Tocilizumab Injection : Uses, Side Effects, Interactions & More
Using tocilizumab injection may decrease your ability to fight bacteria, viruses, and fungal infections and increase your risk of getting a serious or life-threatening infection that can spread throughout the body. Tell your doctor if you often have any kind of infection, or if you have or think you may have some kind of infection now. This includes minor infections (like open cuts or sores), infections that come and go (like cold sores), and continuous infections that don’t go away. Also tell your doctor if you have or have ever had diabetes, human immunodeficiency virus (HIV), or any condition that affects your immune system, and if you live, have lived, or traveled to areas such as the Ohio River valleys and Mississippi and the Southwest where severe fungal infections are most common. Ask your doctor if you don’t know if these infections are common in your area. Also tell your doctor if you are taking: abatacept (Orencia); adalimumab (Humira); anakinra (Kineret); certolizumab (Cimzia); etanercept (Enbrel); golimumab (Simponi); infliximab (Remicade); drugs that suppress the immune system, such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), methotrexate (Otrexup, Trexall, others), sirolimus (Rapamune), and tacrolimus (Prograf); oral steroids such as dexamethasone, methylprednisolone and prednisone (Rayos); or rituximab (Rituxan). If you experience any of the following symptoms, call your doctor immediately: fever; cold; perspiration; labored breathing; sore throat; cough; weightloss; Diarrhea; stomach ache; phlegm blood; exhausted; muscle pains; warm, red, or painful skin; sores on the skin or in the mouth; burning when urinating; frequent urination; or other signs of infection.
You may be infected with tuberculosis (TB; a type of lung infection) or hepatitis B (a type of liver disease) but do not have any symptoms of the disease. In this case, tocilizumab injection may increase the risk that your infection will become more severe and develop symptoms. Your doctor will perform a skin test to see if you have an inactive TB infection and may order blood tests to see if you have an inactive hepatitis B infection. If necessary, your doctor will give you medicine to treat this infection before you start using tocilizumab injection. Tell your doctor if you have or have ever had TB or hepatitis B, if you have visited a country where TB is common, or if you have been around someone who has TB. If you have any of the following symptoms of TB, or if you develop any of these symptoms during your treatment, call your doctor immediately: cough, chest pain, coughing up blood or mucus, weakness or tiredness, weight loss, loss appetite, chills, fever, or night sweats. Also call your doctor right away if you have any of these hepatitis B symptoms or if you develop any of these symptoms during or after your treatment: excessive tiredness, yellowing of the skin or eyes, loss of appetite, nausea, vomiting, pain muscle, dark urine, clay-colored stools, fever, chills, stomach pain, or skin rash.
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your health carefully to make sure you do not develop a serious infection. Your doctor will order certain laboratory tests before and during your treatment to check your body’s response to tocilizumab injection.
Your doctor or pharmacist will provide you with the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with tocilizumab injection and each time you receive the medication. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.
Talk to your doctor about the risks of using tocilizumab injection.
Why is this medication prescribed?
Tocilizumab injection is used alone or in combination with other medications to relieve the symptoms of certain types of arthritis and other conditions including:
• Rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) in people who have not been helped by other disease-modifying antirheumatic drugs (DMARDs),
• Giant cell arteritis (a condition that causes inflammation of the blood vessels, especially the scalp and head),
• Polyarticular juvenile idiopathic arthritis (PJIA; a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function) in children 2 years of age or older.
• Systemic juvenile idiopathic arthritis (SJIA; a condition in children that causes inflammation in different areas of the body, causing fever, joint pain and swelling, loss of function, and delayed growth and development) in children 2 years of age or greater,
• Cytokine release syndrome (a serious and life-threatening reaction) that occurs in adults and children 2 years of age or older after receiving certain immunotherapy infusions.
Tocilizumab injection belongs to a class of medications called interleukin-6 receptor inhibitors (IL-6). It works by blocking the activity of interleukin-6, a substance in the body that causes inflammation.
How should this medicine be used?
Tocilizumab injection comes as a solution (liquid) to be injected intravenously (into a vein) by a doctor or nurse into your arm at a hospital doctor’s office or outpatient clinic, or as a pre-filled syringe to inject subcutaneously ( under the skin) home. When tocilizumab is given intravenously to treat rheumatoid arthritis or polyarticular juvenile idiopathic arthritis, it is usually given once every 4 weeks. When tocilizumab is given intravenously to treat systemic juvenile idiopathic arthritis, it is usually given once every 1 to 2 weeks. When tocilizumab is given intravenously to treat cytokine release syndrome, it is usually given once, but up to 3 additional doses can be given at least 8 hours apart. It will take approximately 1 hour to receive your dose of tocilizumab injection intravenously. When tocilizumab is administered subcutaneously to treat rheumatoid arthritis or giant cell arteritis, it is usually given once a week or once every two weeks.
You will receive your first subcutaneous dose of tocilizumab injection in your doctor’s office. If you are going to inject the tocilizumab injection subcutaneously at home, or if a friend or family member injects the medication, your doctor will show you or the person who will inject the medication how to inject it. You and the person who will be injecting the medicine should also read the written instructions for use that come with the medicine.
Thirty minutes before you are ready to inject the tocilizumab injection, you will need to remove the medicine from the refrigerator, take it out of its box, and allow it to reach room temperature. When removing a pre-filled syringe from the box, be careful not to touch the fingers of the syringe trigger. Do not try to heat the medication by heating it in a microwave, placing it in warm water, or using any other method.
Do not remove the cap from the pre-filled syringe while the medicine is heating. You must remove the cap no more than 5 minutes before injecting the medicine. Do not replace the cap after removing it. Do not use the syringe if you drop it on the floor.
Check the pre-filled syringe to make sure the expiration date printed on the package has not passed. Holding the syringe with the covered needle pointing down, look closely at the liquid in the syringe. The liquid should be clear or pale yellow and should not be cloudy or discolored or contain lumps or particles. Call your pharmacist if there is a problem with the package or syringe and do not inject the medication.
Tocilizumab injection may be injected into the front of the thighs or any part of the stomach except the navel (belly button) and the area 2 inches around it. If someone else is injecting your medicine, you can also use the outer area of the upper arms. Do not inject the medication into sensitive, bruised, red, hard, or skin that is not intact, or has scars, moles, or bruises. Choose a different place each time you inject the medicine, at least 1 inch from a place you have used before. If the full dose is not injected, call your doctor or pharmacist.
Do not reuse pre-filled tocilizumab syringes and do not re-cap the syringes after use. Dispose of used syringes in a puncture-resistant container and ask your pharmacist how to throw away the container.
Tocilizumab injection may help control your symptoms, but will not cure your condition. Your doctor will monitor you carefully to see how well the tocilizumab injection works for you. Your doctor may adjust your dose or delay your treatment if you have certain changes in your laboratory results. It is important to tell your doctor how you feel during your treatment.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before receiving tocilizumab injection,
• Tell your doctor and pharmacist if you are allergic to tocilizumab, any other medications, or any of the ingredients in tocilizumab injection. Consult your pharmacist or consult the Medication Guide for a list of ingredients.
• Tell your doctor and pharmacist what other prescription and over-the-counter medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: blood thinners (‘blood thinners’) such as warfarin (Coumadin, Jantoven); aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others); cholesterol-lowering medications (statins) such as atorvastatin (Lipitor, in Caduet), lovastatin (Altoprev, in Advicor), and simvastatin (Zocor, in Vytorin); oral contraceptives (birth control pills); or theophylline (Elixophyllin, Theo-24, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications can also interact with tocilizumab injection, so be sure to tell your doctor about all the medications you are taking, even those that are not listed here.
• Tell your doctor if you have or have ever had cancer; diverticulitis (small pockets in the lining of the large intestine that can become inflamed); ulcers in your stomach or intestines; high cholesterol and triglycerides; any condition that affects the nervous system, such as multiple sclerosis (MS; a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and control of the bladder) or chronic inflammation demyelinating polyneuropathy (PDIC; a disorder of the immune and nervous system); or liver disease.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while receiving tocilizumab injection, call your doctor.
• If you are going to have surgery, including dental surgery, tell the doctor or dentist that you are receiving tocilizumab injection.
• Ask your doctor if you should receive any vaccines before starting your treatment with tocilizumab injection. If possible, all childhood vaccines should be updated before starting treatment. Do not get vaccinated during your treatment without talking to your doctor.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
If you miss an appointment to receive a tocilizumab infusion, call your doctor.
If you forget to inject a subcutaneous dose of tocilizumab, inject the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inject a double dose to make up for a missed one. Call your doctor or pharmacist if you do not know when to inject tocilizumab injection.
What side effects can this medication cause?
Tocilizumab injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- runny nose or sneezing
- redness, itching, pain, or swelling in the place where tocilizumab was injected
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:
- chest pain
- difficulty breathing or swallowing
- dizziness or fainting
- swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
- fever, ongoing stomach-area pain, or change in bowel habits
- yellow eyes or skin; right upper abdominal pain; unexplained bruising or bleeding; loss of appetite; confusion; yellow or brown-colored urine; or pale stools
Tocilizumab may increase the risk of developing certain types of cancer. Talk to your doctor about the risks of receiving this medication.
Tocilizumab injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medicine.
If you experience a serious side effect, you or your doctor can submit an online report to the Food and Drug Administration (FDA) MedWatch Adverse Event Reporting Program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medicine in the package it came in, away from light, tightly closed, and out of the reach of children. Store tocilizumab injection in the refrigerator, but do not freeze it. Keep the prefilled syringes dry. Throw away any medicine that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medicine.
It is important to keep all medications out of the sight and reach of children, as many containers (such as those for taking pills weekly and those used for eye drops, creams, patches, and inhalers) are not resistant to children and children. young children can easily open them. To protect young children from poisoning, always close the safety caps and immediately put the medicine in a safe place, one that is up and away and out of your sight and reach. http://www.upandaway.org
Unnecessary medications must be disposed of in special ways to ensure that pets, children, and others cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to get rid of your medication is through a medication take-back program. Talk to your pharmacist or contact your local recycling / trash department to find out about return programs in your community. Check out the FDA’s Safe Drug Disposal website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of emergency/overdose
In case of overdose, call the Poison Control Helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim collapsed, had a seizure, is having trouble breathing, or cannot wake up, call 911 immediately.
What other information should I know?
Ask your pharmacist any questions you have about tocilizumab injection.
Do not allow anyone to use your medicine. Ask your pharmacist any questions you have about refilling your prescription.
It is important that you keep a written list of all prescription and over-the-counter (non-prescription) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should carry this list with you every time you visit a doctor or if you are admitted to a hospital. It is also important information to take with you in emergencies.
Disclaimer: We have made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.