Medications
Biologics (Humira, Enbrel) Before Surgery
Biologic medicines such as Humira and Enbrel calm an overactive immune system to treat conditions like rheumatoid arthritis, inflammatory bowel disease and psoriasis. Because they dampen immunity, they're usually paused around surgery to protect healing and lower infection risk, then restarted once your wound has healed.
Quick answer
Why it matters
Biologics work by blocking specific parts of the immune system that drive inflammation. That's exactly what helps your arthritis, bowel or skin condition — but the same effect means your body is a little less able to fight infection and to heal a fresh surgical wound. Around an operation, that can translate into a higher chance of wound infection or slower healing, which is why these drugs are usually held.
Unlike most tablets, biologics aren't timed in 'days before surgery'. They're given on a cycle — etanercept (Enbrel) often weekly, adalimumab (Humira) typically every two weeks, infliximab every several weeks — and they linger in the body for a while. The usual rule is to skip a dose and schedule surgery for the week after your next dose would have been due, so drug levels are at their lowest: that works out around two weeks after a weekly Enbrel dose, or about three weeks after a fortnightly Humira dose, rather than stopping at a set number of days.
After surgery they're usually restarted once the wound has clearly healed and there's no sign of infection — often around two weeks, or after stitches or staples come out. Stopping isn't free of risk either: pausing can let the underlying disease flare, so the decision balances infection risk against keeping your condition controlled, and is made with your specialist.
Do not stop without instruction
What to ask your doctor
- My biologic is given every [week / 2 weeks / few weeks] — when exactly should my last dose be before surgery?
- How long after surgery, and after what signs of healing, can I restart it?
- Should my rheumatologist, gastroenterologist or dermatologist be involved in the plan?
- What should I do about my other medicines for the same condition, such as steroids or methotrexate?
Red flags — call your team
Red flags — call your team
- Signs of wound infection after surgery — increasing redness, swelling, warmth, pus or a wound that opens or won't heal — seek prompt medical advice
- Fever, chills or feeling generally unwell in the days after surgery, which can signal infection while your immunity is lowered
- A significant flare of your arthritis, bowel disease or skin condition while the biologic is paused — contact your specialist rather than restarting it yourself
References
- Reflects standard perioperative and specialty guidance (rheumatology and surgical sources such as ACR/ASRA-type recommendations) that biologic DMARDs are generally withheld around surgery — timed so surgery falls roughly one dosing interval after the last dose, when drug levels are lowest — and resumed once the wound has healed and infection is excluded. Exact timing depends on the specific drug and your surgery.
- Names covered include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and similar agents. Your surgical team's and prescribing specialist's instruction takes precedence over any general guidance here.
Frequently asked questions
Why do biologics need to be stopped before surgery?
Biologics dampen the immune system to control inflammation, so the body becomes a little less able to fight infection and to heal a fresh wound. Around surgery that raises the risk of wound infection and slow healing, so the drug is usually held. It's restarted once the wound has healed and there's no infection, balancing that risk against keeping your underlying disease controlled.
How long before surgery should I stop Humira or Enbrel?
There's no single number of days — it's based on the dosing cycle. The usual approach is to skip a dose and have surgery the week after your next dose would have been due, so the drug is at its lowest level: that's about two weeks after a weekly Enbrel dose, or about three weeks after a fortnightly Humira dose. Drugs given less often, like infliximab, are spaced out further, so confirm the exact timing with your prescriber.
When can I restart my biologic after surgery?
Usually once the surgical wound has clearly healed and there's no sign of infection — often around two weeks, or after any stitches or staples have been removed. Your specialist will give the exact timing. Don't restart while the wound is still healing or if there's any sign of infection, as that's when resuming immune-suppressing treatment is riskiest.
What if my condition flares while the biologic is paused?
A flare of arthritis, inflammatory bowel disease or psoriasis is a real possibility when treatment is paused, which is exactly why the stop should be planned with your specialist rather than done alone. If you flare during the gap, contact the team that prescribes your biologic for advice instead of restarting it yourself — they can manage symptoms and decide the safest time to resume.