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Tocilizumab

Drug Class: Commonly Known As: Category:
Adult

Tocilizumab - What is it for

Tocilizumab belongs to a new class of medicines called biological disease modifying antirheumatic drugs (biological DMARDs).

These medicines block natural substances called cytokines, which are found in excessive amounts in the blood and joints of people with rheumatoid arthritis, psoriatic arthritis, juvenile arthritis and ankylosing spondylitis.

The increased levels of cytokines cause inflammation, which results in symptoms of pain, joint swelling and stiffness, and can lead to joint damage.

By blocking the cytokine called interleukin-6 (IL-6), tocilizumab reduces inflammation, lessens the symptoms and helps stop further joint damage.

Tocilizumab - Side Effects, Precautions, and Contraindications

What side effects can Tocilizumab cause?

You may experience side effects with your treatment. Contact your doctor if you have any concerns about possible side effects

Most common possible side effects

  • Infusion reactions (e.g. fever or chills, itch, dizziness, headache, chest pain, shortness of breath or changes in blood pressure). These effects are more likely to occur during the first or second infusion and can usually be reduced by giving steroids, antihistamines and paracetamol before the treatment
  • Headache or cough
  • Stomach or bowel discomfort
  • Skin effects (e.g. rash, dermatitis and itching)
  • Reversible elevation of liver enzymes
  • Reversible increase in cholesterol level
  • Mild infections (e.g. colds) 

Less common or rare possible side effects

  • Decrease in white blood cell count
  • Serious infections (e.g. tuberculosis)
  • Perforations of the stomach or gut
  • Contact your rheumatologist if you have concerns about any of these possible side effects
  • Many side effect disappear when tocilizumab treatment is stopped

Before taking Tocilizumab, what precautions must I follow?

If you have an active infection of any kind, treatment with tocilizumab will not be given until the infection is treated successfully.

Tocilizumab will not be given if you have active untreated tuberculosis or HIV infection, as it is likely to worsen these conditions.

If you have latent (inactive) tuberculosis, preventive anti-tuberculosis treatment will be started at least 4 weeks before tocilizumab. The anti-tuberculosis treatment will need to be taken for 9 months.

Hepatitis B or C infection may not necessarily exclude treatment.

Before of the risks associated with infection, laboratory tests will be conducted before commencing treatment with tocilizumab.

Blood tests will be required during your treatment to monitor your condition and to determine the effectiveness of treatment.

You should receive annual pneumococcal and seasonal flu vaccinations to reduce risks of infections.

If you require surgery for any reason, treatment will be stopped before surgery and restarted again after the surgery at a time determined by your surgeon and rheumatologist.

If cancer has previously been treated and cured, it is unclear whether a biological DMARD such as tocilizumab can be used safely.

At present an interval of at least 5 years is recommended between cure of a cancer and starting biological DMARDs.

Talk to your rheumatologist if you have any concerns about issues relating to cancer risk.

What food or medicine must I avoid when I take Tocilizumab?

You may drink alcohol while taking tocilizumab

However, since you are likely to be also taking methotrexate, you should be cautious about your alcohol intake

It is not known precisely what level of drinking is safe when on methotrexate, however there is general agreement that 1 to 2 standard drinks taken once or twice a week is unlikely to cause a problem

Drinking more than 4 standard drinks on one occasion, even if infrequently, is strongly discouraged

Tocilizumab - Dosage and How to Use

How should Tocilizumab be used?

Tocilizumab is given as a drip (infusion) into the vein.

The infusion normally takes one hour and is followed by a period of observation for at least one hour to make sure you do not have any side effects.

Doses are usually given every 4 weeks.

Dosing is based on weight, so each person's dose may differ.

Tocilizumab may be used with other arthritis medicines including:

  • Other DMARDs such as methotrexate
  • Steroid injections such as prednisolone
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Over-the-counter pain medicines such as paracetamol

What should I do if I miss a dose?

If tocilizumab treatment is stopped for more than a few weeks there is a risk that your condition will get worse again.

Continue with your treatment unless advised by your doctor or unless side effects develop.

If you stop tocilizumab for any reason you must contact your doctor.

What should I do if I overdose?

Tocilizumab - Handling and Storage

How should I handle Tocilizumab safely?

How should I store Tocilizumab?

Others;#Tocilizumab is usually given at the doctor's clinic, therefore you do not need to store the medicine at home

How should I dispose of Tocilizumab safely?

Tocilizumab - Additional Information

How LONG does it take for the medicine to be EFFECTIVE?

  • Unlike many standard DMARDs, tocilizumab works relatively quickly.
  • You may notice some relief of joint swelling, pain and stiffness within the first 8 weeks of treatment.

Do I skip dose if I am sick?

  • Seek prompt advice from your doctor when you develop any of the serious symptoms of infection described above.
  • Your doctor will decide whether to stop tocilizumab on a case-by-case basis.

When do I seek medical attention IMMEDIATELY?

  • See your doctor straightaway if you experience any of the following:
    • Serious infections
    • Severe stomach or bowel discomfort
    • Serious skin reactions

Can I take other MEDICINES or SUPPLEMENTS?

  • If you are on tocilizumab it is recommended you should not be immunized with 'live' vaccines such as MMR (measles, mumps and rubella), OPV (oral polio virus), BCG (Bacillus Calmette Guerin) or yellow fever. Talk with your rheumatologist before receiving any vaccines.
  • Tocilizumab can interact with other medicines. You should tell your doctor about all medicines you are taking or plan to take. This includes over-the-counter or herbal medicines.
  • You should also mention your treatment when you see other healthcare professionals.
  • Over-the-counter pain medicines (e.g. paracetamol) can be used while you are receiving tocilizumab treatment provided you take them as directed.

Can I get PREGNANT or BREASTFEED?

  • Not enough is known regarding the possible side effects of tocilizumanb. If you plan to become pregnant, it is important to discuss this with your doctor
  • You should not breastfeed when taking tocilizumab

In SUMMARY… what you need to know about tocilizumab?

  • While taking tocilizumab you must see your rheumatologist regularly to ensure the treatment is working and minimise any possible side effects.
  • If you stop tocilizumab for any reason you must contact your doctor. Failure to do so may mean that your continued treatment will no longer be subsidized.
  • If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
  • It is important to tell your doctor if you have had cancer or if you develop cancer while you are taking tocilizumab.
  • If you are taking tocilizumab and plan to become pregnant you must discuss the timing with your doctor.
  • If you have further questions about Tocilizumab, please call ______________________ (office number) to discuss with your doctor / pharmacist / specialty nurse (please circle as appropriate).
  • Updated on Friday, June 12, 2015
  • This article is contributed by Pharmacy, Rheumatology & Immunology Singapore General Hospital

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