Biologics: Autoinjector or syringe?

When I started Humira, my doctor automatically put it in as an autoinjector prescription. That was a mistake.

The first time I did the injection, it was okay. No big deal. Sure, it hurt, and it took awhile to get myself to press the button, but I could deal with it. The second time, though, it took a little longer, and definitely felt more painful. The third time took a little longer to do, and the fourth time… Well, I couldn’t do it.

Each shot was like injecting burning venom into my body. It was so painful, I just couldn’t bring myself to press the button. It led to a breakdown… or a few. I started making my partner do it, but that wasn’t working, either. He might be able to give himself shots all day long for diabetes, but giving me a shot that would hurt that much was not something he could do. Plus, as an adult, I needed to be able to give myself my own medication.

I was ashamed by my inability. Tons of people use the autoinjectors, so why couldn’t I?  The internet came to my rescue, though, when I learned that I wasn’t the only one having these problems. A lot of people have experienced intense pain with the autoinjectors, and the good news is, Humira is offered in two main forms: autoinjectors (or pens, as they call them) and prefilled syringes. And Enbrel is the same!

Autoinjectors aren’t for everybody, just like syringes aren’t for everybody. If you’re starting Humira or Enbrel, or are already on them and wondering about other options, I’m going to go through what I’ve learned about Humira and Enbrel and using the autoinjectors versus the prefilled syringes.

Autoinjectors (pens)

Humira and Enbrel both have an autoinjector option, which automatically gives your your dose when you press the tip of the pen to your skin and push the button. I’ve talked so far about how painful they were for me, but not everyone experiences a lot of pain, so the autoinjector may be perfectly fine for you. If that’s the case, they’re easy, quick, and convenient to use, and you don’t have to see the needle at all!

However, if it takes hours just to get yourself to press the button, don’t feel like you’re stuck with it because that’s how it must be for everybody. Humira and Enbrel autoinjectors can be excruciating for some people, because unfortunately, everybody is different in terms of body structure and pain tolerance and many other things. And for me, personally, another issue with the autoinjector was the lack of control after pressing the button. It was a little scary and resulting in a lot of psyching myself out, so I was forced to decide that the autoinjector wasn’t for me.

Prefilled syringes

The other option commonly available is the Humira  or Enbrel prefilled syringe, which is just a syringe that comes with your dose already in it. The problem for some people may be in seeing the actual needle, unfortunately. For anyone worried, I can assure you that sticking yourself with the needle is almost completely painless, and sometimes it is completely painless. It’s also easy to learn how to use, if that’s a concern.

In my experience, the Humira prefilled syringe still stings a little, because the medication itself stings. However, I can control how fast the medicine enters my body, and having that control is key for me. Injecting slowly reduces how much it stings by a huge amount, and it can even be painless, if I spend the time to take it slowly. Still, it takes more care to position the syringe needle and inject the medicine than using the autoinjector does, and the needle, I know, is not for everybody.

If you decide you need to switch to either the autoinjector or the prefilled syringe, talk to your doctor. Mine put in another prescription (or two, because CVS couldn’t find the first one), and I was soon good to go!

Pain-reducing tips

To reduce pain, there are some tricks to consider whether you’re using the autoinjector or the prefilled syringe:

1.  Make sure to let your Humira or Enbrel reach room temperature before injecting it, because cold medicine can be more painful to inject. It’s recommended to let it sit out for 30 minutes, but leaving it out longer to ensure that it’s room temperature won’t hurt it as long as it’s in a dark location at room temperature for less than 14 days. The instructions you get with the medication have more information on how it should be stored.

2. Icing the area before giving yourself the shot can help to numb it and make the injection less painful. I don’t think this is officially recommended, but people say it can help a lot.

3. Test different injection locations to find a place that hurts less. For me, my stomach is much less painful than injecting on my legs.

4. If you haven’t already started the medication or have the option of switching: If pain is a huge problem for you, Humira is typically taken every other week and Enbrel every week. So, if you want to reduce your number of shots, Humira may be a good choice for you. On the other hand, Enbrel makes it more of a routine, which may make it easier. These are things you can consider when you discuss appropriate treatments with your doctor.

Summary

Based on experience, the Humira or Enbrel prefilled syringe is a less painful option if you’re able to handle the needle. It lets you control the speed of the medicine, which can reduce pain a lot. If the autoinjectors work fine for you, keep using them! Autoinjectors are definitely a much easier way to take Humira and Enbrel, so if they’re not painful (or not very painful), they’re they way to go.

If you want to make either method as painless as possible, make sure to let the medication warm up before injecting it. Also, test for locations that may be less painful.

What’s your experience with autoinjectors versus syringes for Humira and Enbrel? I’d love to hear about it in the comments!

-Bri

(If you’re looking for more information about biologics, check out my post about flying with biologics or subscribe to get notified when I post my upcoming article about side effects of biologics.)

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