monocytes, and fibroblasts IL-6 has been shown to be involved in diverse physiological processes such as T-cell activation, induction of immunoglobulin secretion, initiation of hepatic acute phase protein synthesis, and stimulation of hematopoietic precursor cell proliferation and differentiation IL-6 is also produced by synovial and endothelial cells leading to local production of IL-6 in joints affected by inflammatory processes Absorption Peak plasma concentration RA (4 mg/kg IV q4Weeks): 86.1 mcg/mL RA (8 mg/kg IV q4Weeks): 176 mcg/mL RA (162 mg SC every other week): 12.1 mcg/mL RA (162 mg SC weekly): 49.8 mcg/mL GCA (162 SC every other week): 17.2 mcg/mL GCA (162 SC weekly): 72.1 mcg/mL PJIA (8 mg/kg IV q4Weeks): 181 mcg/mL PJIA (10 mg/kg IV q4Weeks): 167 mcg/mL PJIA (162 mg SC q2Weeks): 29.7 mcg/mL PJIA (162 mg SC q3Weeks): 62.4 mcg/mL SJIA (8 mg/kg IV q2Weeks): 253 mcg/mL SJIA (12 mg/kg IV q2Weeks): 274 mcg/mL SJIA (162 mg SC weekly): 89.8 mcg/mL SJIA (162 mg SC q2Weeks): 127 mcg/mL Plasma trough concentration RA (4 mg/kg IV q4Weeks): 0.1 mcg/mL RA (8 mg/kg IV q4Weeks): 13.4 mcg/mL RA (162 mg SC every other week): 4.1 mcg/mL RA (162 mg SC weekly): 42.9 mcg/mL GCA (162 SC every other week): 7.7 mcg/mL GCA (162 SC weekly): 9.6 mcg/mL PJIA (8 mg/kg IV q4Weeks): 3.28 mcg/mL PJIA (10 mg/kg IV q4Weeks): 0.35 mcg/mL PJIA (162 mg SC q2Weeks): 12.7 mcg/mL PJIA (162 mg SC q3Weeks): 13.4 mcg/mL SJIA (8 mg/kg IV q2Weeks): 70.7 mcg/mL SJIA (12 mg/kg IV q2Weeks): 65.9 mcg/mL SJIA (162 mg SC weekly): 72.4 mcg/mL SJIA (162 mg SC q2Weeks): 64.2 mcg/mL Peak plasma time RA (weekly): 2.8 days RA (every other week): 4.7 days GCA (weekly): 3 days GCA (every other week): 4.5 days Distribution Vd: 6.4L (RA); 7.46 L (GCA); 4.08 L (PJIA); 2.54 L (SJIA) Elimination Half-life: up to 11 days (4 mg/kg); up to 13 days (8 mg/kg) Half-life in RA patients: 13 days (162 mg every week); 5 days (162 mg every other week) Half-life in GCA patients: 18.3-18.9 days (162 mg SC every week); 4.2-7.9 days (162 mg SC every other week) Clearance: 0.0125 L/hr IV Compatibility 0.9% or 0.45% NaCl IV Preparation Withdraw a volume of 0.9% or 0.45% NaCl from bag/bottle equal to volume of the solution required for patient's dose Adults and children weighing ≥30 kg: Dilute to 100 mL in 0.9% or 0.45% NaCl Children <30 kg: Dilute to 50 mL in 0.9% or 0.45% NaCl Slowly add dose to infusion bag or bottle and gently invert to mix (prevent foaming) Fully diluted solutions are compatible with polypropylene, polyethylene and polyvinyl chloride infusion bags and polypropylene, polyethylene, and glass infusion bottles Recommended volume per kg of body weight 4 mg/kg-dose (RA): 0.2 mL/kg 6 mg/kg-dose (GCA): 0.3 mL/kg 8 mg/kg-dose (RA, SJIA, PJIA, and CRS ≥30 kg): 0.4 mL/kg 10 mg/kg-dose (PJIA <30 kg): 0.5 mL/kg 12 mg/kg-dose (SJIA and CRS <30 kg): 0.6 mL/kg IV Administration Infuse over 1 hr with an infusion set Do NOT administer as bolus or push Do not infuse with any other drugs as no compatibility studies have been conducted SC Preparation Remove prefilled SC syringe/autoinjector from refrigerator 30 minutes before administration SC injection is not intended for IV drip infusion Do not use prefilled syringes or autoinjectors exhibiting particulate matter, cloudiness, or discoloration; solution for SC administration should appear clear and colorless to pale yellow SC Administration Rotate SC injection sites (ie, thighs, abdomen, outer area of upper arm [caregiver only]) and inject full amount of the syringe (0.9 mL) Transition from IV to SC (adult or pediatric arthritis indications): Administer first SC dose instead of next scheduled IV dose Storage Undiluted vials and prefilled SC syringes/autoinjectors: Refrigerate at 2-8ºC (36-46ºF) in original container and protect from light Diluted IV solutions Using 0.45% NaCl: Refrigerate at 2-8ºC (36-46ºF) for up to 24 hr or store at room temperature for up to 4 hr Using 0.9% NaCl: Refrigerate at 2-8ºC (36-46ºF) or store at room temperature for up to 24 hr Protect from light Do not freeze Do not save unused, reconstituted drug in vials because product contains no preservatives BRAND FORM. UNIT PRICE PILL IMAGE Actemra intravenous- 400 mg/20 mL (20 mg/mL) vialActemra intravenous- 200 mg/10 mL (20 mg/mL) vialActemra intravenous- 80 mg/4 mL (20 mg/mL) vialCopyright © 2010 First DataBank, Inc.Select a drug:tocilizumab subcutaneoustocilizumab intravenousPrint Patient Educationtocilizumab subcutaneous TOCILIZUMAB - SUBCUTANEOUS INJECTION (TOE-si-LIZ-ue-mab) COMMON BRAND NAME(S): Actemra WARNING: This medication may lower your ability to fight an infection. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Your risk may be increased if you are also taking other drugs that can lower your ability to fight an infection (such as methotrexate or corticosteroids). Before using tocilizumab, tell your doctor your medical history, especially of any kind of infection. During treatment, tell your doctor right away if you develop any signs of infection (such as cough, sore throat, fever, chills, pain when urinating).Before and during treatment with this medication, your doctor will test you for tuberculosis (TB). Your doctor should also monitor you for symptoms of TB during and after treatment with this drug. If needed, treatment for tuberculosis or other infections should be given before receiving this medication. USES: This medication is used to treat rheumatoid arthritis in adults and in children (such as polyarticular juvenile idiopathic arthritis-PJIA, systemic juvenile idiopathic arthritis-SJIA). It helps to reduce pain and swelling due to rheumatoid arthritis. Tocilizumab is used to treat giant cell arteritis. It helps to reduce swelling in your blood vessels so blood can flow more easily. This medication is also used to slow down the decrease in lung function in people with a certain type of lung disease (systemic sclerosis-associated interstitial lung disease - SSc-ILD). Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. It works by blocking IL-6, a substance made by the body that causes swelling (inflammation). HOW TO USE: Read the Medication Guide and Instructions for Use provided by your pharmacist before you start using tocilizumab and each time you get a refill. If you have any questions, ask your doctor or pharmacist.If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product package.Before use, take this medication out of the refrigerator. If you are using the prefilled syringe, let it warm up to room temperature for at least 30 minutes. If you are using the autoinjector, let it warm up to room temperature for at least 45 minutes. Do not heat this medication any other way, such as by heating in the microwave or placing in hot water. Do not leave in direct sunlight. Check this product visually for particles or discoloration. If either is present, do not use the liquid.If you are using this medication to treat rheumatoid arthritis in adults, inject this medication under the skin as directed by your doctor, usually starting with once every 2 weeks, then increasing to once a week.If you are using this medication to treat PJIA in children, give this medication by injection under the skin as directed by the doctor, usually once every 2 or 3 weeks, based on your child's weight.If you are using this medication to treat SJIA in children, give this medication by injection under the skin as directed by the doctor, usually once every 1 or 2 weeks, based on your child's weight.If you are using this medication to treat giant cell arteritis or for SSc-ILD, inject this medication under the skin as directed by your doctor, usually once a week.Recommended injection sites include the abdomen or the front of your thigh. The outer area of the upper arms may also be used if another person is giving you the injection. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin. Do not inject into moles, scars, bruises, or areas where the skin is tender, red, hard, or broken.Learn how to store and discard medical supplies safely.The dosage is based on your weight, laboratory tests, and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, mark the days you need to inject the medication on a calendar.Tell your doctor if your condition does not get better or if it gets worse. SIDE EFFECTS: See also Warning section.Headache or irritation/redness/pain at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: stomach/abdominal pain.Tocilizumab has rarely caused very serious (possibly fatal) liver disease. This effect may occur months to years after starting this medication. Tell your doctor right away if you develop symptoms of liver disease, such as nausea/vomiting that doesn't stop, loss of appetite, yellowing eyes/skin, dark urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before using tocilizumab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, infections (including past/current/returning), liver problems, low blood cell count, nervous system problems (such as multiple sclerosis), stomach/abdominal problems (such as ulcers, diverticulitis).Tocilizumab can make you more likely to get infections or may make current infections worse. Stay away from anyone who has an infection that may easily spread (such as chickenpox, COVID-19, measles, tuberculosis, flu). Tell your doctor if you live in, have lived in, or have traveled to certain areas where there is an increased chance of getting certain kinds of fungal infections (blastomycosis, coccidioidomycosis, histoplasmosis). Talk to your doctor if you have been exposed to an infection or for more details.Tell your health care professional that you are using tocilizumab before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Drugs that affect the immune system (such as tocilizumab) may increase your risk of certain cancers. Tell your doctor if you have ever had any type of cancer.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that can affect the immune system (such as certolizumab, corticosteroids including prednisone).This medication can speed up the removal of other medications from your body, which may affect how they work. Examples of affected drugs include omeprazole, warfarin, and some cholesterol drugs such as atorvastatin/lovastatin/simvastatin, among others.This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist