t patients and larger children on ENBREL® may use the vial adapter device to assist with mixing the powder with the liquid and withdrawing ENBREL®, and then use a 27-gauge needle to inject the dose. This method should not be used for children using multiple doses from the same vial of ENBREL®. The instructions for using the vial adapter method are in STEP 2A.
The Free-Hand Method
In the free-hand method, a 25-gauge needle is used to assist with mixing the powder with the liquid and withdrawing ENBREL®, and a 27-gauge needle is used to inject the dose. Obtain 25-gauge needles from your healthcare provider. Instructions for using the free-hand method are in STEP 2B.
The instructions for preparing additional doses from the same vial of ENBREL® solution are in STEP 3. For each additional dose, you will need two new needles (one 25-gauge needle to withdraw the solution and one 27-gauge needle for injection) and one new empty syringe (1 mL). NEVER REUSE A SYRINGE OR NEEDLE.
If you are using the vial of ENBREL® for more than one dose, you should write the date you mixed the powder and liquid in the area marked “Mixing Date:” on the sticker supplied with these instructions, and attach the sticker to the ENBREL® vial.
After you have withdrawn the dose of ENBREL® that you need, store the ENBREL® vial (in the dose tray) in the refrigerator at 36° to 46°F (2° to 8°C) as soon as possible, but always within 4 hours of mixing the solution.
The ENBREL® solution must be used within 14 days of the mixing date. You should discard the ENBREL® vial and any remaining solution if it is not used within 14 days. Do not mix any remaining liquid in one vial of ENBREL® solution with another.
STEP 2A: Vial Adapter Method
Remove the pink plastic cap from the ENBREL® vial. Do not remove the gray stopper or silver metal ring around the top of the ENBREL® vial.
Place the ENBREL® vial on your flat work surface or turn your dose tray upside down and place your ENBREL® vial in the round space marked “V”. Use one alcohol swab to clean the gray stopper on the ENBREL® vial. Do not touch the gray stopper with your hands.
Open the wrapper that contains the 27-gauge needle by peeling apart the tabs and set the needle aside for later use.
Open the wrapper that contains the vial adapter by peeling apart the tabs and set the vial adapter aside for later use. Do not touch the vial adapter’s twist-on end or the spike inside.
Slide the plunger into the flange end of the syringe.
Attach the plunger to the gray rubber stopper in the syringe by turning the plunger clockwise until a slight resistance is felt.
Remove the twist-off cap from the prefilled diluent syringe by turning counter-clockwise. Do not bump or touch the plunger. Doing so could cause the liquid to leak out. You may see a drop of liquid when removing the cap. This is normal. Place the cap on your flat work surface. Do not touch the syringe tip.
Once the twist-off cap is removed, pick up the vial adapter with your free hand. Twist the vial adapter onto the syringe until a slight resistance is felt. Do not over-tighten.
Hold the ENBREL® vial upright on your flat work surface. Grasp the sides of the vial adapter and place it over the top of the ENBREL® vial. Do not bump or touch the plunger. Doing so could cause the liquid to leak out. Insert the vial adapter into the gray stopper on the ENBREL® vial. The plastic spike inside the vial adapter should puncture the gray stopper. The vial adap |
