Tocilizumab, Injection toh-sih-LIZ-oo-mab

What are other names for this medicine?

Type of medicine: interleukin-6 (IL-6) receptor inhibitor

Generic and brand names: tocilizumab, injection; Actemra

What is this medicine used for?

This medicine is given by IV infusion (slow drip through a needle into a large vein) to treat:

• rheumatoid arthritis (RA) in adults who have not responded well to other treatment
• juvenile idiopathic arthritis (JIA) in children over the age of 2 years

It may be used for other conditions as determined by your healthcare provider.

This medicine may be used alone or along with another medicine.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a weakened immune system from diseases such as HIV/AIDS or from cancer chemotherapy, radiation therapy, kidney disease, or steroid medicine
• diverticulitis or an ulcer
• high cholesterol or triglycerides
• diabetes
• high blood pressure
• hepatitis B or other liver problems
• lymphoma or other cancer
• multiple sclerosis, Guillain-Barré syndrome, neuropathy, or any condition that causes numbness or tingling
• tuberculosis (TB), a positive skin test for TB, or close contact with someone who has TB (your healthcare provider may give you a skin test to check for this).

Tell your healthcare provider if you currently have an infection such as the flu or an open cut or sore, or if you often have infections that come back. Also tell your healthcare provider if you:

• are scheduled to have major surgery
• have recently received any vaccines or are scheduled to receive any kind of vaccination

Some infections are more likely to occur in certain parts of the country. Tell your provider where you have lived or recently traveled or where you plan to travel to during treatment.

Tell your provider if you take any other medicines for RA or JIA, especially anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), adalimumab (Humira), rituximab (Rituxan), infliximab (Remicade), or tocilizumab (Actemra).

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you have a treatment.

These infusions are given by your healthcare provider. You need to have more infusions of this medicine several weeks after the first one. Keep all your appointments for infusions.

What should I watch out for?

This medicine increases your risk for serious or life-threatening infections. Stay away from people with colds, flu, or other infections. Contact your healthcare provider right away if you develop a fever or ANY other symptoms of infection. Also, do not have any vaccines without getting your healthcare provider's approval first.

Your healthcare provider will check you regularly to see how this medicine affects you. Keep all appointments.

This medicine may make you dizzy. Do not drive or operate machinery unless you are fully alert.

This medicine may increase your risk for lymphoma, leukemia, and other cancers. Talk to your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Unexplained tiredness or weakness; yellowish skin or eyes; dark urine; light colored bowel movements; loss of appetite; fever; unexplained cough or sore throat; mouth sores; unusual bruising or bleeding; muscle pain; severe or persistent stomach pain; black or tarry stools; severe diarrhea; severe nausea or vomiting; pain when urinating or urinating more often than normal; chest pain; trouble breathing; runny or stuffy nose; unusual numbness or tingling.

Other: Redness, swelling, or bruising around the injection site; headache; dizziness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking any other medicines.

• birth control pills
• cholesterol-lowering medicines (statins) such as atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), and simvastatin (Zocor)
• cyclosporine (Sandimmune, GenGraf, Neoral)
• echinacea
• natalizumab (Tysabri)
• other medicines given by injection to treat rheumatoid arthritis or JIA, such as abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), and tocilizumab (Actemra)
• omeprazole (Prilosec)
• theophylline

• vaccines
  • warfarin (Coumadin)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.