Choosing and Preparing an Injection Site

Choose an injection site

• Three recommended injection sites for ENBREL include:
  1. Upper part of Your thigh
  2. Belly, except for a 2-inch area right around your belly button
  3. Outer area of upper arm (only if someone else is giving you the injection)

Rotate Sites

• Rotate the site for each injection.
• Make sure that the new injection is given at least one inch from sites of recent injections.
• Do NOT inject into areas where the skin is tender, bruised, red, or hard. Avoid areas with scars or stretch marks.
• If you have psoriasis, you should try to not inject directly into any raised, thick, red or scaly skin patches (psoriasis skin lesions).

Prepare the injection site

• To prepare the area of skin where ENBREL is to be injected, wipe the injection site with a new alcohol swab.
• Do NOT touch this area again before giving the injection.

Remove needle cover

• Pick up the syringe from your flat work surface.
• Hold the barrel of the syringe with one hand, remove the paper packaging off the 27-gauge needle.
• Pull the hard plastic needle cover straight off.
• Do NOT touch the needle or allow it to touch any surface.

Inject the ENBREL solution

• With one hand, gently pinch the cleaned area of skin and hold it firmly.
• With the other hand, hold the syringe at about a 45º angle to the skin.

Push needle into skin

• With a quick, "dart-like" short motion, push the needle into the skin.

Push plunger down

• After the needle is inserted, let go of the skin with the other hand.
• With your free hand, slowly push the plunger down to inject ENBREL.

Pull needle out

• When the syringe is empty, remove the needle from the skin, being careful to keep it at the same angle it was when it was inserted.
• Slight bleeding may occur. If needed, press a cotton ball or gauze over the injection site for 10 seconds.
• Do NOT rub the injection site. If needed, you may cover the injection site with a bandage.
• Remember: If you have problems, please call 1-877-9ENBREL (1-877-936-2735) for assistance, weekdays 8:00 am to 8:00 pm EST.

If there is enough solution left in the ENBREL vial for another dose, write the date you mixed the powder and liquid in the area marked "mixing date" on the sticker supplied and attach the sticker to the ENBREL vial. Refrigerate the reconstituted (mixed) ENBREL vial (in the dose tray) after use. Prepare additional doses from the ENBREL vial as described above. Otherwise, discard the vial and any remaining solution.

Disposing of Supplies

• The syringe, needle, and vial adapter should NEVER be reused.
• NEVER recap a needle.
• Instructions have been provided for children's caregivers to help them safely switch from the 25-gauge needle used for mixing and withdrawing ENBREL to the 27-gauge needle used for injecting ENBREL.
• Immediately throw away the used needle and syringe in a sharps disposal container.
• Do NOT remove the plunger from the syringe prior to disposal. A sharps disposal container made specifically for disposing of used syringes and needles may be used. Do NOT recycle the container.
• Keep the container out of the reach of children.
• When the container is about two-thirds full, dispose of it as instructed by your/your child's doctor, nurse, or pharmacist.
• Follow any special provincial or local laws regarding the proper disposal of needles and syringes.
• The ENBREL vials, vial adapters, and used swabs should be placed in the trash, unless otherwise instructed by your/your child's doctor, nurse, or pharmacist.
• The dose tray and cover may be recycled.

If you have any questions, contact a doctor, nurse, or pharmacist familiar with ENBREL. A toll-free information service is also available. Call Enliven to speak to a nurse at 1.877.9ENBREL (1.877.936.2735), weekdays 8:00 am to 8:00 pm EST.

To order a sharps disposal container, call Enliven at 1.877.9ENBREL (1.877.936.2735), weekdays 8:00 am to 8:00 pm EST.

Keep out of the reach of children.