Etanercept-szzs (Solution, Subcutaneous, Injection)

Etanercept-szzs is a drug that is used to treat the effects of certain forms of arthritis, including psoriatic and rheumatoid arthritis. It is also used to treat children who have polyarticular juvenile idiopathic arthritis.

Overview

In the US, etanercept-szzs is known by the brand name, Erelzi. The drug comes on prescription from your treating physician and is administered via an injection under the skin.

Etanercept-szzs is used to treat the symptoms and effects of certain types of arthritis, including rheumatoid arthritis and psoriatic arthritis. The drug can also be effective in reducing joint swelling, tiredness, pain, and morning stiffness duration in other conditions such as plaque psoriasis and ankylosing spondylitis. Etanercept-szzs is usually the medication of choice when treating children aged over two years of age who are suffering from a condition called polyarticular juvenile idiopathic arthritis.

Conditions treated

Type of medicine

  • Injection
  • Solution

Side effects

Together with the effects it is designed to have, some medications can cause unwanted side effects. Not all patients notice any side effects at all when using etanercept-szzs, but if you do experience anything strange while taking this drug, you may need to seek further medical attention.

If you notice any of the side effects listed below, you should check with your treating physician straight away:

  • Yellow skin and eyes
  • Weight gain or loss
  • Upper right abdominal or stomach pain
  • Unusual tiredness or weakness
  • Unusual bleeding or bruising
  • Troubled breathing with exertion
  • Tightness in the chest
  • Swollen or painful glands
  • Swelling of the face, fingers, feet, or lower legs
  • Sudden numbness and weakness in the arms and legs
  • White spots, sores, ulcers, on the lips or in the mouth
  • Sore throat
  • Sneezing
  • Slurred speech
  • Seizures
  • Runny nose
  • Red, irritated eyes
  • Red skin lesions, frequently with a purple center
  • Swelling or puffiness of the eyelids, or around the eyes, face, lips, or tongue
  • Pale skin
  • Painful or difficult urination
  • Numbness or tingling in your arms, fingers, legs, feet, or face
  • Development of new moles
  • Nausea and vomiting
  • Nasal congestion
  • Sudden, progressive muscle weakness
  • Muscle aches or cramps
  • Mole that leaks fluid or bleeds
  • Lower back or side pain
  • Loss of voice
  • Light-colored stools
  • Joint or muscle pain
  • Irregular heartbeat
  • Irregular breathing
  • Paralysis of the arms and legs
  • Hives, itching, or rash
  • High fever
  • Headache
  • General tiredness and weakness
  • General feeling of illness
  • Fever or chills
  • Feeling sad or depressed
  • Fast heartbeat
  • Eye pain
  • Extreme fatigue
  • Ear congestion
  • Dizziness
  • Dilated neck veins
  • Difficulty with walking
  • Difficulty with swallowing
  • Difficulty with breathing
  • Difficulty controlling bladder or bowels
  • Diarrhea
  • Decreased vision
  • Decreased urine output
  • Dark urine
  • Cough or hoarseness
  • Chest pain
  • Changes in size, shape, or color of existing moles
  • Bone pains
  • Body aches or pains
  • Blurred vision
  • Blue-yellow color blindness
  • Bloody, black, or tarry stools
  • Blistering, peeling, or loosening of the skin
  • Blindness
  • Black, tarry stools
  • Sudden or severe back pain

There are some effects that can be caused by etanercept-szzs that do not need medical attention. These effects usually resolve themselves as your body gets used to the new medication. Your doctor may be able to recommend ways in which you can mitigate or prevent some or all of these unwanted effects. However, if any of the side effects are very persistent or cause you considerable inconvenience, you should have a chat with your treating physician.

Self-resolving side effects caused by etanercept-szzs include the following that can occur at the injection site:

  • Soreness, stinging, swelling, tenderness, tingling and ulceration
  • Scarring
  • Redness
  • Rash
  • Pain
  • Numbness
  • Lumps
  • Itching
  • Inflammation
  • Infection
  • Hives
  • Feeling of pressure
  • Blistering, burning, coldness, or discoloration of the skin
  • Bleeding

There are a number of effects reported by some patients that are not included in this overview. If you experience any other odd or unusual effects, you should check with your GP right away.

Dosage

Etanercept-szzs is administered via subcutaneous injection (a shot under the skin). The medication may be given in your own home, in which case your nurse or GP will show you how to prepare and administer the drug. Make sure that you are confident in how to use the medication before you try to self-dose.

Your prescription of etanercept-szzs will be accompanied by a medication guide, containing important information about the use of the drug, which you should read thoroughly. If you do not understand any of the instructions in the guide, ask your pharmacist or GP for clarification.

You will be shown whereabouts on the body the injection should be given. Use a different injection site each time you administer a dose of the drug and make a note of where each shot was given to ensure that you rotate the sites. This is important to avoid causing adverse skin reactions.

You may be given etanercept-szzs either as a prefilled syringe or as a prefilled Sensoready® pen.

Note that both these forms of injectable etanercept-szzs devices have an integral latex rubber component. If you or your child has a sensitivity to latex, you should tell your doctor before you begin using this medication.

Usage guide

  • Before and after you use the medication, you should wash and dry your hands.
  • Take the product from the fridge and put it on a clean cloth. Allow up to 30 minutes for the product to reach room temperature.
  • While the device warms up, do not remove the needle cover. Leave this in place until you are ready to use the device. Do not shake the device.
  • Before use, inspect the liquid within the device to make sure that it is clear and either colorless or very slightly yellow. If the liquid has white particles floating in it or appears cloudy, do not use it.
  • You may inject the drug into your thigh, stomach, or lower abdomen. Choose a suitable injection site and clean it with a fresh alcohol wipe. Allow the site to dry.
  • Avoid using any areas where the skin is bruised, red, hard, or tender.
  • When you are ready to administer the injection, remove the cap or needle cover from the device.
  • After you have administered the drug, discard the used device in a sharps box that will not allow the needles to punch through. Keep the sharps box well away from pets and children.

Dose levels

Note that different patients will be prescribed differing doses of etanercept-szzs. Keep to the dosage levels that your doctor gave you or that are shown on the dispensary label on the product. The information given in this guide is based on the average. If your dose varies from this, do not change it unless you are told to do so by your GP.

The size of the dose depends on the strength of the preparation you have been given. The number of daily doses, the dose frequency, and the overall length of your course of treatment will depend on the medical condition for which you are being treated.

Prefilled syringe or Sensoready® pen ' for juvenile idiopathic arthritis:

  • Children aged over 2 years, over 63 kg in weight: take 50 mg once weekly.
  • Children aged over 2 years, under 63 kg in weight: your child's doctor will calculate the dose and determine frequency of use.
  • Children aged under 2 years: your child's doctor will calculate the dose and determine frequency of use.

Prefilled syringe or Sensoready® pen'for plaque psoriasis:

  • Adults: initially, take 50 mg two times each week, at intervals of three or four days for a duration of three months. Your dose will then be cut down to 50 mg once each week.
  • Children: your child's doctor will calculate the dose and determine frequency of use.

Prefilled syringe or Sensoready® pen'for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis:

  • Adults: initially, take 50 mg, once weekly.
  • Children: your child's doctor will calculate the dose and determine frequency of use.

If you forget to use a dose of etanercept-szzs, try to give it as soon as you can. If it is nearly time for your next injection, leave out the dose you missed and pick up where you left off with your correct dosing schedule.

Do not use a double dose to make up for the one you missed.

Interactions

Some drugs should never be used at the same time together, as this may cause an interaction between them, which could be harmful. However, if it is the best option for your treatment, your GP or specialist may decide to use two or more medications at the same time, even though there may be an interaction. In this case, you may be told to adjust the dose of one of the drugs or take other precautions to manage the expected interaction. The list of interactive drugs given in this guide is not necessarily all-inclusive. Be sure to tell your treating physician about any other form of medicine that you are using, including over the counter products, herbal remedies, or vitamin supplements.

It is not usually recommended that any of the medications listed below are used with etanercept-szzs. If you are prescribed both medicines, you may find that your GP has adjusted the dose of either of them or has changed the frequency of use of one or both of the drugs:

  • Yellow Fever Vaccine
  • Varicella Virus Vaccine
  • Typhoid Vaccine
  • Smallpox Vaccine
  • Rubella Virus Vaccine
  • Rotavirus Vaccine
  • Rilonacept
  • Poliovirus Vaccine
  • Mumps Virus Vaccine
  • Measles Virus Vaccine
  • Influenza Virus Vaccine
  • Cyclophosphamide
  • Bacillus of Calmette and Guerin Vaccine
  • Anakinra
  • Adenovirus Vaccine Type 7
  • Adenovirus Vaccine Type 4
  • Abatacept

Etanercept-szzs should not be used following treatment with any form of live vaccine.

Some drugs must not be taken at the same time as eating or consuming specific types of food as doing so could cause an interaction to take place. In addition, using tobacco or alcohol with some medications is not recommended as doing so could cause an interaction to occur. You should discuss this aspect of your treatment with your GP before you begin using etanercept-szzs.

Medical history

Some other existing or historical medical conditions can affect how this medication works. Be sure to discuss your medical history in full with your treating physician before you start your course of treatment with etanercept-szzs.

Etanercept-szzs should be used with extreme caution in patients who have a history of any of the following conditions. This medication can make all of these conditions worse:

  • Seizures
  • Psoriasis (skin disease)
  • Optic neuritis (inflammation of the eye nerve)
  • Nervous system problems (eg. Guillain-Barré syndrome, multiple sclerosis, demyelinating disease)
  • Moderate to severe alcoholic hepatitis
  • Congestive heart failure
  • Aplastic anemia
  • Low levels of white blood cells
  • Blood or bone marrow conditions

It should be noted that using etanercept-szzs in patients with a history of the following health conditions can present an increased risk of side effects:

  • Wegener's granulomatosis
  • Weak immune system (eg, HIV/AIDS)
  • Tuberculosis
  • Infections (eg. hepatitis b, bacteria, fungus, virus)
  • Diabetes
  • Cancer

Patients who are suffering from a sepsis must not be treated with etanercept-szzs.

Warnings

When deciding whether or not to begin using any form of new medication, you should discuss the risks versus the benefits of doing so with your treating physician.

Throughout the course of your treatment with etanercept-szzs, you must attend your GP for regular check-ups to make sure that the drug is working as expected and to discuss any unwanted effects it may be causing.

If you have a history of any allergic or strange reactions to any form of prescription or over the counter medicines, you should tell your doctor before you begin using etanercept-szzs. It is also important to mention any other allergies that you have to particular food groups, food colors, preservatives, or animal by-products.

Pediatric

Although etanercept-szzs can be used safely to treat juvenile idiopathic arthritis in children over the age of two years, efficacy and safety have not been confirmed in children under two.

Geriatric

There is no evidence to suggest that using etanercept-szzs is necessarily harmful to elderly patients. However, older people are more likely to be susceptible to infections, so caution must therefore be taken when using this medication.

Pregnancy and breastfeeding

There is no evidence to suggest that using etanercept-szzs presents any risk to the unborn baby. However, if you are pregnant, you should tell your doctor before you begin using this medicine.

Similarly, there have been no studies to determine any risk to a nursing infant in patients who are using etanercept-szzs. However, if you are breastfeeding, you should discuss the risks versus the benefits of continuing to do so with your GP. You may prefer to use an alternative method of feeding your child for the duration of your treatment with this drug.

Medication conditions

It should be noted that your body's ability to resist infection may be compromised while you are taking etanercept-szzs. If you notice any of the following signs, you must consult your GP right away:

  • Feeling weak or tired
  • Painful or difficult urination
  • Lower back or side pain
  • Flu-like symptoms
  • Fever
  • Cough or hoarseness
  • Chills

Before you begin using etanercept-szzs, you or your child will need to be tested for TB (tuberculosis). You must inform your GP if you or anyone else in your household has ever tested positive for TB.

In very rare cases, patients, including teenagers and children who are being treated with etanercept-szzs have contracted cancer, including lymphoma and leukemia. If you or your child develops any of the symptoms listed below, consult your GP right away:

  • Weakness
  • Bleeding
  • Weight loss
  • Swollen lymph nodes in the neck, underarms, or groin
  • Reddened skin, scaly patches of skin, or raised lumps that are filled with pus
  • Unexplained bruising

In a few rare cases, people suffering from multiple sclerosis, demyelinating disease, and Guillain-Barré syndrome have experienced seizures. If you have concerns about this, check with your GP or specialist.

Etanercept-szzs can sometimes predispose patients to suffering congestive heart failure. If you experience one or more of any of the following signs, contact your doctor immediately:

  • Swelling of the face, fingers, feet, or lower legs
  • Sudden weight gain
  • Shortness of breath

In some patients, etanercept-szzs can cause a serious allergic reaction called anaphylaxis. This can be a fatal condition if it is not treated urgently. If you experience any of the following effects, immediately after using the drug, call 911.

  • Trouble breathing or swallowing
  • Swelling of the face, tongue, and throat
  • Rash
  • Itching
  • Chest pain

It is important that you or your child do not receive any vaccinations while you are being treated with etanercept-szzs. If immunization is necessary, be sure to ask your doctor to give this medication well before you or your child start treatment with etanercept-szzs.

Some people who are vulnerable may suffer autoimmune hepatitis or a lupus-like syndrome while using etanercept-szzs. If you or your child notice any of the following effects, you should check with your treating physician right away:

  • Stomach pain
  • Pain in the upper right side of the abdomen
  • Nausea and vomiting
  • Light-colored stools
  • Jaundice of the skin or eyes
  • General feeling of being unwell
  • Feeling ill or weak
  • Chills or fever

If you think that your condition has not improved within a week or so of beginning your treatment with etanercept-szzs, or if you feel that you are actually feeling worse, you should talk to your GP straight away.

Storage

Keep your medication well out of the reach of children and pets. If a pet does consume any etanercept-szzs, contact your emergency vet right away.

You should store your prescriptions of etanercept-szzs in their original packaging, in the fridge. Do not freeze the medicine. When you are ready to use the product, take it out of the fridge and allow it to come to room temperature. Once the product has been allowed to reach room temperature, you must not place it back in the fridge to re-chill.

If necessary, the medication can be stored at room temperature for a maximum period of 28 days. After this period, you should dispose of the drug and ask for a fresh prescription.

If it is not in the fridge, keep the medication somewhere away from direct heat and sunlight.

Dispose of any unwanted product safely. Place the devices in a sharps box, and with the needle caps in place. If you are unsure of how to dispose of unwanted medication, ask your GP or pharmacist for guidance.

Summary

Etanercept-szzs is an injectable drug that is used to treat the effects and symptoms of some forms of arthritis and certain other conditions, including rheumatoid arthritis, psoriatic arthritis, plaque psoriasis and ankylosing spondylitis. Etanercept-szzs is also used to treat children aged over two years of age who are suffering from a condition called polyarticular juvenile idiopathic arthritis.

There are a number of medical conditions that can be complicated by using this medication. You should also not have vaccinations using live vaccines while you are receiving treatment with this drug. For these reasons, it is important that you attend regular update appointments with your doctor. During these appointments, your GP will check that the medicine is working properly. You can also use these sessions to mention any side effects that you have noticed.