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Tocilizumab (Intravenous route)

Pronunciation:

toe-si-LIZ-oo-mab

Brand Names:

  • Actemra

Dosage Forms:

  • Solution

Warnings:

Intravenous route(Solution)

Patients treated with tocilizumab are at increased risk for infections, some progressing to serious infections leading to hospitalization or death. These infections have included bacterial infection, tuberculosis, invasive fungal, or other opportunistic infections. Evaluate for latent tuberculosis and treat if necessary prior to initiation of therapy. Monitor patients receiving tocilizumab for signs and symptoms of infection, including tuberculosis, even if initial latent tuberculosis test is negative .

Classifications:

Therapeutic

Immunological Agent

Pharmacologic

Monoclonal Antibody

Uses of This Medicine:

Tocilizumab injection is a monoclonal antibody. It is used alone or together with other medicines to reduce the signs and symptoms of moderate to severe active rheumatoid arthritis. Tocilizumab helps keep joint damage from getting worse after other medicines (eg, adalimumab, etanercept, infliximab) have been used and did not work well.

Tocilizumab injection is also used to treat polyarticular juvenile idiopathic arthritis (PJIA) and systemic juvenile idiopathic arthritis (SJIA) in children 2 years of age and older.

This medicine is to be given only by or under the direct supervision of a doctor.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of tocilizumab injection in children with PJIA and SJIA. However, safety and efficacy have not been established in children younger than 2 years of age.

Older adults

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of tocilizumab injection in the elderly. However, elderly patients are more likely to have serious infections, which may require caution in patients receiving tocilizumab injection.

Pregnancy

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Infliximab

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Chronic inflammatory demyelinating polyneuropathy (nerve problem) or
  • Hyperlipidemia (high fats in the blood) or
  • Liver disease (including hepatitis B), history of or
  • Multiple sclerosis or
  • Neutropenia (low level of white blood cells) or
  • Stomach or bowel problems (eg, diverticulosis, perforations, ulcers) or
  • Thrombocytopenia (low number of platelets) or
  • Weak immune system (eg, cancer history or steroid use) Use with caution. May make these conditions worse.
  • Infection, active or recurring or
  • Liver disease, active Should not be used in patients with this condition.
  • Tuberculosis, history of Use with caution. May cause infection to come back (reactivate).

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine. This medicine is given through a needle placed in one of your veins. This medicine must be given slowly, so the needle will remain in place for at least 1 hour.

This medicine should come with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

Precautions While Using This Medicine:

It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

You will need to have a skin test for tuberculosis before you or your child start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.

This medicine may increase your risk of developing infections. Avoid being near people who are sick or have infections while you or your child are using this medicine. Wash your hands often. Tell your doctor if you have any kind of infection before you start using this medicine. Also tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

Using this medicine may increase your risk of having certain cancers. Talk to your doctor if you or your child have concerns about this risk.

Call your doctor right away if you or your child start to have a cough that won't go away, weight loss, night sweats, fever, chills, or flu-like symptoms, such as a runny or stuffy nose, headache, blurred vision, or feeling generally ill. These may be signs that you have an infection.

Tocilizumab may cause headaches and skin reactions, such as a rash or itching, while you are receiving the injection or within 24 hours after you receive it. Check with your doctor or nurse right away if you or your child have any of these symptoms.

This medicine may cause serious types of allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you or your child have a rash, hives, itching, swelling of the face, tongue, and throat, trouble breathing, or chest pain after you receive the medicine.

This medicine may cause serious stomach and bowel problems, especially if you have a history of ulcers or diverticulosis. Check with your doctor right away if you or your child start having severe stomach cramps or pain, black, tarry stools, diarrhea, fever, or vomiting that is severe and sometimes bloody while being treated with this medicine.

While you or your child are being treated with tocilizumab, and after you stop treatment, do not have any immunizations (vaccines) without your doctor's approval. Tocilizumab may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not get live vaccines (eg, nasal flu virus vaccine). Try to avoid being around persons who have received live vaccines. Do not get close to them and do not stay in the same room with them for very long. If you or your child cannot take these precautions, you should wear a protective face mask that covers the nose and mouth. Talk to your doctor if you have questions about this.

Your child's vaccines need to be current before he or she begins using tocilizumab injection. Be sure to ask your child's doctor if you have any questions about this.

This medicine may increase the level of cholesterol and fats in your blood. If this condition occurs, your doctor may give you a medicine to lower the cholesterol and fats. Talk to your doctor if you or your child have concerns.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
Abdominal or stomach pain
black, tarry stools
bloody or cloudy urine
blurred vision
body aches or pain
chest pain
cough
cough producing mucus
diarrhea
difficult, burning, or painful urination
difficulty breathing
difficulty swallowing
dizziness
ear congestion
fast heartbeat
feeling of warmth
fever or chills
frequent urge to urinate
headache
hives
itching
loss of appetite
loss of consciousness
loss of voice
lower back or side pain
nasal congestion
nausea
nervousness
pain or tenderness around the eyes and cheekbones
painful blisters on the trunk of the body
pale skin
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness of the face, neck, arms, and occasionally, upper chest
shortness of breath or troubled breathing
skin rash
slow or fast heartbeat
sneezing
sore throat
stuffy or runny nose
sudden sweating
tightness of the chest or wheezing
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
weakness
Less common
Bladder pain
blurred vision
burning feeling in the chest or stomach
confusion
dark urine
decrease in height
difficulty moving
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, irregular, pounding, or racing heartbeat or pulse
feeling hot
frequent urge to urinate
general feeling of discomfort or illness
heartburn
indigestion
itching, pain, redness, swelling, tenderness, or warmth on the skin at the injection site
joint pain
light-colored stools
muscle aches and pains
muscle cramps or stiffness
pain in the back, ribs, arms, or legs
pain in the groin or genitals
pale skin
severe stomach pain
sharp back pain just below the ribs
shivering
stomach upset
sweating
swelling
swollen joints
swollen, painful, or tender lymph glands in the face, neck, armpit, or groin
tenderness in the stomach area
trouble with sleeping
troubled breathing with exertion
unexplained runny nose or sneezing
upper right abdominal or stomach pain
vomiting
yellow eyes and skin
Rare
Acid or sour stomach
belching
changes in skin color
confusion
coughing or spitting up blood
fainting
gaseous abdominal or stomach pain
lightheadedness
neck pain
night sweats
noisy breathing
pain
pain, swelling, or redness in the joints
rapid, shallow breathing
recurrent fever
red, tender, or oozing skin at incision
stomach bloating, burning, cramping, or pain
sudden high fever or low-grade fever for months
swelling of the foot or leg
swollen lymph nodes
weight loss
Incidence not known
Dilated neck veins
extreme fatigue
severe abdominal or stomach pain, cramping, or burning
swelling of the face, fingers, feet, or lower legs
vomiting of material that looks like coffee grounds, severe and continuing
weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Burning, dry, or itching eyes
constipation
discharge, excessive tearing
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
skin rash, encrusted, scaly and oozing
swelling or inflammation of the mouth
warmth on the skin
Less common
Abnormal or decreased touch sensation
accumulation of pus
back pain
bleeding gums
blemishes on the skin
bloody eye
chapped, red, or swollen lips
earache
feeling of constant movement of self or surroundings
hives or welts
irritation in the mouth
loose teeth
persistent breath odor or bad taste in your mouth
pimples
redness and swelling of the gums
redness of the eye
redness of the skin
redness or swelling in the ear
scaling, redness, burning, pain, or other signs of inflammation of the lips
sensation of spinning
sleeplessness
sore mouth or tongue
sores on the skin
stomach soreness or discomfort
swollen, red, or tender area of infection
unable to sleep
white patches in the mouth or on the tongue
Rare
Bleeding after defecation
blindness
bloody nose
burning, numbness, tingling, or painful sensations
change in hearing
continuing ringing or buzzing or other unexplained noise in the ears
coughing or spitting up blood
decreased vision or other changes in vision
dry mouth
ear drainage
earache
flushed, dry skin
fruit-like breath odor
hearing loss
increased hunger
increased thirst
increased urination
itching ears
loss of consciousness
redness, swelling, or soreness of the tongue
thirst
uncomfortable swelling around the anus
unexplained weight loss
unsteadiness or awkwardness
weakness in the arms, hands, legs, or feet

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 9/15/2016
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