DOSAGE AND ADMINISTRATION
ADULT RA, AS, AND PSORIATIC ARTHRITIS PATIENTS
The recommended dose of ENBREL® for adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis is 50 mg per week given as two 25 mg subcutaneous (SC) injections at separate sites. The dose should be administered as two 25 mg injections given either on the same day or 3 or 4 days apart (see CLINICAL STUDIES). Methotrexate, glucocorticoids, salicylates, nonsteroidal anti-inflammatory drugs (NSAIDs), or analgesics may be continued during treatment with ENBREL®. Based on a study of 50 mg ENBREL® twice weekly in patients with RA that suggested higher incidence of adverse reactions but similar ACR response rates, doses higher than 50 mg per week are not recommended (see ADVERSE REACTIONS).
ADULT PLAQUE PSORIASIS PATIENTS
The recommended starting dose of ENBREL® for adult patients is a 50 mg dose given twice weekly (administered 3 to 4 days apart) for 3 months followed by a reduction to a maintenance dose of 50 mg per week (see CLINICAL STUDIES).
Starting doses of ENBREL® of 25 mg or 50 mg per week were also shown to be efficacious. The proportion of responders were related to ENBREL® dosage (see CLINICAL STUDIES).
The recommended dose of ENBREL® for pediatric patients ages 4 to 17 years with active polyarticular-course JRA is 0.8 mg/kg per week (up to a maximum of 50 mg per week). The maximum dose that should be administered at a single injection site is 25 mg (1.0 mL). Therefore, for pediatric patients weighing more than 31 kg (68 pounds), the total weekly dose should be administered as two subcutaneous (SC) injections, either on the same day or 3 or 4 days apart. The dose for pediatric patients weighing 31 kg (68 pounds) or less should be administered as a single SC injection once weekly. Glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), or analgesics may be continued during treatment with ENBREL®. Concurrent use with methotrexate and higher doses of ENBREL® have not been studied in pediatric patients.
PREPARATION OF ENBREL®
ENBREL® is intended for use under the guidance and supervision of a physician. Patients may self-inject when deemed appropriate and if they receive medical follow-up, as necessary. Patients should not self-administer until they receive proper training in how to prepare and administer the correct dose.
ENBREL® should be reconstituted aseptically with 1 mL of the supplied Sterile Bacteriostatic Water for Injection, USP (0.9% benzyl alcohol) giving a solution of 1.0 mL containing 25 mg of ENBREL®.
A vial adapter is supplied for use when reconstituting the lyophilized powder. However, the vial adapter should not be used if multiple doses are going to be withdrawn from the vial. If the vial will be used for multiple doses, a 25-gauge needle should be used for reconstituting and withdrawing ENBREL®, and the supplied "Mixing Date:" sticker should be attached to the vial and the date of reconstitution entered. Reconstitution with the supplied BWFI, using a 25-gauge needle, yields a preserved, multiple-use solution that must be used within 14 days.
If using the vial adapter, twist the vial adapter onto the diluent syringe. Then, place the vial adapter over the ENBREL® vial and insert the vial adapter into the vial stopper. Push down on the plunger to inject the diluent into the ENBREL® vial. Keeping the diluent syringe in place, gently swirl the contents of the ENBREL® vial during dissolution. To avoid excessive foaming, do not shake or vigorously agitate.
If using a 25-gauge needle to reconstitute and withdraw ENBREL®, the diluent should be injected very slowly into the ENBREL® vial. It is normal for some foaming to occur. The contents should be swirled gently during dissolution. To avoid excessive foaming, do not shake or vigorously agitate.
Generally, dissolution of ENBREL® takes less than 10 minutes. Visually inspect the solution for particulate matter and discoloration prior to administration. The solution should not be used if discolored or cloudy, or if particulate matter remains.
Withdraw the correct dose of reconstituted solution into the syringe. Some foam or bubbles may remain in the vial. Remove the syringe from the vial adapter or remove the 25-gauge needle from the syringe. Attach a 27-gauge needle to inject ENBREL®.
The contents of one vial of ENBREL® solution should not be mixed with, or transferred into, the contents of another vial of ENBREL®. No other medications should be added to solutions containing ENBREL®, and do not reconstitute ENBREL® with other diluents. Do not filter reconstituted solution during preparation or administration.
The ENBREL® (etanercept) "Patient Information" insert contains more detailed instructions on the preparation of ENBREL®. Reconstitution with the supplied BWFI, using a 25-gauge needle, yields a preserved, multiple-use solution that must be used within 14 days. Discard reconstituted solution after 14 days. PRODUCT STABILITY AND STERILITY CANNOT BE ASSURED AFTER 14 DAYS.
ADMINISTRATION OF ENBREL®
A 50 mg dose should be given as two 25 mg SC injections.
Rotate sites for injection (thigh, abdomen, or upper arm). Never inject into areas where the skin is tender, bruised, red, or hard. See the ENBREL® (etanercept) "Patient Information" insert for detailed information on injection site selection and dose administration.
STORAGE AND STABILITY
Do not use a dose tray beyond the expiration date stamped on the carton, dose tray label, vial label, or diluent syringe label. The dose tray containing ENBREL® (sterile powder) must be refrigerated at 2°-8°C (36°-46°F). DO NOT FREEZE.
Reconstituted solutions of ENBREL® prepared with the supplied Bacteriostatic Water for Injection, USP (0.9% benzyl alcohol), using a 25-gauge needle, may be stored for up to 14 days if refrigerated at 2°-8°C (36°-46°F). Discard reconstituted solution after 14 days. PRODUCT STABILITY AND STERILITY CANNOT BE ASSURED AFTER 14 DAYS.