What should I do if I experience flu-like symptoms while taking Enbrel (etanercept)?

Management of Flu-like Symptoms While Taking Enbrel (Etanercept)

If you experience flu-like symptoms while taking Enbrel (etanercept), you should monitor your symptoms closely and seek medical attention if they become severe or are accompanied by signs of infection, as immunosuppressive medications like Enbrel increase your risk of infections. 1

Symptom Monitoring and Assessment

When experiencing flu-like symptoms while on Enbrel, monitor the following parameters:

• Temperature (check frequently)
• Respiratory rate
• Heart rate
• Blood pressure (if possible)
• Mental status
• Ability to maintain oral intake
• Oxygen saturation (if you have a pulse oximeter) 2, 1

Warning Signs Requiring Medical Attention

Seek immediate medical care if you have two or more of the following:

• Temperature >37.8°C (100°F)
• Heart rate >100/min
• Respiratory rate >24/min
• Systolic blood pressure <90 mmHg
• Oxygen saturation <90%
• Inability to maintain oral intake
• Abnormal mental status 2, 1

Management of Mild to Moderate Symptoms

For mild to moderate flu-like symptoms:

1. Symptomatic treatment:

   • Take antipyretics such as acetaminophen or ibuprofen for fever and pain
   • Maintain adequate hydration
   • Get plenty of rest 1

2. Self-monitoring:

   • Check your temperature frequently
   • Report any fever to your physician immediately
   • Watch for signs of worsening infection 2, 1

3. Communication with healthcare provider:

   • Report any signs of infection promptly, including:
     • Cough, aches, fever, and chills
     • Wounds with redness, pain, discharge, or pus
     • Burning with urination
     • Nausea, vomiting, and diarrhea
     • Shortness of breath or changes in breathing 2

When Antiviral Treatment May Be Needed

Consider antiviral treatment if:

• You have an acute influenza-like illness
• Fever >38°C (100.4°F)
• Symptoms started within the last two days

In such cases, oseltamivir 75 mg every 12 hours for five days may be prescribed. Note that immunocompromised patients (which includes those on Enbrel) may benefit from antiviral treatment even without documented fever. 2, 1

When Antibiotics May Be Needed

Antibiotics are NOT routinely recommended for uncomplicated flu-like symptoms. However, consider antibiotics if:

• You develop worsening symptoms (particularly recrudescent fever or increasing breathlessness)
• You have high risk of complications or secondary infection
• You develop lower respiratory symptoms 2

If antibiotics are needed, common options include:

• Co-amoxiclav
• Tetracyclines (e.g., doxycycline)
• Macrolides (e.g., clarithromycin or erythromycin) as alternatives 2

Special Considerations for Enbrel Users

As an Enbrel user, you should be particularly vigilant about infections because:

1. TNF inhibitors like Enbrel can increase the risk of infections, including:

   • Tuberculosis (TB)
   • Hepatitis B reactivation
   • Fungal infections
   • Viral infections 2

2. Infection risk is further increased when Enbrel is given concurrently with other immunosuppressants 2

3. Report any signs of infection immediately, as infections may progress more rapidly in immunocompromised patients 2, 1

When to Consider Temporarily Stopping Enbrel

While most mild flu-like symptoms don't require discontinuation of therapy, consider temporarily stopping Enbrel (in consultation with your healthcare provider) if:

• You develop a serious infection
• You have high fever that persists despite antipyretics
• You have symptoms of severe infection requiring hospitalization 2, 1

Remember that any decision to stop or continue Enbrel should be made in consultation with your healthcare provider, weighing the risks of infection against the benefits of continued treatment for your underlying condition.