AdultPediatricDosage Forms & Strengths injectable solution (prefilled syringe) 150mg/1.14mL 200mg/1.14mL injectable solution (prefilled pen) 150mg/1.14mL 200mg/1.14mL Rheumatoid Arthritis Indicated for adults with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to ≥1 disease-modifying antirheumatic drugs (DMARDs) 200 mg SC q2wk May be used as monotherapy or in combination with methotrexate (MTX) or other conventional DMARDs Polymyalgia Rheumatica Indicated for adults with polymyalgia rheumatica (PMR) who have had an inadequate response to corticosteroids or who cannot tolerate corticosteroid taper 200 mg SC q2wk Use in combination with a tapering course of systemic corticosteroids or as monotherapy following discontinuation of corticosteroids Coronavirus Disease 2019 (COVID-19) (Off-label) Data available as of March 1, 2023 Sarilumab may be part of an investigational protocol for hospitalized adults with progressive or critical COVID-19 who have elevated markers of systemic inflammation when tocilizumab is not available For guidelines, see the Infectious Disease Society of America (IDSA) website (link https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/#Recommendations11-12:IL-6inhibitorstocilizumabandsarilumab) Additional Medscape COVID-19 references are available Coronavirus Disease 2019 (COVID-19) (link https://emedicine.medscape.com/article/2500114-overview) Novel Coronavirus Resource Center (link https://www.medscape.com/resource/coronavirus) Dosage Modifications Serious or opportunistic infection: Hold treatment until infection is controlled RA ANC >1000 cells/mm³: Maintain current dose 500-1000 cells/mm³: Hold treatment until ANC >1000; resume at 150 mg q2wk and increase to 200 mg q2wk as clinically appropriate <500 cells/mm³: Discontinue Low Platelets 50,000-100,000 cells/mm³: Hold treatment until platelets >100,000; resume at 150 mg q2wk and increase to 200 mg q2wk as clinically appropriate <50,000 cells/mm³: If confirmed by repeat testing, discontinue Liver enzyme abnormalities ALT or AST >ULN to <3 x ULN: Consider dosage modification of concomitant DMARDs as clinically appropriate ALT or AST 3-5 x ULN: Hold treatment until ALT <3 x ULN; resume at 150 mg q2wk and increase to 200 mg q2wk as clinically appropriate ALT or AST >5 x ULN: Discontinue PMR Discontinue if Neutropenia (ANC <1000 cells/mm3 at end of dosing interval) Thrombocytopenia (platelet count <100,000/mm3) AST or ALT increased >3 x ULN Dosage modifications have not been studied in patients with PMR with these conditions Renal impairment Mild-to-moderate: No dose adjustment required Severe: Not studied Hepatic impairment Not studied Dosing Considerations Assess platelet count prior to initiation of therapy and monitor platelets 4 to 8 weeks after start of therapy and every 3 months thereafter Initiation not recommended with ANC <2000/mm³, platelets <150,000/mm³, or ALT or AST >1.5 x ULN Test for latent tuberculosis (TB) before initiating; if positive, consider treating for TB before using sarilumab Avoid coadministering with biological DMARDs (eg, TNF antagonists, IL-1R antagonists, antiCD20 monoclonal antibodies, JAK inhibitors, selective costimulation modulators) because of increased risk for immunosuppression and infection; coadministration with biological DMARDs has not been studied Avoid with active infections Also see Black Box WarningsSafety and efficacy not establishedInteraction CheckerEnter a drug name and sarilumabNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (20)adenovirus types 4 and 7 live, oralsarilumab, adenovirus types 4 and 7 live, oral. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.anthrax vaccine adsorbedsarilumab, anthrax vaccine adsorbed. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.axicabtagene ciloleucelsarilumab, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.BCG vaccine livesarilumab, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.brexucabtagene autoleucelsarilumab, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.cholera vaccinesarilumab, cholera vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.ciltacabtagene autoleucelsarilumab, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.idecabtagene vicleucelsarilumab, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.lisocabtagene maraleucelsarilumab, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.measles (rubeola) vaccinesarilumab, measles (rubeola) vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.measles, mumps, rubella and varicella vaccine, livesarilumab, measles, mumps, rubella and varicella vaccine, live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.rotavirus oral vaccine, livesarilumab, rotavirus oral vaccine, live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.rubella vaccinesarilumab, rubella vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.smallpox (vaccinia) vaccine, livesarilumab, smallpox (vaccinia) vaccine, live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.tisagenlecleucelsarilumab, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.typhoid vaccine livesarilumab, typhoid vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.upadacitinibsarilumab, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.varicella virus vaccine livesarilumab, varicella virus vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.yellow fever vaccinesarilumab, yellow fever vaccine. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.zoster vaccine livesarilumab, zoster vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.Monitor Closely (26)carbamazepinesarilumab, carbamazepine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.clonidinesarilumab, clonidine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.cyclosporinesarilumab, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, sarilumab could normalize the formation of CYP450 enzymes thus decrease levels of CYP substrates. Upon initiation or discontinuation of sarilumab in patients who are receiving concomitant CYP450 substrates with a narrow therapeutic index, monitor therapeutic effect.dengue vaccinesarilumab decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.disopyramidesarilumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.efgartigimod alfaefgartigimod alfa will decrease the level or effect of sarilumab by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.efgartigimod/hyaluronidase SCefgartigimod/hyaluronidase SC will decrease the level or effect of sarilumab by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.fosphenytoinsarilumab, fosphenytoin. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.isavuconazonium sulfatesarilumab and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.lomustinelomustine and sarilumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.mechlorethaminemechlorethamine, sarilumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.ofatumumab SCofatumumab SC, sarilumab. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.phenobarbitalsarilumab, phenobarbital. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared