Do Enbrel (etanercept) injections hurt?

• People do report stinging for up to 20 seconds after Enbrel administration.
• When cleaning the injection site with an alcohol swab, always allow the alcohol to evaporate off so that your skin is dry before administering Enbrel.
• Numbing the area with ice before and after administration may also help reduce stinging.
• Injecting into the stomach area is generally less painful than injecting into the thigh.
• Make sure you rotate injection sites to reduce scar tissue build up.
• Allowing a family member or friend to give you the shots instead can help reduce the anticipation, which generally makes it less painful.

Enbrel (etanercept) is a subcutaneous (under the skin) injection that is administered either once or twice a week and is approved to treat several inflammatory conditions such as psoriasis and rheumatoid arthritis. It belongs to the class of medicines called TNF inhibitors.

Enbrel, like most other biologics, is unable to be given orally because it is such an unstable molecule it barely gets absorbed. Which is why it needs to be given by injection.

People who give themselves Enbrel do report stinging for a short period (up to 20 seconds) after administration.

But there are several things you can do to make the process less painful.

• Make sure you or your doctor or nurse take Enbrel out of the refrigerator for at least 30 minutes before your injection is due to give it time to warm up to room temperature.
• Ask your doctor or nurse to inject the Enbrel slowly, if they are using a prefilled syringe (if your Enbrel is given via an autoinjector you have no control over the speed of the delivery).
• Do your first self-injection in a doctor’s office, so you can ask questions about the process.
• Rotate the injection site. Some people have at least six injection sites that they use, located in their stomach area, upper thigh or upper arm. Changing where you administer Enbrel every week means scar tissue is less likely to build up in that area.
• Blog sites report that injecting into the stomach area is generally less painful than injecting into the thigh.
• When you clean your injection site with an alcohol wipe, allow it to dry completely before administering your Enbrel.
• Consider using ice to numb the site before you inject as well as holding ice on the injection site afterwards to reduce pain and swelling.
• Count while you are administering the injection, blast some music or sing a song to take your mind off it.
• Have a support person sit next to you while you are administering your shot.
• Reward yourself afterwards.
• Train a family member to give you your shots.

How do I give myself an Enbrel injection?

Enbrel should be kept refrigerated at between 36°F to 46°F (2°C to 8°C) until it needs to be administered.

• Take your Enbrel autoinjector out of the refrigerator and let it warm up naturally to room temperature for 30 minutes. Do not put it in the microwave or use hot water to heat it. Do not shake the autoinjector or remove the white cap just yet.
• Wash your hands with soap and water.
• Check the injection status through the viewing window of your Enbrel autoinjector. The fluid inside should look clear and colorless. There may be some small white particles in the medicine. Do not use if the medicine is cloudy or discolored or contains large particles. Also, check the expiry date located on the side of the autoinjector and do not use it if expired.
• Choose an injection site and wipe it with an alcohol wipe. Let it dry. Do not use a site where the skin is discolored, bruised, broken, covered with a psoriatic lesion, or has a rash.
• Pull the Enbrel autoinjector cap straight off. Do not leave the cap off for more than five minutes as this can dry out the medicine
• Create a firm surface on your injection site by either using your fingers to stretch out the skin or pinch it up.
• Place the autoinjector on your chosen injection site at a 90° angle (straight up and down). Firmly press and hold down the Enbrel autoinjector.
• Once you are ready to inject, push down on the purple start button. This will insert the needle and start the injection. You will hear a clicking sound.
• Hold the autoinjector down firmly until the clicking sound stops and the viewing window turns from clear to yellow when the injection is done. You may hear a second click. If the window doesn’t change color contact your health care provider.
• Dispose of your autoinjector and cap in an approved sharps bin. Do not put the cap back on the autoinjector.

Each Enbrel autoinjector is administered just one time only.

Enbrel may be left unrefrigerated for a maximum of 14 days, as long as it is kept at room temperature between 68°F to 77°F (20°C to 25°C) and not exposed to light or a heat source. If Enbrel is not used within 14 days after being taken out of the fridge, throw it away in an approved sharps container.

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What is Enbrel used for?

Enbrel is approved to treat the following conditions:

• Rheumatoid arthritis
• Plaque psoriasis in adults and children who are at least 4 years old
• Psoriatic arthritis
• Ankylosing spondylitis
• Polyarticular juvenile idiopathic arthritis in children who are at least 2 years old.

It is sometimes used in combination with methotrexate when used to treat rheumatoid arthritis and psoriatic arthritis.