Skip to Content

Generic Name: tocilizumab (TOE si LIZ oo mab)
Brand Names: Actemra

What is Actemra?

Actemra (tocilizumab) reduces the effects of a substance in the body that can cause inflammation.

Actemra is used to treat moderate to severe rheumatoid arthritis in adults. It is sometimes given together with other arthritis medicines.

Actemra is used to treat systemic juvenile idiopathic arthritis (or "Still disease") in children who are at least 2 years old. It is sometimes given together with methotrexate (Rheumatrex, Trexall).

Actemra is also used in adults to treat giant cell arteritis, or inflammation of the lining of your arteries (blood vessels that carry blood from your heart to other parts of your body).

Actemra is usually given after other medications have been tried without successful treatment of symptoms.

Important information

Serious and sometimes fatal infections may occur during treatment with Actemra. Stop using this medicine and call your doctor right away if you have signs of infection such as: fever, chills, body aches, flu symptoms, cough, sweating, feeling short of breath, diarrhea, weight loss, sores on your skin, painful urination, or feeling very tired.

Before you start treatment with Actemra, your doctor may perform tests to make sure you do not have tuberculosis or other infections. While using Actemra, you may need frequent medical tests.

Before taking this medicine

You should not use Actemra if you are allergic to tocilizumab.

Tell your doctor if you have ever had tuberculosis, if anyone in your household has tuberculosis, or if you have recently traveled to an area where certain infections are common (Ohio River Valley, Mississippi River Valley, and the Southwest).

Tell your doctor if you have any signs of infection such as fever, chills, cough, body aches, tiredness, open sores or skin wounds, diarrhea, stomach pain, weight loss, painful urination, or coughing up blood.

To make sure Actemra is safe for you, tell your doctor if you have ever had:

  • an infection such as herpes, pneumonia, or yeast infection;

  • liver disease;

  • diverticulitis, stomach ulcer, or stomach or intestinal bleeding;

  • diabetes;

  • HIV or AIDS;

  • a weak immune system;

  • hepatitis B (or if you are a carrier of the virus);

  • a nerve-muscle disease such as multiple sclerosis;

  • cancer; or

  • if you have received or are scheduled to receive any vaccines.

Treatment with Actemra may increase your risk of developing certain types of cancer. Talk to your doctor about your specific risk.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of Actemra on the baby.

It is not known whether tocilizumab passes into breast milk. You should not breast-feed while you are using Actemra.

How is Actemra given?

Before you start treatment with Actemra, your doctor may perform tests to make sure you do not have tuberculosis or other infections.

Actemra is injected into a vein through an IV. A healthcare provider will give you this type of injection.

Actemra is sometimes injected under the skin. You may be shown how to use this type of injection at home using a prefilled syringe. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of used needles and syringes.

Actemra is usually given every 1 to 4 weeks. Follow your doctor's instructions.

Use a disposable needle only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Do not use Actemra if it has changed colors or has particles in it. Call your pharmacist for new medication.

Each Actemra prefilled syringe is for one use only. Throw away after one use, even if there is still some medicine left in it after injecting your dose.

Store the prefilled syringes in their original container in a refrigerator. Protect from moisture and light. Do not freeze. Throw away any prefilled syringes not used before the expiration date on the medicine label.

Actemra can lower blood cells that help your body fight infections and help your blood to clot. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Your blood may need to be tested often. Your injections may be delayed based on the results of these tests.

Some infections are more likely to occur in certain areas of the world. Tell your doctor where you live and where you have recently traveled or plan to travel to during treatment.

If you have ever had hepatitis B, Actemra can cause this condition to come back or get worse. You will need frequent blood tests to check your liver function during treatment and for several months after you stop using this medicine.

If you need surgery, tell the surgeon ahead of time that you are using Actemra. You may need to stop using the medicine for a short time.

Actemra can have long-lasting effects on your body. You may need certain medical tests every 6 months after you stop using this medication.

You may be treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.

Actemra dosing information

Usual Adult Dose for Rheumatoid Arthritis:

This drug may be used as monotherapy or concomitantly with methotrexate or other non-biologic DMARDs as an IV infusion or as a subcutaneous injection.

RECOMMENDED IV DOSAGE REGIMEN: 4 mg/kg IV given once every 4 weeks as a 60 minute single drip infusion, followed by an increase to 8 mg/kg IV given once every 4 weeks as a 60 minute single drip infusion based on clinical response
Maximum dose: 800 mg per infusion in RA patients

RECOMMENDED SUBCUTANEOUS DOSAGE REGIMEN:
-Patients less than 100 kg: 162 mg subcutaneously every other week, followed by an increase to every week based on clinical response
-Patients 100 kg or greater: 162 mg subcutaneously every week

Comments:
-This drug should not be administered as an IV push or bolus.
-When transitioning from IV to subcutaneous therapy, give the first subcutaneous dose instead of the next scheduled IV dose.
-This drug should 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).

Use: For adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Usual Pediatric Dose for Juvenile Idiopathic Arthritis:

This drug may be used as monotherapy or concomitantly with methotrexate:
POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS:
2 years or older:
-Weight less than 30 kg: 10 mg/kg IV given once every 4 weeks as a 60 minute single drip infusion
-Weight 30 kg or more: 8 mg/kg given once every 4 weeks as a 60 minute single drip infusion

This drug may be used as monotherapy or concomitantly with methotrexate:
SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS:
2 years or older:
-Weight less than 30 kg: 12 mg/kg IV given once every 2 weeks as a 60 minute single drip infusion
-Weight 30 kg or more: 8 mg/kg IV given once every 2 weeks as a 60 minute single drip infusion

Comments:
-The weight of the patient may fluctuate; therefore, a dose adjustment should not be based on a single visit body weight measurement.
-This drug may be used as monotherapy or in combination with methotrexate.
-Not recommended for use in children less than 2 years of age.
-This drug should 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).

Uses:
-Patients 2 years of age and older with active polyarticular juvenile idiopathic arthritis (PJIA)
-Patients 2 years of age and older with active systemic juvenile idiopathic arthritis (SJIA)

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your Actemra injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving Actemra?

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Do not receive a "live" vaccine while using Actemra. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Actemra side effects

Get emergency medical help if you have signs of an allergic reaction to Actemra: hives; chest pain, difficulty breathing, feeling like you might pass out; swelling of your face, lips, tongue, or throat.

Serious and sometimes fatal infections may occur during treatment with Actemra. Call your doctor right away if you have signs of infection such as:

  • fever, chills, muscle pain, night sweats, mouth sores, white patches in your throat, weight loss, feeling very tired;

  • fast heart rate, rapid breathing, chest pain, wheezing, cough, shortness of breath;

  • redness or swelling under your skin, painful skin sores, blistering skin rash with burning or tingly feeling;

  • watery diarrhea, pain or burning when you urinate;

  • blurred vision, bone pain, confusion, headache, nausea, swollen glands.; or

  • severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Also call your doctor at once if you have:

  • severe stomach cramps, bloating, diarrhea or constipation;

  • black, bloody, or tarry stools;

  • coughing up blood or vomit that looks like coffee grounds; or

  • signs of perforation (a hole or tear) in your stomach or intestines - fever, ongoing stomach pain, change in bowel habits.

Common Actemra side effects may include:

  • runny or stuffy nose, sinus pain, sore throat;

  • headache;

  • high blood pressure (blurred vision, buzzing in your ears, anxiety, confusion, shortness of breath, uneven heartbeats); or

  • pain, swelling, burning, or irritation around the IV needle or where an injection was given.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Actemra?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • any other medicines to treat rheumatoid arthritis, such as abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, or rituximab.

This list is not complete and many other drugs can interact with tocilizumab. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about Actemra.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Actemra only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Cerner Multum, Inc. Version: 4.01.

Last reviewed: May 30, 2017
Date modified: July 02, 2017

Hide