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Drug interactions between Actemra and Vicodin

Results for the following 2 drugs:
Actemra (tocilizumab)
Vicodin (acetaminophen/hydrocodone)

Interactions between your selected drugs


hydrocodone ↔ tocilizumab

Applies to:Vicodin (acetaminophen/hydrocodone) and Actemra (tocilizumab)

Consumer information for this interaction is not currently available.

MONITOR: Plasma concentrations of drugs that are CYP450 substrates may decrease following the initiation of interleukin inhibitors or tumor necrosis factor (TNF) blockers in patients with chronic inflammatory diseases. Because the formation of hepatic CYP450 enzymes is down-regulated during infection and chronic inflammation by increased levels of certain cytokines (e.g., interleukins-1, -6, and -10; tumor necrosis factor alpha; interferons), treatment with interleukin inhibitors and TNF blockers may restore or normalize CYP450 enzyme levels resulting in increased metabolism of these drugs. In vitro studies showed that tocilizumab, an inhibitor of interleukin-6, has the potential to impact expression of various hepatic microsomal enzymes including CYP450 1A2, 2B6, 2C9, 2C19, 2D6, and 3A4. Its effects on CYP450 2C8 or transporters is unknown. In vivo studies with omeprazole (a substrate of CYP450 2C19 and 3A4) and simvastatin (a substrate of CYP450 3A4) showed decreases of up to 28% and 57% in systemic exposure, respectively, one week following a single dose of tocilizumab. A role for other interleukins such as IL-12, IL-17A, or IL-23 in the regulation of CYP450 enzymes has not been established, and it is not known whether antagonists of these interleukins (e.g., ixekizumab, secukinumab, ustekinumab) would similarly affect CYP450 metabolism.

MANAGEMENT: Caution is advised when interleukin inhibitors and TNF blockers are prescribed to patients receiving concomitant drugs that are CYP450 substrates, particularly those with narrow therapeutic ranges (e.g., antiarrythmics, anticonvulsants, immunosuppressants, theophylline) or sensitive substrates where decreases in plasma levels may be significant or undesirable (e.g., oral contraceptives, statins, benzodiazepines, opioids). Clinical and/or laboratory monitoring should be considered following the initiation or withdrawal of interleukin inhibitor/TNF blocker therapy, and the dosage(s) of these drugs adjusted accordingly. Clinicians should note that the effects of interleukin inhibitors and TNF blockers on CYP450 activities may persist for several weeks after stopping therapy.


  1. "Product Information. Ilaris (canakinumab)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Cosentyx (secukinumab)." Novartis Pharmaceuticals, East Hanover, NJ.
  3. "Product Information. Simponi (golimumab)." Centocor Inc, Malvern, PA.
View all 11 references

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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