Orencia (Abatacept) Side Effects

Table of Contents
View All
Table of Contents

Orencia (abatacept) is used to treat autoimmune diseases, mainly it reduces pain and symptoms of rheumatoid arthritis. It's also used for psoriatic arthritis and juvenile idiopathic arthritis. Orencia is available in powder form, which can be taken intravenously when mixed with a solution, and in liquid form, which is also taken intravenously or given through an injection under the skin (subcutaneous injection). The medication works by preventing antigen-presenting cells from binding to T-cells, inhibiting the overactivity of the immune system.

A doctor is giving a flu vaccine for illness prevention.

Kmatta / Getty Images

Common Side Effects

Those taking Orencia may experience mild side effects. Mild side effects typically disappear within days of the first dose and don’t cause any serious issues.

Some of the most common side effects include:

In children and adolescents taking Orencia, the common side effects are different and include:

  • Abdominal pain
  • Diarrhea
  • Cough
  • Fever

Mild Allergic Reactions

Orencia can also cause a mild allergic reaction, possibly with a skin rash. Typically, these were found in less than 5% of participants in the clinical study and went away in days.

Symptoms of a mild allergic reaction to Orencia include:

  • Skin rash that may occur on any part of the body
  • Skin rash that occurs at the injection site
  • Itchiness
  • Warm and redness of the skin
  • Runny nose
  • Dizziness
  • Heartburn
  • Back, leg, or arm pain

Serious Side Effects

Although rare, some people who take Orencia can experience serious side effects, which could potentially result in permanent damage, the need for emergency medical treatment and hospitalization, or death in some cases.


The use of Orencia can increase someone's chances of getting infections, or it may worsen current infections. During clinical trials, infections were reported in 54% of participants being treated with the medication vs. 48% of people treated with placebo, with 3% being serious infections in the Orencia group and 1% in the placebo group. In very rare cases, these infections can be fatal. The most common organs affected are the lungs, kidneys, colon, urinary tract, and skin.

Symptoms of infection that could occur as a serious side effect of the medication include:

  • Fever or chills
  • Cough
  • Skin that is red, warm, or painful to touch
  • Fatigue
  • Flu-like symptoms

Hepatitis B

For those with chronic infections such as hepatitis B, the risk for reactivation of their chronic liver disease is higher while taking Orencia. If Orencia does cause a dormant hepatitis B infection to flare up, symptoms could come back and the infection could become more serious.

Typical symptoms of a flare-up of hepatitis B include:

  • General fatigue
  • Loss of appetite
  • Weakness
  • Joint and muscle pain
  • Dark-colored urine
  • Yellowing of the skin or whites of the eyes, otherwise known as jaundice
  • Fever
  • Abdominal discomfort


Those with chronic obstructive pulmonary disease (COPD) should be cautious when taking Orencia because the medication can worsen difficulties with breathing and worsen the condition over time.

Symptoms to look out include:

  • Difficulty breathing
  • Shortness of breath
  • Unintentional weight loss
  • Night sweats
  • The sudden need to urinate or frequent urination
  • A burning sensation while urinating
  • A red, hot, swollen area on the skin (cellulitis)

Severe Allergic Reactions

Orencia was found to cause severe allergic reactions in 1% of people in clinical studies. Symptoms of a severe allergic reaction include hives, swelling that occurs in the eyelids, lips, hands, feet, tongue, mouth, or throat, and difficulty breathing.

A severe allergic reaction can be life-threatening. If you notice any of the signs of a severe allergic reaction, call 911 for medical help immediately.


Taking Orencia can increase your risk of developing cancer over time because of the effects it has on cell growth and multiplication. The most common types of cancer that occurred because of Orencia are lung cancer and blood cancer.

When To Call Your Doctor

The mild side effects of Orencia will typically go away in a few days once the body adjusts to the medication, but if they persist or become worse, talk to your doctor.

You should seek emergency medical help if you experience the following symptoms:

  • Trouble breathing
  • Stabbing chest pain, wheezing, cough with yellow or green mucus
  • Pain or burning when you urinate
  • Signs of skin infection such as itching, swelling, warmth, redness, or oozing


Orencia comes with several warnings, including hypersensitivity and anaphylaxis, serious infections like pneumonia and sepsis, and adverse events in COPD patients (rhonchi, shortness of breath, and worsening symptoms). People who are taking Orencia should not receive live vaccines while taking the medication or within three months of stopping the drug. There is also a warning regarding immunosuppression to Orencia use because it inhibits the body's T-cell response and lower the body's defense against infections.

For people who are pregnant, Orencia should be used only when it is prescribed. It is unclear if Orencia passes into breast milk or if it would harm a nursing baby. Breastfeeding is therefore not recommended while using this drug.


The main drug interaction one should be concerned about while using Orencia is with anti-TNFs (tumor necrosis factor inhibitors) or TNF antagonists. This type of medication is also used to treat arthritic autoimmune disorders, and includes Humira, Enbrel, and Remicade. People receiving IV Orencia and TNF antagonist therapy experienced more infections (63%) and serious infections (4.4%) compared with those who were only on TNF antagonists. While transitioning from anti-TNFs to Orencia, people should therefore monitor for signs of infections.

A Word From Verywell

Dealing with an arthritic autoimmune disorder can be tough. The right medication can ease symptoms and help slow the progression of the disease, but it often comes with its own set of side effects. If you are thinking about taking Orencia or are already taking the medication, it’s important to talk with your doctor about possible side effects and how best to minimize them. If you experience any of the side effects mentioned above and they become bothersome, there may be another medication that works better for you.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. DailyMed. ORENCIA- abatacept injection, powder, lyophilized, for solution ORENCIA- abatacept injection, solution. Updated June 17, 2020.

  2. MedlinePlus. Abatacept Injection. Updated August 15, 2020.

  3. Montastruc F, Renoux C, Dell'Aniello S, Simon TA, Azoulay L, Hudson M, Suissa S. Abatacept initiation in rheumatoid arthritis and the risk of cancer: a population-based comparative cohort study. Rheumatology (Oxford). 2019 Apr 1;58(4):683-691. doi: 10.1093/rheumatology/key352

  4. U.S. Food and Drug Administration. Orencia (abatacept) Label.

  5. U.S. Food and Drug Administration. Orencia (abatacept).