Generic Name: tocilizumab, Injectable Solution

Generic Name:

tocilizumab, Injectable Solution

Actemra

All Brands

  • Actemra
SECTION 1 of 5

Highlights for tocilizumab

Injectable Solution
1

Tocilizumab is an injected drug used to treat rheumatoid arthritis.

2

The recommended dose for adults is 162 mg taken as an injection every week or every other week, depending upon your body weight.

3

Common side effects include upper respiratory infections, nasal congestion, headaches, high blood pressure, liver problems, and injection site reactions.

4

Before you start this drug, your doctor will do a tuberculosis test and check your white blood cell count and liver function.

5

Tocilizumab can decrease your body’s ability to fight infection. You may have an increased chance to develop serious infections or cancer while taking this medication.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Risk of infection. Tocilizumab can lower the ability of your immune system to fight infections. Some people develop serious infections while taking this drug. These may include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria.

Your doctor may test you for TB before starting tocilizumab. They may monitor you closely for symptoms during treatment with the drug even if you tested negative for TB.

Your doctor may check you for symptoms of any type of infection before, during, and after your treatment with tocilizumab. Don’t start taking the drug if you have any kind of infection without checking with your doctor first. Tell your doctor right away if you develop any symptoms of an infection while taking the drug.

Risk of stomach ulcers

Tell your doctor if you’ve had diverticulitis or ulcers in your stomach or intestines. Some people taking tocilizumab get tears in their stomach or intestines. This is most likely to happen in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your doctor right away if you have a fever, stomach pain that doesn’t go away, or a change in your bowel habits.

Changes in blood test results

Your doctor may do blood tests before you start and during treatment with tocilizumab. These blood tests check your neutrophil cell and platelet count and liver function. Your doctor may need to adjust your dose of tocilizumab based on the results of these tests.

Risk of high cholesterol

Tocilizumab may raise your cholesterol levels. Your doctor may check your cholesterol levels 4–8 weeks after starting tocilizumab, and then every 6 months after that.

Drug features

Tocilizumab is a prescription drug. It’s available in these forms: self-injectable prefilled syringe and intravenous (IV), which is only given by a healthcare provider.

Why it's used

Tocilizumab is used to treat moderate to severe rheumatoid arthritis in adults. It’s used when other arthritis drugs haven’t worked well.

How it works

Tocilizumab works to block a protein in your body that leads to inflammation.

More Details

How it works

Tocilizumab works to block a protein in your body that leads to inflammation.

This drug blocks the signals of interleukin-6. Interleukin-6 is a protein your body makes to help activate your immune system. However, in the case of rheumatoid arthritis, blocking interleukin-6 actually stops your immune system from attacking your body. This may improve arthritis symptoms and slow the progression of the disease.

SECTION 2 of 5

tocilizumab Side Effects

Injectable Solution

Most Common Side Effects

The most common side effects that occur with tocilizumab include:

  • upper respiratory infections, such as sinus infections and the common cold

  • nasal congestion, including runny nose or sore throat

  • headache

  • high blood pressure

  • increased liver enzymes

  • injection site reactions, such as:

    • pain
    • itching
    • bruising
    • skin reddening

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • symptoms of serious infections, such as:

    • sweating or chills
    • muscle aches
    • cough
    • shortness of breath
    • blood in phlegm
    • unexplained weight loss
    • warm, red, or painful skin or sores on your body
    • diarrhea or stomach pain
    • burning sensation when you urinate or urinating more often than usual
    • feeling very tired
  • cancer

  • tears in your stomach or intestines. Symptoms may include:

    • moderate or severe stomach pain
    • abdominal tenderness
    • vomiting
  • serious allergic reactions. Symptoms may include:

    • hives
    • skin rash
    • reddening of your skin (flushing) after your injection
  • shortness of breath or trouble breathing

  • swelling of your lips, tongue, or face

  • chest pain

  • feeling dizzy or faint

  • hepatitis B virus infection. If you have had the hepatitis B virus infection, it may become active while you take tocilizumab. Symptoms may include:

    • feeling very tired
    • yellowing of your skin or whites of your eyes
    • little or no appetite
    • vomiting
    • clay-colored stool
    • fever
    • chills
    • upset stomach
    • muscle aches
    • dark-colored urine
    • skin rash
  • nervous system problems. While rare, multiple sclerosis has been diagnosed in people who use tocilizumab. Symptoms of multiple sclerosis may include:

    • muscle weakness
    • poor balance and coordination
    • slurred speech
    • blurred vision
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Tocilizumab does not cause drowsiness.

Mild side effects may go away within a few days or a couple of weeks. Talk to your doctor or pharmacist if they’re more severe or don’t go way.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

tocilizumab May Interact with Other Medications

Injectable Solution

Tocilizumab can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Medications that might interact with this drug

Anti-inflammatory drugs

These drugs can increase your risk of infection if taken with tocilizumab:

  • etanercept (Enbrel)
  • adalimumab (Humira)
  • infliximab (Remicade)
  • certolizumab (Cimzia)
  • golimumab (Simponi)

Rheumatoid arthritis drugs

These drugs can increase your risk of infection if taken with tocilizumab:

  • rituximab (Rituxan)
  • abatacept (Orencia)
  • anakinra (Kineret)

Anticoagulant, blood thinner
  • warfarin

Tocilizumab can change the effectiveness of this medication. Your warfarin dose may need to be adjusted.

Immune system suppressant
  • cyclosporine

Tocilizumab can change the effectiveness of this medication. Your cyclosporine dose may need to be adjusted.

Asthma and lung drug
  • theophylline

Tocilizumab can change the effectiveness of this medication. Your theophylline dose may need to be adjusted.

Birth control pills

These drugs are metabolized by a specific enzyme in your body known as CYP3A4. Tocilizumab can increase how well this enzyme works, which means the drugs are metabolized and removed more quickly by your body. Tocilizumab may decrease the effectiveness of these medications.

Heart and cholesterol drugs
  • lovastatin
  • atorvastatin

These drugs are metabolized by a specific enzyme in your body known as CYP3A4. Tocilizumab can increase how well this enzyme works, which means the drugs are metabolized and removed more quickly by your body. Tocilizumab may decrease the effectiveness of these medications.

Live vaccines

Examples are:

  • live flu vaccine
  • measles, mumps, and rubella vaccine
  • shingles vaccine

Don’t receive a live vaccine while taking tocilizumab. It may not fully protect you from disease while you’re taking this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with infections

Tell your doctor if you have any kind of infection, even if it’s small, such as an open cut or sore that looks infected. Your body may have a harder time fighting off the infection while you’re taking tocilizumab.

People with liver problems

Tocilizumab is broken down by your liver. If you have liver disease, it may build up in your body and cause toxic effects. Treatment with tocilizumab is not recommended in people with active liver disease.

People with stomach or intestinal problems

This drug can irritate your stomach or intestines, which can worsen your stomach or intestinal problems. 

People with nervous system conditions

This includes multiple sclerosis. While rare, multiple sclerosis has been diagnosed in people who use tocilizumab. It isn’t known what effect the drug may have on some nervous system disorders.

People who plan to have surgery

Surgery increases your risk for infections, and your body may have a harder time fighting off infection while you’re taking tocilizumab. Tell your doctor you’re taking tocilizumab before scheduling surgery of any kind.

People with the hepatitis B

If you’ve had the hepatitis B virus infection, it may become active while you’re taking tocilizumab. Your doctor may do blood tests before you start treatment and while you’re taking this drug.

Pregnant women

Tocilizumab is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Tocilizumab should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding

It is not known if tocilizumab passes through your breastmilk. If it does, it may cause side effects in a breastfeeding child.

You and your doctor may need to decide if you will take tocilizumab or breastfeed.

For seniors

If you’re a senior, this medication may further increase your risk of infections.

For children

The safety and effectiveness of tocilizumab (prefilled syringe) haven’t been established in children under the age of 18 years.

Allergies

Tocilizumab can cause a severe allergic reaction. Symptoms may include:

  • shortness of breath or trouble breathing
  • swelling of your lips, tongue, or face
  • chest pain
  • feeling dizzy or faint
  • moderate or severe abdominal pain or vomiting

Don’t take this drug again if you’ve ever had an allergic reaction to it before. Taking it a second time after an allergic reaction could be fatal.

SECTION 4 of 5

How to Take tocilizumab (Dosage)

Injectable Solution

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Rheumatoid arthritis
Form: Injectable prefilled syringe
Strengths: 162 mg in 0.9 mL
Adult dosage (ages 18 years and older)

The recommended dosage depends on your weight:

  • people who weigh less than 220 pounds (100 kg): The dose is 162 mg injected under the skin every other week. Your doctor may increase your dose to every week based on your response to the drug.
  • people who weigh 220 pounds (100 kg) more: The dose is 162 mg injected under the skin every week.
Child dosage (ages 0-17 years)

A safe and effective dose hasn’t been established in children under the age of 18 years.

 Warnings

It’s recommended that tocilizumab not be started in a person with:

  • an absolute neutrophil count below 2,000 per mm3
  • a platelet count below 100,000 per mm3
  • liver enzymes (ALT or AST) above 1.5 times the upper limit of normal

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Tocilizumab comes with risks if you don’t take it as prescribed by your doctor.

If you don’t take it at all

Rheumatoid arthritis is a chronic, progressive condition. This means it can get worse over time, especially it’s left untreated. There is no cure, but tocilizumab may help you feel better. Rheumatoid arthritis is active in your body and can cause damage, even when you don’t have symptoms. Taking your medications as directed by your doctor, even when you’re feeling well, will give you the best chance of managing your disease and improving your quality of life.

If you skip or miss doses

If you stop taking this medication, miss doses, or don’t receive it on schedule, your arthritis may get worse.

If you take too much

If you take too much tocilizumab, you may experience more side effects. Call your doctor if you take more than the prescribed dose of tocilizumab.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. But if it’s just a few days until your next scheduled dose, then take only one dose at that time.

Never try to catch up by taking two doses at once. This could result in toxic side effects. Call your doctor if the full dose is not given.

How to tell if the drug is working

You may be able to tell this drug is working if your pain decreases and you’re able to perform daily tasks, like gripping objects or walking, better. Your doctor may also do lab tests and X-rays to see if the drug is working.

Tocilizumab is a long-term drug treatment.

Important considerations for taking tocilizumab

Store tocilizumab in the refrigerator

Keep it in temperatures from 36–46°F (2–8°C). Don’t freeze the medication.

Store it in its original package. Keep it away from light and moisture until you use it. 

Don’t use the drug after its expiration date.

Travel

When traveling with your medication:

  • Always carry it with you in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s label to identify the medication. Keep the original pharmacy label bottle with you when traveling.
  • Make sure that you have enough medication and supplies before you travel. It might be hard to get this medicine at another pharmacy because it’s not always in stock.
  • Keep the syringes in their original packaging and pack them in a travel cooler with a frozen ice pack. The syringe must be kept at 36–46°F (2–8°C). Don’t freeze syringes.

Self-management

Your doctor or nurse will train you how to inject yourself under the skin with tocilizumab. After proper training, you or a caregiver may give tocilizumab.

To prepare the injection:

  • Remove the prefilled syringe from the refrigerator and allow it to sit at room temperature outside of the carton for 30 minutes. Don’t warm up tocilizumab in any other way.
  • The solution in syringes should look clear and colorless to pale yellow. There should be no particles in it. If the prefilled syringe looks cloudy, discolored, or has particles in it, don’t use it.
  • Inject yourself with the full amount in the syringe.
  • Rotate the injection site with each injection. Never give the injection into moles, scars, or areas where the skin is tender, bruised, red, hard, or has a wound.

In addition to the medication, you may also need:

  • alcohol wipes
  • cotton balls
  • a safe container to dispose your used needles

Clinical monitoring

Your doctor may do these tests to check your health and make sure that the drug is working for you:

  • neutrophil and platelet count
  • liver tests
  • blood cholesterol levels
  • tuberculosis

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for tocilizumab.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

SECTION 5 of 5

How Much Does tocilizumab Cost?

Injectable Solution
We've partnered with GoodRX so you can compare prices and save money on your next prescription. Check out the lowest cash prices below and enter your zip code to find the best deal near you.

Compare prices and save money on your next refill!

Lowest price for tocilizumab

Membership warehouse $1,669.95
CVS Pharmacy $1,686.66
Kmart $1,686.66
These represent the lowest cash prices for tocilizumab and may be lower than your insurance.

Find the lowest prices of tocilizumab near you

These represent the lowest cash prices for tocilizumab and may be lower than your insurance.

Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on June 10, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Read This Next

The Best Rheumatoid Arthritis iPhone and Android Apps of the Year
The Best Rheumatoid Arthritis iPhone and Android Apps of the Year
Rheumatoid Arthritis-Inspired Tattoos
Rheumatoid Arthritis-Inspired Tattoos
The 10 Best Places to Live with RA
The 10 Best Places to Live with RA
Advertisement
Advertisement
Advertisement