Enbrel is a brand-name prescription drug that treats certain autoimmune conditions in which the immune system attacks healthy cells, causing inflammation, pain, and tissue damage. It is approved to treat rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and polyarticular juvenile idiopathic arthritis. Etanercept, the active ingredient in Enbrel, is a monoclonal antibody that is part of a group of drugs called TNF blockers. It attaches to and blocks the activity of one of the key inflammatory signaling molecules called TNF. Enbrel is administered as a subcutaneous injection (under the skin) once or twice per week.
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Enbrel forms and strengths
Enbrel is usually self-administered or given by a caretaker as a subcutaneous injection. Enbrel is available in different forms.
Single-dose prefilled SureClick autoinjector: 50 mg/mL
Enbrel Mini single-dose prefilled cartridge for use with the AutoTouch reusable autoinjector: 50 mg/mL
Single-dose prefilled syringe: 25 mg/0.5 mL or 50 mg/mL
Single-dose vial: 25 mg/0.5 mL
Powder in a multidose vial: 25 mg to be reconstituted, or mixed, with 1 mL of sterile water
Enbrel dosage for adults
For adult patients, Enbrel is prescribed to treat plaque psoriasis and different forms of arthritis, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The usual dosage is 50 mg injected under the skin once or twice per week.
| Enbrel dosage chart | |||
|---|---|---|---|
| Indication | Starting dosage | Standard dosage | Maximum dosage |
| Rheumatoid arthritis | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg weekly |
| Psoriatic arthritis | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg weekly |
| Plaque psoriasis | 50 mg subcutaneous injection taken twice per week (with 3 to 4 days in between each dose) for 3 months | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 100 mg weekly for starting dosage and 50 mg weekly for standard dosage |
| Ankylosing spondylitis | 50 mg subcutaneous injection taken once per week or or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg subcutaneous injection taken once per week or or two 25 mg subcutaneous injections taken twice per week (with 3 to 4 days in between each dose) | 50 mg weekly |
Source: Epocrates, Enbrel prescribing information, Prescriber’s Digital Reference
Enbrel dosage for rheumatoid arthritis (RA)
Enbrel is prescribed to treat rheumatoid arthritis, a progressive autoimmune disease that causes inflammation in the soft tissues of the body, including the joints. Certain substances, such as tumor necrosis factor (TNF), activate the inflammatory response of the immune system. However, elevated levels of TNF may contribute to RA flare-ups and cause symptoms like pain and stiffness in the joints. Etanercept is a TNF inhibitor that binds and stops the activity of TNF.
Standard Enbrel dosage for rheumatoid arthritis: 50 mg subcutaneous injection taken once per week, or two 25 mg subcutaneous injections taken twice per week with three to four days in between each dose
Maximum Enbrel dosage for rheumatoid arthritis: 50 mg weekly
Enbrel dosage for psoriatic arthritis (PsA)
Enbrel is FDA-approved to treat psoriatic arthritis (PsA), a type of arthritis associated with psoriasis (PsO). Psoriatic arthritis affects about 20% to 30% of people with psoriasis. Enbrel helps improve the symptoms of psoriatic arthritis by blocking the critical role tumor necrosis factor plays in stimulating the body’s inflammatory response.
Standard Enbrel dosage for psoriatic arthritis: 50 mg subcutaneous injection taken once per week, or two 25 mg subcutaneous injections taken twice per week with three to four days in between each dose
Maximum Enbrel dosage for psoriatic arthritis: 50 mg weekly
Enbrel dosage for plaque psoriasis (PsO)
Enbrel can be used to treat chronic moderate to severe plaque psoriasis in people who are candidates for systemic therapy or phototherapy. In plaque psoriasis, the immune system attacks healthy skin cells, producing thick, scaly patches of skin on the scalp, trunk, and other areas of the body. Enbrel improves the symptoms of plaque psoriasis by blocking TNF and the immune response that may contribute to inflammation and skin plaques. Treatment is usually started at 50 mg twice per week for three months, after which the standard dosage is taken.
Standard Enbrel dosage for plaque psoriasis: 50 mg subcutaneous injection taken once per week, or two 25 mg subcutaneous injections taken twice per week with three to four days in between each dose
Maximum Enbrel dosage for plaque psoriasis: 50 mg weekly
Enbrel dosage for ankylosing spondylitis (AS)
Adults with active ankylosing spondylitis may be prescribed Enbrel. Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the spine, but it can also affect the pelvis, ribs, shoulders, and heels. As with rheumatoid arthritis, ankylosing spondylitis may be associated with elevated levels of tumor necrosis factor, the molecule primarily responsible for promoting inflammation. Etanercept shuts down the inflammatory process that causes the symptoms of ankylosing spondylitis by blocking the effects of TNF.
Standard Enbrel dosage for active ankylosing spondylitis: 50 mg subcutaneous injection taken once per week, or two 25 mg subcutaneous injections taken twice per week with three to four days in between each dose
Maximum Enbrel dosage for active ankylosing spondylitis: 50 mg weekly
Enbrel dosage for children
Enbrel is FDA-approved to treat children as young as 4 years of age for plaque psoriasis and children as young as 2 years of age for moderate to severe polyarticular juvenile idiopathic arthritis. For children, a dose of Enbrel is usually based on body weight. Children weighing less than 63 kilograms (138 pounds) may be prescribed a weekly dose of 0.8 mg per kilogram. For children weighing 63 kilograms or more, the weekly dose is the same as that for adults.
| Enbrel pediatric dosage chart | ||||
|---|---|---|---|---|
| Indication | Age | Weight | Standard dosage | Maximum dosage |
| Plaque psoriasis | 4–17 years | <63 kg | 0.8 mg/kg given once per week or 0.4 mg/kg twice per week with 3 to 4 days in between each dose | 50 mg weekly |
| ≥63 kg | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week with 3 to 4 days in between each dose | 50 mg weekly | ||
| Polyarticular juvenile idiopathic arthritis | 2–17 years | <63 kg | 0.8 mg/kg given once per week or 0.4 mg/kg twice per week with 3 to 4 days in between each dose | 50 mg weekly |
| ≥63 kg | 50 mg subcutaneous injection taken once per week or two 25 mg subcutaneous injections taken twice per week with 3 to 4 days in between each dose | 50 mg weekly |
Source: Epocrates
Enbrel dosage restrictions
Enbrel should not be used in people with an active infection, such as tuberculosis, or sepsis. The use of Enbrel can increase the risk of severe complications from infections.
It is not recommended to use Enbrel in people with granulomatosis with polyangiitis, a rare autoimmune condition. Enbrel can increase the risk of cancer in people with granulomatosis with polyangiitis.
TNF blockers like Enbrel are immunosuppressants, that is, they weaken the immune system, the body’s first line of defense against different pathogens. For this reason, certain people may need to be monitored more closely while using Enbrel, including:
People who are older than 65
People with a history of chronic or opportunistic infections
People with latent tuberculosis, previous hepatitis B infection, or varicella exposure
People with uncontrolled diabetes
People with neurological disorders, like seizures
People who are at risk for malignancies, or cancer growths, including skin cancer
People with heart failure
People with hepatitis, or liver disease
People with congestive heart failure, moderate to severe alcoholic hepatitis, or any central or peripheral nervous system demyelinating disease (such as multiple sclerosis) may need to be regularly monitored and tested for problems while taking Enbrel.
How to take Enbrel
Enbrel is administered as a subcutaneous injection once or twice per week. It can either be self-administered or given by a caretaker. It is available in different forms:
The single-dose prefilled SureClick autoinjector is designed to give a single once-per-week 50 mg injection. Once the injection is finished, the SureClick autoinjector is disposed of in a sharps container.
The Enbrel Mini single-dose prefilled cartridge is inserted into the AutoTouch reusable autoinjector to administer a once-per-week 50 mg injection. The needle is inside the Enbrel Mini cartridge. Once the injection is finished, the used Enbrel Mini cartridge is removed and disposed of in a Sharps container. The AutoTouch can be cleaned with an alcohol wipe and reused the next week.
The Enbrel single-dose prefilled syringe is a standard syringe and needle with either a 25 mg dose given twice weekly or a 50 mg dose given once weekly. When the injection is finished, the empty syringe and needle are disposed of in a sharps container.
The Enbrel single-dose vial is intended for use with a standard syringe and needle. Each vial contains only 25 mg, so a 50 mg dose will require two vials. The vial contains both medicine and liquid, so the medicine will not need to be reconstituted. Withdrawing the medicine from the vial into the syringe and making an injection involves a series of steps. When the injection is finished, both the needle and syringe should be disposed of in a sharps container.
Each injection method may involve several steps. To make an injection, follow the instructions provided in the demonstration and the illustrated instructions for use.
A healthcare professional will demonstrate all the steps in giving an injection. Make sure you understand those instructions.
Each prescription will include illustrated instructions for use for the injection method prescribed. Read these instructions before giving each injection. The illustrated instructions can also be found in the Enbrel prescribing information
or on the Enbrel website. Amgen, the manufacturer of Enbrel, provides useful video demonstrations
on how to administer an injection using any one of the injection methods. When starting treatment, it’s helpful to watch these videos before each injection.
Always remember the following general instructions when taking Enbrel:
Take this medicine as directed by a healthcare professional. Follow the dosing schedule given by the prescriber.
Each Enbrel prescription is packaged with a medication guide. It has valuable medical advice and information about adverse effects. Read this medication guide after picking up each prescription.
A healthcare provider will demonstrate where the injection can be made. These include the stomach area, thighs, and upper arms.
To avoid injection site reactions or other problems, choose a different injection area for each injection.
Always inspect the medicine and the injector. The medication guide will tell you what to look for. Do not use the injector or the medicine if there is a problem with the injector or the medicine is discolored, cloudy, or has lumps floating in it.
Do not shake the medicine or the injection device before administration.
Store Enbrel in a refrigerator (36°F to 46°F). Do not freeze. The medicine can be stored at room temperature (68°F to 77°F) away from heat and light for up to 14 days
. Remove the medicine from the refrigerator 30 minutes before giving the injection to allow the medicine to warm to room temperature. Do not heat the medicine or expose it to sunlight while it warms up. Once the medicine has warmed to room temperature, do not put it back in the refrigerator.
Enbrel dosage FAQs
What happens if I miss a dose of Enbrel?
If a dose is missed, take that dose as soon as it’s remembered. Take the next dose at the regularly scheduled time. Do not administer two Enbrel injections at the same time to make up for a missed dose.
How do I stop taking Enbrel?
Enbrel can be stopped at any time without causing withdrawal symptoms. However, before stopping Enbrel, make sure to consult with a healthcare professional.
Some people may decide to stop taking Enbrel for several reasons. The use of Enbrel may increase the risk of serious adverse reactions that may require hospitalization, such as blood problems (aplastic anemia or pancytopenia), Guillain-Barre syndrome, lupus-like syndrome, malignancies (melanoma, non-melanoma skin cancer, leukemia, or lymphoma), serious infections (tuberculosis or invasive fungal infections), new-onset congestive heart failure, and inflammatory bowel disease. Some people might develop immunity to the drug and need to switch to another drug. Certain side effects, such as respiratory infections, diarrhea, and injection site reactions, may be intolerable for other people.
Fortunately, different drugs can help manage the immune system response in people with plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Other drugs, such as corticosteroids (prednisone, dexamethasone, etc.), antimetabolites (methotrexate), and biologic immunosuppressants (secukinumab, abatacept, etc.), may be prescribed instead of Enbrel.
Can you overdose on Enbrel?
An overdose on Enbrel is possible. However, in clinical trials, no effects of toxicity have been observed in people receiving twice the recommended dose. If an overdose is suspected, call a poison control center or seek immediate medical attention from a healthcare provider.
What interacts with Enbrel?
As with most prescription drugs, Enbrel is associated with certain drug interactions. Because Enbrel is an immunosuppressant, drug interactions typically involve other drugs or substances that can also suppress the immune system.
Live vaccines should not be taken while using Enbrel because of the risk of serious infections. It is important to undergo any necessary immunizations before starting Enbrel.
Biologics can act as immunosuppressants and increase the risk for serious infection when combined with Enbrel. The use of Enbrel should be avoided with Kineret (anakinra) or Orencia (abatacept).
Cyclophosphamide, an anticancer drug, is associated with an increased risk of developing certain cancers when combined with Enbrel.
Doses of anti-diabetic medications may need to be lowered in people who are taking Enbrel due to an increased risk of hypoglycemia
.The combination of Enbrel and sulfasalazine, a disease-modifying anti-rheumatic drug (DMARD), may cause low white blood cell counts.
Is it safe to take Enbrel during pregnancy?
Studies have shown that there is no increased risk of birth defects in pregnant women taking Enbrel. However, it is important to consult a healthcare professional to weigh the risks and benefits of using Enbrel while pregnant.
Enbrel may be present in small amounts in breast milk and poorly absorbed by infants. Not enough data is available on the long-term effects of etanercept in breastfed infants. Consult a healthcare provider before taking Enbrel while breastfeeding.
Related resources for Enbrel dosages:
Ankylosing spondylitis
, StatPearlsEnbrel
, EpocratesEnbrel prescribing information
, U.S. National Library of MedicineEnbrel patient website
, AmgenEtanercept
, Drugs and Lactation DatabaseEtanercept drug summary
, Prescriber’s Digital ReferencePsoriatic arthritis
, StatPearls
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