Should I skip Enbrel if I have a cold? Expert Guidance for Biologic Users

October 14, 2025 •

4 min read

According to official prescribing information, upper respiratory infections like the common cold are among the most common side effects reported in clinical trials for Enbrel. Given that Enbrel suppresses the immune system, it is understandable that patients often ask: Should I skip Enbrel if I have a cold? The answer depends on the severity of your symptoms and always requires a conversation with your healthcare provider.

Quick Summary

It is generally safe to continue Enbrel with a mild cold, but you must contact your doctor. Treatment should be paused for a severe infection, especially with a fever. The decision to skip a dose should always be made in consultation with a healthcare provider.

Key Points

Consult Your Doctor: Always inform your healthcare provider about any new illness, even a mild cold, before deciding on your Enbrel dose.
Differentiate by Severity: Mild cold symptoms often do not require pausing treatment, but a fever or signs of a severe infection warrant immediate medical contact and likely a temporary pause.
Never Self-Adjust: Do not unilaterally skip a dose or double up on injections without consulting a medical professional, as this can affect the management of your condition.
Monitor Closely: While on Enbrel, be aware of symptoms that could indicate a minor cold is worsening into a more serious infection and report them promptly.
Focus on Prevention: Practice good hygiene and avoid contact with sick individuals to minimize your risk of infection while on immunosuppressive therapy.
Know the Pause-Points: In addition to severe infections, planned surgeries are another common reason to temporarily hold your Enbrel dose, as directed by your doctor.

Understanding Enbrel and Your Immune System

Enbrel (etanercept) is a biologic medication that works by blocking a protein called tumor necrosis factor (TNF), which causes inflammation in the body. By inhibiting TNF, Enbrel helps manage inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, and other autoimmune diseases. However, this process also affects your immune system's ability to fight off infections, which is why infections, including upper respiratory infections like the common cold, are common side effects.

This immunosuppressive effect is why patients on Enbrel need to be vigilant about any signs of infection, no matter how minor they seem. The primary concern is that a seemingly simple infection could potentially escalate into a more serious one due to the dampened immune response. Therefore, understanding the difference between a mild and severe infection is critical.

The Protocol for Mild vs. Severe Infections

Managing a Mild Cold

If you develop a mild cold with symptoms like a runny nose, sneezing, a mild cough, or a sore throat without a fever, the standard advice is often to continue your Enbrel as scheduled. However, this is not a universal rule and should always be confirmed with your doctor. The most important step is to call your healthcare provider or rheumatologist to inform them of your symptoms. This allows them to monitor your condition and provide guidance based on your overall health and the specific symptoms you are experiencing.

Inform your doctor: Call your rheumatology team to let them know you have a cold. Even if they recommend continuing treatment, they should be aware. This also ensures they have a record of your illness.
Monitor symptoms closely: Pay attention to any worsening of symptoms, especially the development of a fever, severe body aches, or shortness of breath. The cold should not be lingering or getting worse.
Do not self-medicate: Before taking over-the-counter cold medicines, ask your doctor or pharmacist if they are safe to use with Enbrel.

Handling a Severe Infection

If you experience symptoms of a more serious infection, you should hold your Enbrel dose and contact your doctor immediately. A serious infection is a different clinical situation entirely and often requires pausing biologic therapy to allow your body's immune system to mount a stronger defense. Signs of a severe infection can include:

A high or persistent fever
Chills and body aches
Shortness of breath or a persistent, worsening cough
Severe stomach pain or persistent diarrhea
Symptoms like burning during urination or increased frequency
Unusual skin sores or unexplained redness

Your doctor will evaluate your situation and determine if you need to stop Enbrel temporarily and may prescribe antibiotics or other treatment. It's crucial to follow their instructions for resuming therapy once the infection has fully resolved. Do not restart Enbrel without their explicit approval.

Comparison of Infection Management Strategies


Aspect	Mild Infection (e.g., Common Cold)	Severe Infection (e.g., Flu with fever, Pneumonia)
Typical Symptoms	Runny nose, sneezing, mild cough, sore throat, no fever.	High fever, chills, severe fatigue, body aches, persistent cough, shortness of breath, significant GI distress.
Action Recommended	Contact your healthcare provider to inform them of symptoms.	Contact your healthcare provider immediately. Do not wait for your scheduled appointment.
Enbrel Dose Decision	Often, your provider will advise you to continue the dose, but they must confirm it.	Almost always advised to pause the dose until the infection is treated and symptoms resolve.
Reason for Decision	The risk of inflammation from skipping a dose is often higher than the risk posed by a minor, self-limiting viral infection.	The risk of the infection becoming more severe is too great, and the immune system needs its full capacity to fight it off.
Follow-up	Monitor your symptoms and contact your doctor if they worsen.	Requires close follow-up with your doctor, who will determine when it is safe to resume treatment.

Important Considerations for All Biologic Patients

What if you miss a dose?

If you have to skip a dose of Enbrel due to a severe infection, you should not double up on your next dose or shorten the time between injections. Simply take your next scheduled dose, or follow the new timeline set by your healthcare provider. Your provider will guide you on how to get back on track safely and effectively.

What if you are exposed to someone who is sick?

Patients on Enbrel should take extra precautions to avoid contact with people who are sick, especially with highly contagious infections like chickenpox or the flu. Excellent hand hygiene and social distancing are important preventative measures. Always consult your doctor if you've had a known exposure to a serious communicable disease.

Are vaccines still effective?

Live vaccines, such as the nasal spray flu vaccine, are not recommended for individuals on Enbrel. However, most inactivated vaccines, such as the standard flu shot and pneumonia vaccine, are safe and recommended. It's best to ensure you are up-to-date on all recommended immunizations before starting Enbrel therapy. Your healthcare provider can advise you on the appropriate vaccination schedule.

Conclusion: Prioritize Medical Consultation

Ultimately, the decision to skip Enbrel for a cold is not one to be made alone. While a mild cold may not necessitate pausing treatment, a severe infection certainly does, and the line between the two can be hard to judge on your own. Always consult your doctor for personalized medical advice. They have the expertise to weigh the risks of pausing your treatment, which could cause a disease flare, against the risks of continuing it with an active infection. Following their guidance is the safest path to protecting your health and managing your condition effectively. For more detailed prescribing information, patients can consult the FDA's official documentation for Enbrel.

Frequently Asked Questions

Yes, because Enbrel can weaken the immune system, a minor viral infection like a common cold has the potential to become more severe. This is why it is essential to monitor your symptoms and contact your doctor if they worsen.

Signs of a serious infection include a persistent or high fever, chills, severe body aches, shortness of breath, widespread pain, or persistent diarrhea. If you experience these symptoms, contact your doctor immediately.

You should always inform your doctor when you have any infection, including a cold, but a phone call is often sufficient for mild cases without fever. For severe infections, an in-person visit may be necessary.

Before taking any over-the-counter medications, including cold and flu remedies, you should consult with your doctor or pharmacist. Some medicines can have interactions or effects that need to be considered while on Enbrel.

If your doctor advises you to skip a dose, do not take a double dose or shorten the time until your next injection. Simply resume your regular schedule once your doctor gives you clearance. If you are unsure, call your doctor for guidance.

A mild infection is typically a self-limiting viral illness, like a common cold without a fever. A severe infection often involves a high fever and more pronounced systemic symptoms, requiring immediate medical attention and usually a pause in treatment.

Patients on Enbrel should not receive live vaccines. However, most inactivated vaccines, such as the flu shot, are safe. Your doctor can help you create a safe vaccination schedule.

You can typically restart Enbrel once your symptoms have completely cleared and your doctor confirms it is safe to do so. This timeline will be decided on a case-by-case basis by your medical team.