No specific adjustment required.

Pharmacokinetics

Absorption: Subcutaneous administration with maximum serum concentrations reached in 48-125 hours.

Distribution: Once absorbed, distributes mainly to the extracellular fluid.

Metabolism: Metabolized via proteolytic pathways, similar to other proteins.

Excretion: Eliminated via proteolytic degradation, not primarily cleared by the kidneys.

Half Life: Approximately 4.4 days.

Contraindications

  • Active infections, including tuberculosis
  • Hypersensitivity to etanercept or its components

Precautions

  • History of recurrent infections
  • Patient with demyelinating diseases
  • Congestive heart failure
  • Screen for latent tuberculosis prior to therapy
  • Use caution in patients with hepatitis B or C

Adverse Reactions - Common

  • Injection site reactions (Common)
  • Infections (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Serious infections (including tuberculosis) (Uncommon)
  • Reactivation of hepatitis B (Rare)
  • Potential increased risk of lymphoma and other malignancies (Rare)

Drug-Drug Interactions

  • Other biologic agents or immunosuppressants may increase risk of infections

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, injection site reactions, and changes in neurological status.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity

Implementation: Administer as prescribed subcutaneously, educate patient on infection signs.

Evaluation: Monitor for efficacy and adverse effects, including infections and adverse reactions.

Patient/Family Teaching

  • Report signs of infection promptly.
  • Use proper injection technique and rotate injection sites.
  • Avoid live vaccines during therapy.
  • Inform healthcare provider of all medications.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis and bacterial sepsis

Genetic Factors: None established

Lab Test Interference: Potential false-positive tests for tuberculosis or infectious diseases.

Overdose Management

Signs/Symptoms: Potential for increased immunosuppression leading to infections.

Treatment: Supportive care; discontinuation of drug if overdose suspected.

Storage and Handling

Storage: Refrigerate at 2°C to 8°C (36°F to 46°F). Do not freeze.

Stability: Stable until expiration date when stored as recommended.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.