Indications
Tocilizumab is a biological medicine used to treat moderate to severe rheumatoid arthritis (often with Methotrexate), giant cell arteritis, systemic and polyarticular juvenile idiopathic arthritis, and cytokine release syndrome (a severe immune reaction that can follow some cancer treatments). It is also used in some patients in hospital with severe COVID-19 who need oxygen and are receiving Corticosteroids.
How It Works
Tocilizumab is a monoclonal antibody, a laboratory-made protein that blocks the receptor for interleukin-6 (IL-6). IL-6 is a messenger that drives inflammation in the joints and blood vessels and causes fever, tiredness and anaemia. Blocking it reduces inflammation, pain, swelling and joint damage.
Dosage and Administration
Tocilizumab is given as an infusion (drip) into a vein by a doctor or nurse, usually every 4 weeks, or as an injection under the skin at intervals set by the doctor, which some patients learn to give themselves after training. The dose depends on body weight and condition and is given as prescribed. Blood tests are done before and during treatment.
Interactions
Live vaccines must not be given during treatment. By reducing inflammation, it can speed up the breakdown of some medicines such as Warfarin, Ciclosporin, Simvastatin, Atorvastatin, Theophylline and oral contraceptives, so their effect may change. Combining with other biological immune suppressants is avoided. Tell the doctor about all medicines.
Contraindications
Do not use if you are allergic to Tocilizumab or have an active, serious infection, including untreated tuberculosis.
Side Effects
Common effects include upper respiratory infections, cold sores, headache, high blood pressure, raised cholesterol, raised liver enzymes, low white cell counts, and reactions at the injection or infusion site. Serious infections, liver damage and tears in the bowel wall (especially in people with diverticulitis) can occur rarely.
Get urgent medical help if you have fever, chills, persistent cough or other signs of infection; severe stomach pain with fever or a change in bowel habit; yellowing of the skin or eyes or dark urine; or swelling of the face or throat, difficulty breathing, chest tightness or a widespread rash during or after a dose.
Pregnancy and Lactation
Use in pregnancy only if clearly needed. Women who could become pregnant should use effective contraception during treatment and for 3 months after the last dose. It is not known whether it passes into breast milk; the doctor will advise on breastfeeding.
Precautions and Warnings
You will be checked for tuberculosis and hepatitis B before starting. Tell the doctor about any infection, diverticulitis or stomach ulcers, liver disease, or recent vaccines. Because it can hide signs of infection such as fever, report feeling unwell early. Liver tests, blood counts and cholesterol are checked regularly.
Overdose
Information is limited. A high dose may lower white cell counts. Treatment is supportive with monitoring, managed by the healthcare team.
Therapeutic Class
Interleukin-6 receptor inhibitor (monoclonal antibody, immunosuppressant)
Storage
Store in a refrigerator at 2 to 8°C, do not freeze, keep in the outer carton to protect from light, and keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.