Tocilizumab is used on its own or together with other medicines to treat certain types of arthritis (inflammatory disease that causes pain and swelling in the joints) in adults and children.
This medicine is also used on its own or together with other medicines to treat giant cell arteritis (inflammation of the lining of your arteries).
It may also be used to slow down the progression of lung disease associated with systemic sclerosis (an autoimmune disorder that causes hardening and tightening of the skin and connective tissues).
This medicine may be used to treat other conditions as decided by your doctor.
Use Tocilizumab exactly as directed by your doctor or according to the instructions on the label. Do not administer more or less than instructed by your doctor.
Your doctor or nurse will administer the injection for you. If you or a caregiver had been given the proper training on the preparation and injection techniques of Tocilizumab, you or your caregiver may do the administration.
Tocilizumab is available as a prefilled syringe or pen. Make sure you know how to use the specific device you have been given. If you have problems or do not understand the instructions, ask your doctor or pharmacist.
This medicine is to be injected subcutaneously (into the fatty layer under the skin, usually in the thigh, upper arm or abdomen area).
Remember to rotate the injection sites. Do not inject into the same area all the time. New injection sites should be at least 1.5 inches away from the previous injection site. Do not inject near the navel (belly button), into moles, scars or areas where the skin is tender, bruised, red, hard or not intact.
The dose of Tocilizumab will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type and severity of your condition and your response to the medication.
Ensure that you keep all appointments with your doctor so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Tocilizumab.
If you miss an appointment or miss an injection, alert your doctor or nurse. A replacement appointment or injection should be given as soon as possible.
If you or a caregiver had been trained to administer this medicine and missed your once weekly dose within 7 days of the scheduled dose, skip the missed dose and return to your normal dosing schedule.
If you miss your once weekly dose within 7 days of the scheduled dose, skip the missed dose and return to your normal dosing schedule.
If you miss your once every other week dose within 7 days of the scheduled dose, administer the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to use your medicine, let your doctor and pharmacist know.
Alert your doctor if you have an active and severe infection (e.g. lung infection known as tuberculosis, hepatitis B infection [a contagious liver infection caused by a virus that is spread through contact with infected blood or other body fluids]) as Tocilizumab may not be suitable for you.
Inform your doctor if you have the following conditions:
- history of a long-term infection or recurring serious infections, or conditions that may predispose to developing infections (e.g. diabetes, certain lung diseases)
- history or at risk for stomach or intestinal ulcer
- damage in the protective covering of your brain or spinal cord
- liver disease
Let your doctor know if you are pregnant or breastfeeding.
Women who may become pregnant and men with sexual partners that may become pregnant must use proven birth control methods during Tocilizumab therapy and for at least 3 months after stopping the treatment. You may wish to discuss birth control methods with your doctor or pharmacist.
Be sure to check with your doctor or pharmacist before giving this medicine to a child and the elderly. Children and elderly people may be more sensitive to the side effects.
Do not receive any vaccinations without first asking your doctor.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- TB skin test, hepatitis B surface antigen test, up to date vaccinations, complete blood count, and risk assessment for cancer must be obtained to know if this medicine is suited for you to use.
- Routine tests (e.g. complete blood count, neutrophil and platelet counts, lipid panel, liver function test) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Regular monitoring for signs and symptoms of infections may also be needed.
Tocilizumab may cause dizziness. If affected, do not drive or take part in any activity in which you need to be alert.
Other side effects may include any of the following: headache, constipation, diarrhoea, nausea, abdominal pain, mouth sores or ulcers, increased weight, cough, rash, itch, and injection site pain, irritation or swelling.
This medicine may cause the level of your white blood cells and platelets to drop.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, or a cough or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- signs and symptoms of allergic reaction e.g. rashes, breathlessness, swollen mouth or eyes
- signs and symptoms of liver problems e.g. yellowing of the skin or eyes, abdominal pain, dark coloured urine, tiredness, swelling in the legs and ankles
- swelling and persistent pain in your stomach
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Inform your doctor or pharmacist if you are taking any of these medicines:
- other medicines for rheumatoid arthritis (inflammation in the joints of fingers, wrist, feet, and ankles)
- medicines for allergy and/or inflammation e.g. methylprednisolone, dexamethasone
- atorvastatin (cholesterol-lowering medicine)
- medicine for high blood pressure
- theophylline (asthma medicine)
- warfarin (blood-thinning medicine)
- phenytoin (medicine for epilepsy [fits or seizures])
- ciclosporin (medicine used in organ transplants or certain immune disorders)
- medicines for anxiety
This list does not include all medicines that may interact with Tocilizumab.
Avoid vaccinations during treatment with this medicine. It is recommended to be up to date with all vaccinations before using this medicine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Avoid alcohol.
Store in the refrigerator, between 2-8°C. Do not allow Tocilizumab to freeze. If frozen, this medicine will become ineffective and should not be used. Protect from light.
Medicines must not be used past the expiry date.
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