Actemra Dosage

Generic name: tocilizumab
Dosage form: injection, solution, concentrate

This dosage information does not include all the information needed to use Actemra safely and effectively. See full prescribing information for Actemra.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Rheumatoid Arthritis

​ACTEMRA may be used as monotherapy or concomitantly with methotrexate or other DMARDs. The recommended dose of ACTEMRA for adult patients given as a 60-minute single intravenous drip infusion is 4 mg per kg every 4 weeks followed by an increase to 8 mg per kg every 4 weeks based on clinical response.

Polyarticular Juvenile Idiopathic Arthritis

​ACTEMRA may be used alone or in combination with methotrexate. The recommended dose of ACTEMRA for PJIA patients given once every 4 weeks as a 60-minute single intravenous drip infusion is:

Recommended PJIA Dosage Every 4 Weeks
Patients less than 30 kg weight 10 mg per kg
Patients at or above 30 kg weight 8 mg per kg
  • A change in dose should not be made based solely on a single visit body weight measurement, as weight may fluctuate.
  • Interruption of dosing may be needed for management of dose-related laboratory abnormalities including elevated liver enzymes, neutropenia, and thrombocytopenia [see Dosage and Administration (2.5)].

Systemic Juvenile Idiopathic Arthritis

ACTEMRA may be used alone or in combination with methotrexate. The recommended dose of ACTEMRA for SJIA patients given once every 2 weeks as a 60-minute single intravenous drip infusion is:

Recommended SJIA Dosage Every 2 Weeks
Patients less than 30 kg weight 12 mg per kg
Patients at or above 30 kg weight 8 mg per kg
  • A change in dose should not be made based solely on a single visit body weight measurement, as weight may fluctuate.
  • Interruption of dosing may be needed for management of dose-related laboratory abnormalities including elevated liver enzymes, neutropenia, and thrombocytopenia [see Dosage and Administration (2.5)].

General Considerations for Administration

  • ​ACTEMRA has not been studied and its use should be avoided in combination with biological DMARDs such as TNF antagonists, IL-1R antagonists, anti-CD20 monoclonal antibodies and selective co-stimulation modulators because of the possibility of increased immunosuppression and increased risk of infection.
  • It is recommended that ACTEMRA not be initiated in patients with an absolute neutrophil count (ANC) below 2000 per mm3, platelet count below 100,000 per mm3, or who have ALT or AST above 1.5 times the upper limit of normal (ULN).

ACTEMRA for intravenous infusion should be diluted by a healthcare professional using aseptic technique as follows:

  • PJIA and SJIA patients less than 30 kg: utilize a 50 mL infusion bag or bottle, then follow steps 1 and 2 below.
  • Adult Rheumatoid Arthritis, PJIA and SJIA patients at or above 30 kg weight: utilize a 100 mL infusion bag or bottle, then follow steps 1 and 2 below.
    Step 1. Withdraw a volume of 0.9% Sodium Chloride Injection, USP, equal to the volume of the ACTEMRA injection required for the patient's dose from the infusion bag or bottle.
    Step 2. Slowly add ACTEMRA for intravenous infusion from each vial into the infusion bag or bottle. To mix the solution, gently invert the bag to avoid foaming.
  • The fully diluted ACTEMRA solutions for infusion may be stored at 2° to 8°C (36° to 46°F) or room temperature for up to 24 hours and should be protected from light. ACTEMRA solutions do not contain preservatives; therefore, unused product remaining in the vials should not be used.
  • Allow the fully diluted ACTEMRA solution to reach room temperature prior to infusion.
  • The infusion should be administered over 60 minutes, and must be administered with an infusion set. Do not administer as an intravenous push or bolus.
  • ACTEMRA should not be infused concomitantly in the same intravenous line with other drugs. No physical or biochemical compatibility studies have been conducted to evaluate the co-administration of ACTEMRA with other drugs.
  • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If particulates and discolorations are noted, the product should not be used. Fully diluted ACTEMRA solutions are compatible with polypropylene, polyethylene and polyvinyl chloride infusion bags and polypropylene, polyethylene and glass infusion bottles.

Dosage Modifications

​ACTEMRA treatment should be interrupted if a patient develops a serious infection until the infection is controlled.

Rheumatoid Arthritis

Liver Enzyme Abnormalities [see Warnings and Precautions (5.3)]:
Lab Value Recommendation
Greater than 1 to 3x ULN Dose modify concomitant DMARDs if appropriate

For persistent increases in this range, reduce ACTEMRA dose to 4 mg per kg or interrupt ACTEMRA until ALT or AST have normalized
Greater than 3 to 5x ULN

(confirmed by repeat testing)
Interrupt ACTEMRA dosing until less than 3x ULN and follow recommendations above for greater than 1 to 3x ULN

For persistent increases greater than 3x ULN, discontinue ACTEMRA
Greater than 5x ULN Discontinue ACTEMRA
Low Absolute Neutrophil Count (ANC) [see Warnings and Precautions (5.3)]:
Lab Value
(cells per mm3)
Recommendation
ANC greater than 1000 Maintain dose
ANC 500 to 1000 Interrupt ACTEMRA dosing

When ANC greater than 1000 cells per mm3 resume ACTEMRA at 4 mg per kg and increase to 8 mg per kg as clinically appropriate
ANC less than 500 Discontinue ACTEMRA
Low Platelet Count [see Warnings and Precautions (5.3)]:
Lab Value
(cells per mm3)
Recommendation
50,000 to 100,000 Interrupt ACTEMRA dosing

When platelet count is greater than 100,000 cells per mm3 resume ACTEMRA at 4 mg per kg and increase to 8 mg per kg as clinically appropriate
Less than 50,000 Discontinue ACTEMRA

Polyarticular and Systemic Juvenile Idiopathic Arthritis:

Dose reduction of ACTEMRA has not been studied in the PJIA and SJIA populations. Dose interruptions of ACTEMRA are recommended for liver enzyme abnormalities, low neutrophil counts, and low platelet counts in patients with PJIA and SJIA at levels similar to what is outlined above for patients with RA. If appropriate, concomitant methotrexate and/or other medications should be dose modified or stopped and ACTEMRA dosing interrupted until the clinical situation has been evaluated. In PJIA and SJIA the decision to discontinue ACTEMRA for a laboratory abnormality should be based upon the medical assessment of the individual patient.

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