Key takeaways

  • Doctors prescribe Enbrel for arthritis, psoriasis, and other conditions. The medication can cause side effects that are mild and some serious ones.
  • Serious side effects of Enbrel include neurologic (nervous system) problems, allergic reaction, and immune system reaction.
  • The drug has boxed warnings for the risk of serious infection and the risk of cancer. Before starting Enbrel, your doctor will discuss your history of infection, including tuberculosis. They’ll also want to learn about your family history of cancer.

Enbrel (etanercept) is a prescription injection that’s used to treat:

Knowing the possible side effects of Enbrel can help you decide whether this drug may be right for you. Keep reading to learn about the possible side effects of Enbrel.

This drug has boxed warnings for the risk of serious infection and risk of cancer. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous. To learn more, see the “Side effects explained” section.

Like most drugs, Enbrel may cause side effects in some people. Your doctor will suggest Enbrel if they think the benefits you’ll receive from the drug outweigh your risk of side effects.

The more commonly reported side effects of Enbrel include:

For more information about some of these side effects, see the “Side effects explained” section.

Enbrel may cause mild side effects in some people. Examples of side effects that have been reported appear in the following list.

  • respiratory infection, such as sinus infection or the flu
  • injection site reaction, such as irritation or pain
  • rash
  • itchy skin
  • fever
  • diarrhea

In most cases, mild side effects should be temporary. And some may be easily manageable. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. Don’t stop using Enbrel unless your doctor recommends it.

This list may not include all of the possible mild side effects of Enbrel. For more information, see Enbrel’s prescribing information.

For more information about some of the side effects listed here, see the “Side effects explained” section.

In rare cases, Enbrel can cause serious side effects in some people. You may have an increased risk of serious side effects if you take other drugs with Enbrel that weaken your immune system.

Serious side effects that have been reported with Enbrel include:

For more information about some of these side effects, see the “Side effects explained” section.

If you have questions about your specific risk of serious side effects, talk with your doctor.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medication safer for everyone. It gives doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Enbrel and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Doctors may prescribe Enbrel for children with the following conditions:

In general, side effects in children are similar to those in adults. But Enbrel has a boxed warning for the risk of cancer in children and young adults. (See the “Side effects explained” section to learn more.) In some cases, cancer from Enbrel has led to death.

Before your child starts Enbrel, talk with their doctor about the risks and benefits.

Get answers to some common questions about Enbrel’s side effects.

How do I stop side effects from Enbrel?

Side effects from Enbrel are usually mild and may be temporary. But if they bother you, you can take steps to manage certain side effects. To learn more, see the “Side effects explained” section.

Will I have side effects where I inject Enbrel?

It’s likely. Injection site reaction is one of the most commonly reported side effects of Enbrel. It may include:

  • redness or discoloration
  • itching
  • pain
  • swelling
  • bleeding
  • bruising

Injection site reaction is more common in the first month of treatment. In most cases, a reaction goes away about 3 to 5 days after injecting a dose.

If you’re concerned about injection-site reaction during your Enbrel treatment, talk with your doctor.

Does Enbrel cause weight loss or weight gain?

No, Enbrel shouldn’t cause weight gain or weight loss. These side effects weren’t reported in studies of Enbrel.

But unexplained weight change can sometimes be a symptom of more serious side effects. Or it could be a sign of a different health condition.

Let your doctor know right away if you have unexplained weight loss or weight gain after starting Enbrel. They may want to do a physical exam or order blood tests to find out why you’ve lost or gained weight.

Is hair loss a side effect of Enbrel?

No, hair loss wasn’t a side effect of Enbrel in studies. But some people with rheumatoid arthritis or psoriatic arthritis use methotrexate along with Enbrel. And methotrexate can cause hair loss.

Also, hair loss can sometimes be caused by plaque psoriasis, which Enbrel treats. With plaque psoriasis, skin patches that are itchy and raised can form on the scalp. Scratching at these plaques could contribute to hair loss.

If you’re concerned about hair loss during your Enbrel treatment, talk with your doctor.

Can Enbrel cause side effects for my heart?

It’s possible. Although heart side effects weren’t seen in studies, some people have reported heart problems with Enbrel treatment. But it’s unclear how often this has happened.

For example, it’s been reported that some people with congestive heart failure had worsened symptoms during Enbrel treatment. In rare reports, people have been newly diagnosed with heart failure after using Enbrel.

While using Enbrel, call your doctor right away if you notice any symptoms of congestive heart failure:

  • shortness of breath
  • fatigue (lack of energy)
  • cough
  • swelling in legs and ankles

During your Enbrel treatment, your doctor will monitor your heart closely. Let your doctor know if you’ve had any heart problems. They’ll discuss the risks and benefits of Enbrel with you.

Learn more about some of the side effects Enbrel may cause.

Boxed warning: Risk of serious infection

Enbrel has a boxed warning for risk of serious infection. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

People using Enbrel have an increased risk of serious infection. This is because Enbrel may weaken your immune system. Serious infections that are possible with Enbrel include tuberculosis (TB) and other bacterial, fungal, or viral infections. These infections could lead to a hospital stay or death.

What might help

Before starting Enbrel, tell your doctor if you have any current infection or have had infections in the past that have come back. Let them know if you’ve ever had TB or were exposed to someone with TB. Enbrel can cause TB to reactivate (flare up). Your doctor will test you for TB before you start Enbrel. If you do have TB, your doctor likely won’t have you start using Enbrel until the TB is treated.

While using Enbrel, call your doctor right away if you have any symptoms of a serious infection, such as:

  • fever
  • nausea or vomiting
  • diarrhea
  • shortness of breath

During your treatment, your doctor will monitor you for symptoms of a serious infection. If you do get a serious infection, your doctor will likely stop your Enbrel treatment.

If you’re concerned about your risk of a serious infection from Enbrel, talk with your doctor.

Boxed warning: Risk of cancer

Enbrel also has a boxed warning for the risk of cancer in children and young adults. Enbrel has been linked with certain types of cancer (such as lymphoma and skin cancer) in these people.

What might help

Before you or your child begins treatment with Enbrel, tell your doctor if there’s any family history of cancer. If there’s a higher risk of cancer, the doctor may need to increase monitoring during Enbrel treatment. This may include additional blood tests and routine skin examinations.

While using Enbrel, call your doctor right away if you notice any possible symptoms of cancer, such as:

  • ongoing fever without infection
  • night sweats, fever, or chills
  • weight loss and reduced appetite
  • ongoing fatigue (lack of energy)
  • skin changes, such as a new wart

Before your child uses Enbrel, talk with their doctor about the risks and benefits of the drug.

Neurologic (nervous system) problems

In rare cases, Enbrel can cause neurologic conditions or make an existing one worse. Symptoms of neurologic problems may include:

  • confusion
  • memory loss
  • feeling disoriented
  • vision changes or vision loss
  • muscle weakness

What might help

If you have any of these listed side effects while using Enbrel, talk with your doctor right away. These symptoms could be a sign of a neurological condition such as multiple sclerosis (MS), seizures, or optic neuritis (swelling of the eye nerves). Your doctor may order blood tests or refer you to a neurologist for possible treatment.

Injection site reaction

A common side effect of Enbrel is a reaction at the site where the drug is injected. These side effects are usually mild and may include:

  • redness or discoloration
  • itching
  • pain
  • swelling
  • bleeding
  • bruising

What might help

Injection site reaction is more common in the first month of treatment. In most cases, these reactions go away about 3 to 5 days after injecting a dose. But if you have injection-site reactions that bother you, you could try using a cool compress to soothe the area. Or ask your doctor for other suggestions on how to ease injection-site reactions.

Blood disorders

In rare cases, some people using Enbrel may experience low levels of certain types of blood cells. An example of a blood disorder that can occur is pancytopenia, and its symptoms can include:

  • ongoing fever
  • bruising
  • bleeding more easily than usual
  • pale-looking skin or gums

What might help

During your treatment with Enbrel, your doctor will monitor you for blood disorders by checking your blood cell levels.

If you notice any symptoms of your blood being unusual, such as excessive bleeding from gums while flossing, let your doctor know. If any of your blood cell levels are low, your doctor might have you stop Enbrel while you’re monitored or treated for low blood cells.

Allergic reaction

Like most drugs, Enbrel can cause an allergic reaction in some people. Symptoms can be mild or serious and can include:

  • rash
  • itchiness
  • flushing (warmth, swelling, redness, or discoloration in your skin)
  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it difficult to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest over-the-counter products to manage your symptoms. These include an oral antihistamine, such as diphenhydramine (Benadryl), and a topical product, such as hydrocortisone cream.

If your doctor confirms you had a mild allergic reaction to Enbrel, they’ll decide whether you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911. Or call your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

Your doctor can confirm whether you had a serious allergic reaction to Enbrel. If you have, they’ll discuss your treatment options with you.

Keeping track of side effects

During your Enbrel treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things like:

  • what dose of the drug you were using when you had the side effect
  • how soon after starting that dose you had the side effect
  • what your symptoms were from the side effect
  • how it affected your daily activities
  • what other medications you were also taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help your doctor learn more about how Enbrel affects you. Your doctor can use this information to adjust your treatment plan if needed.

Enbrel has several warnings that may affect whether or not it’s safe for you to use this drug.

Boxed warnings

Enbrel has boxed warnings about the risk of serious infection and the risk of cancer. Boxed warnings are the most serious warnings from the FDA.

Risk of serious infection: People using Enbrel have an increased risk of serious infection that may lead to a hospital stay or death. See your doctor right away if you have any symptoms of a serious infection, such as fever, nausea, vomiting, diarrhea, or shortness of breath. Let your doctor know if you’ve ever had tuberculosis (TB) or were exposed to someone with TB. Enbrel can cause TB to reactivate (flare up).

Risk of cancer: Enbrel has been associated with certain types of cancer (such as lymphoma) in children and young adults.

To learn more about these warnings, see the “Side effects explained” section.

Other warnings

Enbrel may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you start Enbrel. Be sure to talk with your doctor if any of the following apply to you:

Diabetes: If you have diabetes, using Enbrel may raise your risk of hypoglycemia (low blood sugar). Your doctor may adjust your dose of diabetes medications while using Enbrel. This can help prevent your blood sugar level from getting too low. Also, having diabetes raises your risk of infection, and infections can occur during treatment with Enbrel.

Other infection: If you have a current infection, Enbrel can make it worse. This includes any type of fungal, bacterial, or viral infections, even minor colds or skin wounds. Before starting your Enbrel treatment, tell your doctor if you have an infection or have had one recently.

Sepsis: You should not use Enbrel if you have sepsis. Sepsis is a very serious infection that affects your entire body. Because Enbrel can weaken your immune system, it could make sepsis worse.

Neurologic reactions: Using Enbrel could make some neurological (nervous system) conditions worse. If you have multiple sclerosis (MS), seizures, optic neuritis, or any other brain or nervous system condition, talk with your doctor before using Enbrel. They may want to discuss the risks and benefits of Enbrel with you.

Hepatitis B reactivation: If you’ve had hepatitis B, using Enbrel could make the hepatitis B virus reactivate (flare up). If not treated, hepatitis B can cause serious liver problems. Your doctor will check you for hepatitis B with a blood test before prescribing Enbrel.

Vaccines: Because Enbrel can weaken the immune system, you should not receive live vaccines during your Enbrel treatment. Live vaccines contain a weakened form of a virus or bacterium. Examples of live vaccines include:

It’s best to get caught up with any vaccines you need before starting Enbrel. If you have questions about what vaccines you may need, ask your doctor or pharmacist.

Immune reactions such as lupus-like syndrome: It’s possible that Enbrel could cause your immune system to attack your healthy tissues. In rare cases, lupus-like syndrome and autoimmune hepatitis have occurred. Your doctor will monitor you closely for immune reactions during your treatment. If you do experience any of these reactions, your doctor may stop your Enbrel treatment.

Certain other drugs: You should not use certain other medications during Enbrel treatment. These include anakinra, abatacept, cyclophosphamide, and sulfasalazine. If you’re taking any of these medications, let your doctor know before starting Enbrel. They may make a change to your treatment plan.

Alcohol-induced hepatitis: Alcohol-induced hepatitis (formerly called alcoholic hepatitis) is inflammation (swelling and damage) of the liver caused by heavy alcohol use. It’s possible that people who have moderate to severe alcohol-induced hepatitis may have a higher risk of death when using Enbrel. If you have alcohol-induced hepatitis, talk with your doctor about the best treatment option for your condition.

Allergic reaction: If you’ve ever had an allergic reaction to Enbrel or any of its ingredients, you should not use Enbrel. Ask your doctor what other medications are better options for you.

Alcohol use and Enbrel

It should be safe for you to drink alcohol during your Enbrel treatment. But certain drugs that are often prescribed along with Enbrel should not be used with alcohol. This may include methotrexate or certain pain medications such as oxycodone, depending on your condition.

If you drink alcohol, talk with your doctor about how much may be safe for you to drink with your condition and treatment plan.

Pregnancy and breastfeeding during Enbrel treatment

Before starting Enbrel, tell your doctor if you’re pregnant or planning to become pregnant. Enbrel should be used during pregnancy only in certain cases and after discussing the risks with your doctor.

If you’re breastfeeding or planning to breastfeed, talk with your doctor before using Enbrel. This drug may pass into breast milk in very small amounts, but researchers don’t yet know how this might affect a child who’s breastfed. Talk with your doctor to learn more.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.