Home Drug Guide Etanercept-szzs

Drug Guide

Generic Name

Etanercept-szzs

Brand Names Erelzi

Classification

Therapeutic: Immunosuppressant, Anti-rheumatic agent

Pharmacological: Tumor necrosis factor (TNF) inhibitor

FDA Approved Indications

Juvenile idiopathic arthritis (JIA)
Ankylosing spondylitis
Crohn's disease (moderate to severe)
Plaque psoriasis
Psoriatic arthritis
Rheumatoid arthritis

Mechanism of Action

Erelzi (etanercept-szzs) is a recombinant biological agent that acts as a decoy receptor for TNF-alpha, binding to TNF-alpha and reducing its activity, thereby diminishing inflammatory responses.

Dosage and Administration

Adult: Typically, 50 mg subcutaneously once weekly or 25 mg twice weekly. Dose adjustments depend on specific condition and response.

Pediatric: Doses vary based on weight and condition; for juvenile idiopathic arthritis, common doses are 0.8 mg/kg (up to 50 mg) once weekly.

Geriatric: Generally, no adjustment necessary but caution advised due to increased risk of infections.

Renal Impairment: No specific adjustment, but caution recommended.

Hepatic Impairment: No specific adjustment, caution advised.

Pharmacokinetics

Absorption: Slow subcutaneous absorption with peak serum concentrations in 48-120 hours.

Distribution: Widely distributed in the extracellular fluid.

Metabolism: Metabolized by proteolytic enzymes; no significant hepatic metabolism.

Excretion: Primarily via cellular uptake and degradation; no specific renal excretion data.

Half Life: Approximately 4.8 days (115 hours).

Contraindications

Hypersensitivity to etanercept or excipients
Active infections, including localized infections

Precautions

Screen for latent tuberculosis before starting therapy
Monitor closely for signs of infection during treatment
Use caution in patients with heart failure
Potential for development of autoimmune antibodies, including lupus-like syndrome

Adverse Reactions - Common

Injection site reactions (Common)
Upper respiratory infections (Common)
Headache (Common)

Adverse Reactions - Serious

Serious infections (e.g., tuberculosis, sepsis) (Uncommon to rare)
Lymphoma and other malignancies (Rare)
Demyelinating diseases (Rare)
Hepatitis B reactivation (Rare)

Drug-Drug Interactions

Other immunosuppressants, Live vaccines (avoid concomitant use)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline screening for tuberculosis, hepatitis B/C, and screening for autoimmune diseases.

Diagnoses:

Risk for infection
Impaired skin integrity

Implementation: Administer subcutaneously as prescribed, monitor for signs of infection or adverse reactions.

Evaluation: Assess for therapeutic response and adverse effects, monitor for infections throughout therapy.

Patient/Family Teaching

Report signs of infection promptly.
Do not receive live vaccines during therapy.
Maintain good hygiene and avoid contact with sick individuals.
Inform healthcare providers about etanercept therapy prior to any surgery or dental procedures.

Special Considerations

Black Box Warnings:

Risk of serious infections and malignancies, including lymphoma.

Genetic Factors: Patients with certain genetic predispositions may have increased risk of adverse effects.

Lab Test Interference: May cause false-positive results in tuberculin skin testing; confirm with other diagnostics.

Overdose Management

Signs/Symptoms: Unusual increase in side effects or signs of infection.

Treatment: Supportive care; no specific antidote; discontinue etanercept and monitor patient closely.

Storage and Handling

Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze.

Stability: Stable until expiration date if stored properly. Protect from light and freezing.