etanercept

etanercept /eta·ner·cept/ (e-tan´er-sept) a soluble tumor necrosis factor receptor that inactivates tumor necrosis factor, used in the treatment of rheumatoid arthritis.

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e·tan·er·cept (-tnr-spt)

n.

A drug that blocks tumor necrosis factor receptors and is used primarily to treat rheumatoid arthritis.

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etanercept,

a biologic agent.

indication It is used to treat acute, chronic rheumatoid arthritis that has not responded to other treatments.

contraindications Known hypersensitivity and sepsis prohibit its use.

adverse effects Adverse effects include abdominal pain, dyspepsia, headache, asthenia, dizziness, injection site reaction, cough, upper respiratory infection, non-upper respiratory infection, and sinusitis. Common side effects include rash, pharyngitis, and rhinitis.

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etanercept

Enbrel

Pharmacologic class: Immunomodulator

Therapeutic class: Antiarthritic

Pregnancy risk category B

Action

Reacts with and deactivates free-floating tumor necrosis factor, responsible for inflammation

Availability

Powder for injection: 25 mg in multiple-use vial

Prefilled syringe (single-use): 50 mg/ml

⊘Indications and dosages

➣ Moderately to severely active rheumatoid arthritis; ankylosing spondylitis; psoriatric arthritis

Adults: 50 mg subcutaneously q week given as a single injection. Dosages above 50 mg/week are not recommended.

➣ Chronic moderate to severe plaque psoriasis

Adults ages 18 and older: 50 mg subcutaneously twice weekly (given 3 or 4 days apart) for 3 months, followed by reduction to a maintenance dosage of 50 mg weekly

➣ Polyarticular-course juvenile rheumatoid arthritis

Children ages 4 to 17: 0.8 mg/kg subcutaneously q week, to a maximum of 50 mg weekly

Contraindications

• Hypersensitivity to drug or its components
• Sepsis

Precautions

Use cautiously in:
• immunosuppression, chronic infection, heart failure
• latex allergy (needle cover of diluent syringe contains latex)
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 4.

Administration

• Inject subcutaneously into thigh, abdomen, or upper arm.
• For adult, use single-use, 50 mg/ml prefilled syringe.
• For child weighing 63 kg (138 lb) or more, use single-use, 50 mg/ml prefilled syringe for weekly dose; for child weighing 31 to 62 kg (68 to 137 lb), administer total weekly dose from multiple-use vial as two injections on same day or 3 or 4 days apart; for child weighing less than 31 kg (68 lb), give as a single weekly injection using multiple-use vial.
• Rotate injection sites.

Route	Onset	Peak	Duration
Subcut.	Slow	72 hr	Unknown

Adverse reactions

CNS: asthenia, headache, depression, dizziness, paresthesia, fatigue, demyelinating disorders (such as multiple sclerosis and myelitis), cerebral hemorrhage, seizures, cerebrovascular accident (CVA)

CV: hypotension, hypertension, chest pain, deep-vein thrombosis, thrombophlebitis, myocardial ischemia, myocardial infarction (MI), heart failure

EENT: ocular inflammation, pharyngitis, rhinitis, sinusitis

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, cholecystitis, abdominal abscess, GI hemorrhage, intestinal perforation, pancreatitis

GU: pyelonephritis, membranous glomerulonephropathy

Hematologic: anemia, aplastic anemia, leukopenia, pancytopenia, thrombocytopenia

Metabolic: hypomagnesemia

Musculoskeletal: bursitis, polymyositis, joint pain

Respiratory: cough, congestion, dyspnea, bronchitis, pneumonia, pulmonary embolism, interstitial lung disease

Skin: flushing, cellulitis, pruritus, rash, cutaneous vasculitis, urticaria, alopecia, angioedema

Other: altered taste, weight gain, adenopathy, fever, irritation at injection site, peripheral edema, flulike symptoms, autoantibody formation, lupus-like syndrome, serious infections

Interactions

None significant

Patient monitoring

☞ Watch for signs and symptoms of pancytopenia and infection.
☞ Monitor for evidence of GI bleeding, lupus-like syndrome, and serious hypersensitivity reactions. Stop therapy immediately if these occur.
• Monitor CBC and coagulation studies.
☞ Check for signs and symptoms of cardiac compromise and cerebrovascular events.
• Monitor pulmonary function test results periodically to assess lung status.
• Assess patient's ability to self-administer drug.
• Check for irritation at injection site. As needed, apply cool compresses.
• Examine eyes for conjunctival dryness. As needed, apply artificial tears.

Patient teaching

☞ Tell patient to withhold dose and contact prescriber if he develops signs or symptoms of infection or is exposed to anyone with chickenpox.
☞ Tell patient to immediately report hypersensitivity reaction, neurologic or respiratory problems, sudden weight gain, chest pain, or easy bruising or bleeding.
• Teach patient or caregiver how to administer drug and handle and dispose of equipment.
• Caution patient not to get live-virus vaccines.
• Tell female to inform prescriber if she is pregnant or breastfeeding.
• Advise patient to expect redness, swelling, and pain at injection site. Assure him that these problems will diminish over time.
• As appropriate, review all other significant and life-threatening adverse reactions mentioned above.

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etanercept

Molecular medicine A genetically engineered molecule that blocks TNF activity, used to manage therapeutically refractive rheumatoid arthritis. See Rheumatoid arthritis.