Pen vs Syringe

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New Member

Date Joined Nov 2017
Total Posts : 5
   Posted 11/10/2017 12:12 PM (GMT -7)   
I have been diagnosed with severe Rheumatoid Arthritis. I am still waiting for the insurance company to authorize ENBREL. HOWEVER, my question to you all, if I choose the PEN - and decide that I do not like it, can I switch to the SYRINGE.... and even back again? I can't imagine giving myself a shot, but if the paid is too pain with the PEN, I might just have to do it. Thank you

celebrate life
Veteran Member

Date Joined Dec 2014
Total Posts : 2076
   Posted 11/11/2017 1:22 AM (GMT -7)   
Hello Boo and welcome to HW. I'm sorry you have gotten this diagnosis, but I do hope the Enbril gives you relief. I have used both the pen and syringe and the dosage is the same, so I'm sure you can use whichever you like and switch modes with your pharmacy if you decide you want to. My insurance requires me to use a mail order company.
Here is my take on pen vs syringe:
I found myself struggling with the stupid button on the pen and when I finally got it to release the needle, the urge to yank back when it hit flesh had me concerned I would at some point be unable resist the urge, and end up throwing away the medication. However, if the image of the needle freaks you out, the pen may be good. Also, I have dropped the syringe and had the needle break off and had to throw away the dose. Don't know if the pen protects that from happening.
There are several other reasons I like using a syringe: less bulky and less plastic waste. You can inject at the rate you like, and at an angle, which I find helps it be less painful. Sometimes it burns more going in than others. I don't know why, but if it is a burner, I want to go slow.
With either, giving the medication time to warm to room temperature most definitely makes it less painful as it is going in, so leave it out to warm up for an hour or so prior. It won't go bad in that amount of time.
After years of injecting I stumbled across a video about the process and was surprised that there were things I could learn. Go to Enbril web site and watch it before your first injection. And above all, try to not put too much thought into it and freak yourself out. Soon the hassle of remembering to order it on time and give yourself the injection will be a bigger ordeal, not to mention annual renewals of prescription and insurance authorizations and payment assistance program renewal. I keep telling myself that insulin dependant diabetics do it every day, and I only have to do it once in a week.
Best wishes! Let us know how you are doing. A lot of knowledge and collective experience here. Also, my email is open if you want, by clicking on the colored envelope on left hand side.

Regular Member

Date Joined Apr 2017
Total Posts : 78
   Posted 11/11/2017 3:15 AM (GMT -7)   
Hi Boo - There are actually 4 different formulations of Enbrel:

1) 25 mg single-use prefilled syringes (formulated at pH 6.3)
2) 50 mg single-use prefilled syringes (formulated at pH 6.3)
3) 50 mg single-use prefilled SureClick™ autoinjectors (formulated at pH 6.3)
4) 25 mg multiple-use vials (reconstitute with 1 mL of Sterile Bacteriostatic Water at pH 7.4)

Enbrel is a dimeric fusion protein that degrades over time. Refrigeration of the lyophilized powder (i.e., multiple-use vials) at 2 - 8 degrees C slows the rate of degradation considerably. After dissolution, the rate of degradation is much faster. Thus, one should inject within 15 - 30 minutes after reconstitution upon removal from the refrigerator. NEVER let this solution sit at room temperature longer than 30 minutes maximum!

This enhanced degradation in solution required the manufacturer to develop a different formulation to stabilize the protein for the prefilled syringes and autoinjector. Thus, the more acidic pH 6.3 for the pre-dissolved drug. I took Enbrel for 12 years (I have been drug-free for over 1 year now) and had tried both formulations (vial and prefilled syringe). It may be individual, but I personally found the more acidic prefilled syringe formulation to be more painful during injection.

There is another consideration. If you travel for extended periods of time, the lyophilized powder formulation is a much better choice. I used to travel for a couple weeks at a time, which required me to bring Enbrel with me on the trip. Although it is not recommended, the powder is somewhat stable at room temperature for a few days. On my longer trips, the ice packs would always warm to room temperature before arrival at my destination. I do not know the integrity of the prefilled syringe after many hours or a day at room temperature, but I suspect that there would be significant degradation.

Any drug in solution will always degrade faster than the solid tablet or powder. This is why the expiration date for the prefilled syringe/autoinjector is much shorter than that for the lyophilized Enbrel powder in the vial.

Veteran Member

Date Joined Mar 2010
Total Posts : 2470
   Posted 11/11/2017 5:47 AM (GMT -7)   
I am such a needle phobe i took me forever to agree with doctor and try Humira. I used the pen.
The procedure actually ended up being a big nothing. Doctor administered the first dose as a training session. I was like "is that it?"

Wishing you all my best

New Member

Date Joined Nov 2017
Total Posts : 5
   Posted 11/13/2017 9:29 AM (GMT -7)   
Thanks everyone... I feel like I belong now. The dosage that was prescribed to me is: 50 mg single-use prefilled SureClick™ autoinjectors (formulated at pH 6.3).

Beth, you mentioned about the renewals, I had to change insurance companies before the initial one even had time to authorize the drug - so now I am waiting for another to authorize. Do I have to have them RE-AUTHORIZE again in January, or do I wait a year from the point that it is authorized?
I could not find the little envelope to respond to you.

Forum Moderator

Date Joined Feb 2003
Total Posts : 15150
   Posted 11/13/2017 3:17 PM (GMT -7)   
Boo, click on Beth's username & it will take you to her profile where her email is listed.
Moderator in Chronic Pain & Psoriasis Forums

celebrate life
Veteran Member

Date Joined Dec 2014
Total Posts : 2076
   Posted 11/14/2017 11:26 PM (GMT -7)   
Hi Boo,
I didn't get an email from you, so I'll respond to the thread. Unfortunately my answer is I don't know. Mine is annually. Yours may require it calendar year, but I doubt it. I've found that the best thing is to get it filled at the first reminder call each month, so that if you need pre authorization for refills you can get it done before you need the meds. Easier said than done. I have had to go through times when the insurance and pharmacies and Dr office at various points dropped the ball and caused me to do without my meds for as long as two weeks!!!
Sometimes even staying on top of it, things can go wrong.
Did you need information about assistance program for private insurance co pay relief?
Let us know how it works for you.
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