AdultPediatricGeriatricDosage Forms & Strengths injectable solution 20mg/mL (4-, 10-, and 20-mL single-dose vials) injection, single-use autoinjector (ACTPen) for SC 162mg/0.9mL injection, single-use prefilled syringe for SC 162mg/0.9mL Rheumatoid Arthritis Indicated for adults with moderate-to-severe active rheumatoid arthritis with inadequate response to 1 or more disease modifying antirheumatic drugs (DMARDs) May use alone or in combination with methotrexate or other DMARDs Not recommended in patients with an ANC<1,000/mm3 , platelet count <50,000 mm3, or ALT/AST >10x ULN IV infusion 4 mg/kg IV q4Weeks initially; may increase to 8 mg/kg q4Weeks based on clinical response Not to exceed 800 mg/dose q4weeks SC injection Weight <100 kg: 162 mg SC every other week, followed by an increase to weekly based on clinical response Weight ≥100 kg: 162 mg SC weekly Giant Cell Arteritis Indicated for treatment of giant cell arteritis (GCA) Not recommended in patients with an ANC<1,000/mm3 , platelet count <50,000 mm3, or ALT/AST >10x ULN IV 6 mg/kg IV q4Weeks in combination with tapering course of glucocorticoids May be used alone following glucocorticoid discontinuation; if necessary, interrupt dosing for management of dose-related laboratory abnormalities (eg, elevated liver enzymes, neutropenia, thrombocytopenia) Not to exceed 600 mg/infusion SC 162 mg SC weekly in combination with a tapering course of glucocorticoids Based on clinical considerations, may consider 162 mg SC every other week in combination with tapering course of glucocorticoids May be used alone following glucocorticoid discontinuation; if necessary, interrupt dosing for management of dose-related laboratory abnormalities (eg, elevated liver enzymes, neutropenia, thrombocytopenia) Transitioning from IV to SC Administer first SC dose instead of next scheduled IV dose Dose interruption or reduced administration frequency of SC dose from every week to every other week dosing may be needed for management of dose-related laboratory abnormalities Systemic Sclerosis-Associated Interstitial Lung Disease Indicated for slowing the rate of decline in pulmonary function in adults with systemic sclerosis-associated interstitial lung disease (SSc-ILD) 162 mg SC qWeek Dose interruption may be needed for managing dose-related laboratory abnormalities (eg, elevated liver enzymes, neutropenia, thrombocytopenia) SC administration with prefilled ACTPen autoinjector not studied in SSc-ILD IV administration not approved for SSc-ILD Not recommended in patients with an ANC<1,000/mm3, platelet count <50,000 mm3, or ALT/AST >10x ULN Cytokine Release Syndrome Indicated for the treatment of chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome (CRS) 8 mg/kg IV once; may be administered as alone or in combination with corticosteroids If no clinical improvement in the signs and symptoms of CRS occurs after initial dose, may administer up to 3 additional doses; allow 8-hr interval between consecutive doses Not approved for SC administration COVID-19 Indicated for treatment of coronavirus disease 2019 (COVID-19) in hospitalized adults who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) Not recommended in patients with an ANC<1,000/mm3 , platelet count <50,000 mm3 , or ALT/AST >10x ULN 8 mg/kg IV; not to exceed 800 mg/dose May administer 1 additional IV infusion 8 hr after first infusion if clinical signs or symptoms worsen or unimproved SC administration not authorized for treatment of COVID-19 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 Renal impairment Mild-to-moderate (eGFR ≥30 mL/min): No dosage adjustment required Severe (eGFR <30 mL/min): Not studied Hepatic impairment Not recommended with active hepatic disease or hepatic impairment Liver enzyme abnormalities for RA, GCA, or SSc-ILD >1 to 3x ULN Modify dose concomitant DMARDs (RA, SSc-ILD) or immunomodulatory agents (GCA) if appropriate RA or SSc-ILD persistent increases (IV): Reduce tocilizumab dose to 4 mg/kg OR hold dose until ALT/AST normalize GCA persistent increases (IV): Hold dose until ALT/AST normalize RA, GCA, or SSc-ILD persistent increases (SC): Reduce injection frequency to every other week OR hold dose until ALT/AST normalize; resume at every other week and increase frequency to every week as clinically appropriate >3 to 5x ULN For RA, GCA, or SSc-ILD Confirm by repeat dosing Hold dose until <3x ULN and follow recommendations above for >1x to ≤3x ULN Persistent increases >3x ULN: Discontinue tocilizumab >5x ULN Discontinue therapy Neutropenia for RA, GCA, or SSc-ILD ANC >1000 cells/mm3: Maintain dose ANC 500-1000 cells/mm3 Hold dose, then resume when ANC >1000 cells/mm3 RA or SSc-ILD (IV): Resume at 4 mg/kg and increase to 8 mg/kg as clinically appropriate GCA (IV): Resume at 6 mg/kg RA, GCA, or SSc-ILD (SC): Resume at every other week and increase frequency to weekly as clinically appropriate ANC <500 cell/mm3 Discontinue therapy Thrombocytopenia for RA, GCA, SSc-ILD 50,000-10,000 cells/mm3 Hold dose, then resume when platelet count >100,000 cells/mm3 RA or SSc-ILD (IV): Resume at 4 mg/kg and increase to 8 mg/kg as clinically appropriate GCA (IV): Resume at 6 mg/kg RA, GCA, or SSc-ILD (SC): Resume at every other week and increase frequency to weekly as clinically appropriate <50,000 cells/mm3 Discontinue therapy Systemic Sclerosis (Orphan) Orphan designation for treatment of systemic sclerosis Orphan sponsor Genentech, Inc.; 1 DNA Way; South San Francisco, CA 94080-4990 Dosage Forms & Strengths injectable solution 20mg/mL (4-, 10-, and 20-mL single-dose vials) injection, single-use prefilled syringe for SC 162mg/0.9mL Systemic Juvenile Idiopathic Arthritis Indicated for the treatment of active systemic juvenile idiopathic arthritis (SJIA) in in patients ≥2 years IV or SC may be administered as monotherapy or with methotrexate <2 years: Safety and efficacy not established Not recommended in patients with an ANC<1,000/mm3, platelet count <50,000 mm3, or ALT/AST >10x ULN IV infusion ≥2 years (<30 kg): 12 mg/kg IV q2weeks ≥2 years (≥30 kg): 8 mg/kg IV q2weeks SC injection ≥2 years (<30 kg): 162 mg SC q2weeks ≥2 years (≥30 kg): 162 mg SC weekly Polyarticular Juvenile Idiopathic Arthritis Indicated for active polyarticular juvenile idiopathic arthritis (PJIA) in patients ≥2 years IV or SC may be administered as monotherapy or with methotrexate <2 years: Safety and efficacy not established Not recommended in patients with an ANC<1,000/mm3, platelet count <50,000 mm3, or ALT/AST >10x ULN IV infusion ≥2 years (<30 kg): 10 mg/kg IV q4weeks ≥2 years (≥30 kg): 8 mg/kg IV q4weeks SC injection ≥2 years (<30 kg): 162 mg SC q3weeks ≥2 years (≥30 kg): 162 mg SC q2weeks Cytokine Release Syndrome (CRS) Indicated for the treatment of chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome (CRS) in adults and pediatric patients aged ≥2 years SC is not approved for CRS <2 years: Safety and efficacy not established ≥2 years <30 kg: 12 mg/kg IV once ≥30 kg: 8 mg/kg IV once May be administered as monotherapy or with corticosteroids If no clinical improvement in the signs and symptoms of CRS occurs after initial dose, may administer up to 3 additional doses; allow 8-hr interval between consecutive doses Not to exceed 800 mg/dose Not approved for SC administration COVID-19 (EUA) June 24, 2021: Emergency use authorization (EUA) issued by the FDA for treatment of coronavirus disease 2019 (COVID-19) in hospitalized pediatric patients (aged 2-18 years) who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or ECMO <30 kg: 12 mg/kg IV ≥30 kg: 8 mg/kg IV; not to exceed 800 mg/dose May administer 1 additional IV infusion 8 hr after first infusion if clinical signs or symptoms worsen or unimproved SC administration not authorized for treatment of COVID-19 Dosage Modifications Dose reduction has not been studied in PJIA and SJIA populations PJIA or SJIA: Dose interruptions are recommended for liver enzyme abnormalities, low ANC, and low platelet counts in outlined for adults with RA and GCA If appropriate, modify dose or stop concomitant methotrexate and/or other medications and hold tocilizumab until clinical situation has been evaluated Discontinue tocilizumab should be based upon medical assessment of the patient Renal impairment Mild-to-moderate (eGFR ≥30 mL/min): No dosage adjustment required Severe (eGFR <30 mL/min): Not studied Hepatic impairment Not recommended with active hepatic disease or hepatic impairment Increased risk of serious infections in patient ≥65 years; use caution when treating the elderlyInteraction CheckerEnter a drug name and tocilizumabNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (71)abataceptabatacept, tocilizumab. Mechanism: unspecified interaction mechanism. Contraindicated. Concomitant use not recommended (in mfr. info.).adalimumabadalimumab and tocilizumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.adenovirus types 4 and 7 live, oraltocilizumab decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.alefaceptalefacept and tocilizumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.anthrax vaccinetocilizumab decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.antithymocyte globulin equinetocilizumab and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.antithymocyte globulin rabbittocilizumab and antithymocyte globulin rabbit both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.axicabtagene ciloleuceltocilizumab, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.azathioprinetocilizumab and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.baricitinibbaricitinib, tocilizumab. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.basiliximabtocilizumab and basiliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.BCG vaccine livetocilizumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.brexucabtagene autoleuceltocilizumab, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.canakinumabtocilizumab and canakinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.certolizumab pegoltocilizumab and certolizumab pegol both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid combination because of an increased risk of serious infection.ciltacabtagene autoleuceltocilizumab, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.diphtheria & tetanus toxoidstocilizumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.diphtheria & tetanus toxoids/ acellular pertussis vaccinetocilizumab decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccinetocilizumab decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.etanercepttocilizumab and etanercept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.tocilizumab, etanercept. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive immunosuppression; risk of serious infection.everolimustocilizumab and everolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.glatiramertocilizumab and glatiramer both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.golimumabtocilizumab and golimumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.hepatitis A vaccine inactivatedtocilizumab decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.hepatitis a/b vaccinetocilizumab decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.hepatitis a/typhoid vaccinetocilizumab decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.hepatitis b vaccinetocilizumab decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.human papillomavirus vaccine, nonavalenttocilizumab decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.human papillomavirus vaccine, quadrivalenttocilizumab decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.hydroxychloroquine sulfatetocilizumab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.idecabtagene vicleuceltocilizumab, idecabtagene vicleucel. Either increases effects of