IN-HOSPITAL USE FOR COVID-19
Actemra (tocilizumab) has an emergency use authorization (EUA). This EUA allows for
in-hospital useof Actemra as a treatment for COVID-19 in certain cases. Do not take any prescription drug, including Actemra, unless your doctor recommends that you do so.
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If you have certain immune system conditions, your doctor might suggest Actemra (tocilizumab) as a treatment option for you.
Actemra is a prescription medication that’s used to treat these conditions:
- giant cell arteritis in adults
- rheumatoid arthritis in adults
- systemic sclerosis related to interstitial lung disease in adults
- polyarticular juvenile idiopathic arthritis in children 2 years and older
- systemic juvenile idiopathic arthritis in children 2 years and older
- severe cytokine release syndrome after treatment with chimeric antigen receptor (CAR) T-cell therapy in children 2 years and older, and adults
Actemra comes as a liquid solution. It can be given as an injection under your skin or as an intravenous infusion (an injection given over time, into a vein). It contains the active drug tocilizumab, which belongs to a group of drugs called interleukin-6 receptor antagonists.
This article describes the dosages of Actemra, including its forms, strengths, and how to take the drug. To learn more about Actemra, see this in-depth article.
Note: This article covers Actemra’s typical dosages, which are provided by the drug’s manufacturer. But when using Actemra, always take the dosage that your doctor prescribes.
What are the forms of Actemra?
Actemra may be prescribed as an injection under your skin or as an IV infusion (an injection given over time, into a vein).
Actemra comes as a liquid solution, which is available in:
- a single-dose vial for infusion
- a single-dose prefilled syringe for injection
- a single-dose prefilled autoinjector pen called the ACTPen
Which form your doctor prescribes may depend on your age and the condition you’re taking Actemra to treat.
What strengths does Actemra come in?
For infusion, Actemra comes in the following strengths:
- 80 milligrams (mg) per 4 milliliters (ml) of solution
- 200 mg per 10 ml
- 400 mg per 20 ml
For injection, Actemra vials and ACTPens come in a strength of 162 mg per 0.9 ml of solution.
What are the typical dosages of Actemra?
Your dosing schedule depends on the condition you’re taking Actemra for, and possibly other factors such as your weight. (See “What factors can affect my dosage?” below for details.)
Your doctor will start you on the recommended dosage for your condition. Then they may adjust your dosage over time to reach the right amount for you. They’ll ultimately prescribe the dosage that’s most effective without increasing your risk of side effects.
The information below describes dosages that are commonly used or recommended. But be sure to take the dosage your doctor prescribes for you.
Dosage for giant cell arteritis
The Actemra dosage for giant cell arteritis in adults is a 162-mg injection, either once per week or once every other week.
Your doctor might prescribe a decreasing dose of a glucocorticoid medication with Actemra, depending on how severe your condition is.
Dosage for rheumatoid arthritis
The Actemra dosage for rheumatoid arthritis (RA) in adults depends on whether you’re taking Actemra by injection or as an infusion.
For RA, Actemra might be prescribed by itself or with a type of drug called a disease modifying anti-rheumatic drug.
IV infusion dosage
With Actemra infusions, your doctor will typically start you on a lower dosage to see how your treatment goes. The starting dosage is 4 mg per kilogram (kg)* of body weight, every 4 weeks.
For example, if you weigh 68 kg (about 150 pounds [lb]), your starting dose would likely be 272 mg.
After 4 weeks, your doctor may increase your dose to 8 mg per kg (also taken every 4 weeks). This depends on how effective your treatment is and any side effects you’re having.
* One kg equals about 2.2 lb.
With Actemra injections, your dosage depends on your body weight:
- If you weigh less than 100 kg (about 220 lb), Actemra’s dosage is 162 mg, once every other week. Based on how well this dosage works for you, including any side effects you have, your doctor may increase your dosage to 162 mg per week.
- If you weigh more than 100 kg, Actemra’s dosage is 162 mg per week.
Dosage for systemic sclerosis related to interstitial lung disease
Dosage for cytokine release syndrome
For cytokine release syndrome, Actemra is given by infusion. You’ll start with a one-time dose of Actemra. Its dosing is based on your body weight:
- if you weigh less than 30 kg (about 66 lb), your Actemra dose is 12 mg per kg
- if you weigh 30 kg or more, your Actemra dose is 8 mg per kg
For example, if you weigh 68 kg (about 150 lb), your dose would likely be 816 mg.
Depending on whether your symptoms improve after one Actemra infusion, your doctor may prescribe up to 3 more infusions for you. Each infusion will be given at least 8 hours apart.
What’s the dosage of Actemra for children?
Actemra’s dosing in children depends on your child’s body weight and the condition being treated.
Children’s dosage for polyarticular juvenile idiopathic arthritis
Actemra’s dosage for polyarticular juvenile idiopathic arthritis in children depends on which form of the drug is used, as described in the following table:
|infusion dosage||injection dosage|
|children who weigh less than 30 kg (about 66 lb)||10 mg per kg, once every 4 weeks||162 mg, once every 3 weeks|
|children who weigh 30 kg or more||8 mg per kg, once every 4 weeks||162 mg, once every 2 weeks|
For example, if your child weighs 50 kg (about 110 lb), their infusion dosage would likely be 400 mg every 4 weeks.
Children’s dosage for systemic juvenile idiopathic arthritis
Actemra’s dosage for systemic juvenile idiopathic arthritis in children depends on which form of Actemra is used, as shown in this table:
|infusion dosage||injection dosage|
|children who weigh less than 30 kg (about 66 lb)||12 mg per kg, once every 2 weeks||162 mg, once every 2 weeks|
|children who weigh 30 kg or more||8 mg per kg, once every 2 weeks||162 mg, once per week|
For example, if your child weighs 45 kg (about 99 lb), their infusion dosage would likely be 360 mg every 2 weeks.
Children’s dosage for cytokine release syndrome
For cytokine release syndrome in children, Actemra’s recommended dosage is the same as it is for adults. See “Dosage for cytokine release syndrome” above for details.
Is Actemra used long term?
Actemra is typically taken as a long-term treatment for all conditions except cytokine release syndrome. For this condition, Actemra is often taken as a one-time infusion (but up to 4 doses might be prescribed in total).
If you and your doctor determine that Actemra is safe and effective for you, and you’re not taking it to treat cytokine release syndrome, it’s likely you’ll take it long term.
Your doctor may temporarily lower your Actemra dosage if you have any of the following conditions, or if you develop any of the following during treatment:
- low levels of platelets (cells that help your blood clot)
- low levels of certain white blood cells
- high levels of liver enzymes (a type of protein), which can be a sign of liver problems
If any of these problems are severe, your doctor might have you stop taking Actemra permanently.
Also, if you develop a serious infection,* your doctor will pause your Actemra treatment until the infection is treated.
The dosage of Actemra you’re prescribed may depend on several factors. These include:
- the type and severity of the condition you’re using Actemra to treat
- your age
- your body weight
- which form of Actemra you’re taking
Other medical conditions you have can also affect your dosage. See “Dosage adjustments” under “What is Actemra’s dosage?” just above for details, or talk with your doctor.
Your doctor or another healthcare professional might show you (or a caregiver) how to give Actemra injections at home. You can also view this video from Actemra’s manufacturer on how to inject prefilled syringes of Actemra, and follow these step-by-step instructions.
Actemra is prescribed as an infusion for certain conditions (see “What is Actemra’s dosage?” above for details). Infusions are given at your doctor’s office or a medical clinic. A healthcare professional will monitor you for side effects during and soon after each infusion. Actemra infusions usually last about 60 minutes.
For information on Actemra’s expiration, storage, and disposal, see this article.
If you miss an appointment for an Actemra infusion, reschedule the dose right away.
If you forget to give yourself an Actemra injection, call your doctor’s office. They can recommend what you should do next, based on your treatment plan.
If you need help remembering to take your dose of Actemra on time, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.
It’s important to not take more Actemra than your doctor prescribes. Doing so can lead to serious side effects.
Symptoms of overdose
* This dose was 28 milligrams per kilogram (kg) of body weight. 1 kg equals about 2.2 pounds.
What to do in case you use too much Actemra
Call your doctor right away if you think you’ve used too much Actemra. You can also call 800-222-1222 to reach the American Association of Poison Control Centers, or use their online resource. But if you have severe symptoms, call 911 (or your local emergency number) immediately or go to the nearest emergency room.
The sections above describe the typical dosages provided by Actemra’s manufacturer. If your doctor recommends Actemra for you, they’ll prescribe the dosage that’s right for you.
Remember, you shouldn’t change your dosage of Actemra without your doctor’s recommendation. Only take Actemra exactly as prescribed. Talk with your doctor if you have questions or concerns about your current dosage.
Here are some examples of questions you may want to ask your doctor:
- Will my dose need to be adjusted if I have renal (kidney) problems?
- Can my doctor switch me from Actemra infusions to injections?
- Do I need a certain Actemra dosage if I’m pregnant or breastfeeding?
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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 another 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.