Can you take Take Action with Tocilizumab?

The levonorgestrel in Take Action has a major potential interaction with Abnormal Uterine Bleeding.

The use of contraceptives is contraindicated when there is an undiagnosed abnormal genital bleeding. Adequate diagnostic measures should be undertaken to rule out the presence of any malignancy.

The levonorgestrel in Take Action has a moderate potential interaction with Asthma.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

The levonorgestrel in Take Action has a major potential interaction with Breast Cancer.

The use of progestogens is considered by manufacturers to be contraindicated in patients with existing or suspected malignancy of the breast. Some supportive data are available for medroxyprogesterone. Specifically, medroxyprogesterone treatment may be associated with breast cancer, primarily when the drug is administered intramuscularly. A pooled analysis of two case-control studies, one from the World Health Organization and the other from New Zealand, revealed a small overall relative risk of breast cancer in women who have ever used intramuscular medroxyprogesterone acetate. The relative risk was higher in the subgroup of women who had initiated therapy within the previous 5 years. Thus, an increased risk (approximately 2-fold) is associated with intramuscular medroxyprogesterone use in the first 5 years. A more recent U.S. study also found a statistically significant increase in breast cancer risk among recent users (defined as last use within the past five years) who used depo-medroxyprogesterone acetate for 12 months or longer.

The levonorgestrel in Take Action has a moderate potential interaction with Cerebral Vascular Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

The levonorgestrel in Take Action has a moderate potential interaction with Depression.

The use of oral contraceptives has been associated with an increased incidence of depression. It is uncertain whether this effect is related to the estrogenic or the progestogenic component of the contraceptive, although excess progesterone activity is associated with depression. Patients with a history of depression receiving estrogen and/or progestogen therapy should be followed closely. The manufacturer of medroxyprogesterone recommends monitoring patients who have a history of depression and to not re- administer medroxyprogesterone if depression recurs.

The levonorgestrel in Take Action has a moderate potential interaction with Diabetes Mellitus.

Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Caution and close monitoring are recommended in patients with diabetes mellitus during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

Tocilizumab has a moderate potential interaction with Diverticulitis.

The use of tocilizumab may cause gastrointestinal (GI) perforation. Tocilizumab should be used with caution in patients who may be at increased risk for GI perforation. Patients with new onset abdominal symptoms should be evaluated promptly for early detection of GI perforation.

The levonorgestrel in Take Action has a moderate potential interaction with Fluid Retention.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

Tocilizumab has a moderate potential interaction with Gastrointestinal Perforation.

The use of tocilizumab may cause gastrointestinal (GI) perforation. Tocilizumab should be used with caution in patients who may be at increased risk for GI perforation. Patients with new onset abdominal symptoms should be evaluated promptly for early detection of GI perforation.

The levonorgestrel in Take Action has a moderate potential interaction with Heart Failure.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

The levonorgestrel in Take Action has a major potential interaction with Hepatic Tumor.

The use of oral contraceptives is contraindicated in patients with liver tumors. An increased risk of benign hepatic adenomas and hepatocellular carcinomas has been associated with long-term, oral estrogen- progestin contraceptive use of at least 4 years and 8 years, respectively. Although these tumors are rare and have not been reported with other types of estrogen or progestogen therapies, any preparation containing estrogens and/or progestogens should probably be avoided in patients with existing tumors of the liver. Hepatic hemangiomas and nodular hyperplasia of the liver have been reported with isolated estrogen therapy.

The levonorgestrel in Take Action has a moderate potential interaction with High Blood Pressure.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

The levonorgestrel in Take Action has a moderate potential interaction with High Cholesterol.

Some progestogenic agents may elevate plasma LDL levels and/or lower HDL levels, although data have been inconsistent. Patients with preexisting hyperlipidemia may require closer monitoring during progestogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

Tocilizumab has a moderate potential interaction with High Cholesterol.

Tocilizumab treatment was associated with increases in lipid parameters (e.g., total cholesterol, triglycerides, low-density lipoprotein [LDL] cholesterol, and/or high-density lipoprotein [HDL] cholesterol). Lipid parameters should be assessed about 4 to 8 weeks after initiation of therapy. Patients should be managed according to clinical guidelines for the management of hyperlipidemia.

The levonorgestrel in Take Action has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

Tocilizumab has a major potential interaction with History, Tuberculosis.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Tocilizumab has a major potential interaction with Infection.

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving tocilizumab; the most common serious infections reported included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis, and bacterial arthritis. Tocilizumab should not be administered in patients with an active infection, including localized infections. The risks and benefits of treatment should be considered before starting tocilizumab in patients: with chronic/recurrent infection, who have been exposed to tuberculosis, with history of serious/opportunistic infection, who have resided/traveled in areas of endemic tuberculosis/mycoses, or with underlying conditions that may predispose them to infection. Patients should be closely monitored for signs/symptoms of infection during and after tocilizumab treatment as signs/symptoms of acute inflammation may be reduced due to suppression of acute phase reactants. If a serious infection, an opportunistic infection, or sepsis develops, tocilizumab should be interrupted until the infection is controlled. A patient who develops a new infection during treatment with tocilizumab should undergo a prompt and complete diagnostic workup appropriate for an immunocompromised patient; appropriate antimicrobial therapy should be started, and the patient should be monitored closely.

Patients with coronavirus disease 2019 (COVID-19) should be monitored for signs/symptoms of new infections during and after tocilizumab treatment. The risks and benefits of tocilizumab in COVID-19 patients with other concomitant infections should be considered.

The levonorgestrel in Take Action has a major potential interaction with Liver Disease.

The use of progestogens, in general, is contraindicated in patients with impaired hepatic function or liver disease. There are little or no data concerning the pharmacokinetic disposition of the different progestogens in patients with hepatic disease. However, most hormones, including progestational hormones, are known to be extensively metabolized by the liver. Medroxyprogesterone should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur.

Tocilizumab has a moderate potential interaction with Liver Disease.

The safety and efficacy of tocilizumab have not been studied in patients with liver dysfunction, including patients with positive HBV and HCV serology. Treatment with tocilizumab is not recommended in patients with active liver disease or liver dysfunction.

Treatment with tocilizumab was associated with a higher incidence of transaminase elevations. For patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD), a liver test panel (serum ALT, AST, alkaline phosphatase, total bilirubin) should be obtained before starting tocilizumab, every 4 to 8 weeks for the first 6 months of therapy, and every 3 months thereafter. Tocilizumab should not be started in patients with RA, GCA, or SSc-ILD with elevated ALT or AST greater than 1.5 times the upper limit of normal (1.5 x ULN) and should be discontinued in those who develop elevated ALT or AST greater than 5 x ULN. Modifications should be based on increased transaminases. A similar pattern of liver enzyme elevation was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); liver test panel should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA.

Patients hospitalized with coronavirus disease 2019 (COVID-19) may have elevated ALT or AST levels; multi-organ failure with liver involvement is a complication of severe COVID-19. The decision to use tocilizumab should balance the potential benefit of treating COVID-19 against the potential risks of acute therapy. Tocilizumab should not be started in patients with COVID-19 who have elevated ALT or AST greater than 10 x ULN. ALT and AST should be monitored during treatment.

The levonorgestrel in Take Action has a moderate potential interaction with Migraine.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

Tocilizumab has a moderate potential interaction with Multiple Sclerosis.

Clinical studies have reported that tocilizumab may have an effect on demyelinating disorders such as multiple sclerosis and chronic inflammatory demyelinating polyneuropathy. Patients should be monitored for signs/symptoms potentially indicative of demyelinating disorders. Caution should be exercised when considering the use of tocilizumab in patients with preexisting or recent onset demyelinating disorders.

Tocilizumab has a moderate potential interaction with Neutropenia.

Tocilizumab treatment was associated with a higher incidence of neutropenia and a reduction in platelet counts. Tocilizumab should not be started in patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD) who have a low neutrophil count (i.e., absolute neutrophil count [ANC] less than 2000 cells/mm3) or a platelet count less than 100,000 cells/mm3. Tocilizumab is not recommended in patients with RA, GCA, or SSc-ILD who develop an ANC less than 500 cells/mm3 or a platelet count less than 50,000 cells/mm3. Neutrophils and platelets should be monitored in these patients 4 to 8 weeks after the start of therapy and every 3 months thereafter; modifications should be based on ANC results and platelet counts. A similar pattern of low neutrophil and platelet counts was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); neutrophils and platelets should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA. Tocilizumab should not be started in patients with coronavirus disease 2019 (COVID-19) who have an ANC less than 1000 cells/mm3 or a platelet count less than 50,000 cells/mm3; neutrophils and platelets should be monitored in these patients.

The levonorgestrel in Take Action has a moderate potential interaction with Renal Dysfunction.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

Tocilizumab has a moderate potential interaction with Renal Dysfunction.

Tocilizumab has not been studied in patients with severe renal dysfunction; caution is recommended when using tocilizumab in these patients. No dose adjustment is required in patients with mild or moderate renal dysfunction.

The levonorgestrel in Take Action has a moderate potential interaction with Seizures.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

Tocilizumab has a moderate potential interaction with Thrombocytopenia.

Tocilizumab treatment was associated with a higher incidence of neutropenia and a reduction in platelet counts. Tocilizumab should not be started in patients with rheumatoid arthritis (RA), giant cell arteritis (GCA), or systemic sclerosis-associated interstitial lung disease (SSc-ILD) who have a low neutrophil count (i.e., absolute neutrophil count [ANC] less than 2000 cells/mm3) or a platelet count less than 100,000 cells/mm3. Tocilizumab is not recommended in patients with RA, GCA, or SSc-ILD who develop an ANC less than 500 cells/mm3 or a platelet count less than 50,000 cells/mm3. Neutrophils and platelets should be monitored in these patients 4 to 8 weeks after the start of therapy and every 3 months thereafter; modifications should be based on ANC results and platelet counts. A similar pattern of low neutrophil and platelet counts was seen with tocilizumab in patients with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA); neutrophils and platelets should be monitored at the second dose and thereafter every 4 to 8 weeks for PJIA and every 2 to 4 weeks for SJIA. Tocilizumab should not be started in patients with coronavirus disease 2019 (COVID-19) who have an ANC less than 1000 cells/mm3 or a platelet count less than 50,000 cells/mm3; neutrophils and platelets should be monitored in these patients.

The levonorgestrel in Take Action has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.

The use of levonorgestrel requires careful assessment and caution in conditions of arterial disease, including stroke and myocardial infarction, and also, in patients with increased blood pressure and coagulopathies.

The levonorgestrel in Take Action has a moderate potential interaction with Thyroid Disease.

When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Patients on thyroid replacement therapy may require higher doses of thyroid hormone and appropriate monitoring. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.

Tocilizumab has a major potential interaction with Tuberculosis, Active.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Tocilizumab has a major potential interaction with Tuberculosis, Latent.

Tocilizumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting tocilizumab and during therapy; testing for latent infection is not necessary before starting tocilizumab in patients with coronavirus disease 2019 (COVID-19). If positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting tocilizumab. Anti-TB therapy should be considered prior to starting tocilizumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in the treatment of TB is recommended to aid in the decision about whether initiating anti-TB therapy is appropriate for an individual patient. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

The levonorgestrel in Take Action has a minor potential interaction with Weight Loss.

Progestogens can cause weight gain, which may be significant (as is the case with parenteral medroxyprogesterone) and undesirable in obese patients attempting to lose weight.