Actemra
Actemra (tocilizumab) is an interleukin-6 (IL-6) receptor antagonist. It treats several inflammatory conditions in children and adults, including rheumatoid arthritis. It works by blocking IL-6, a chemical released by the immune system that causes inflammation and fever. Actemra (tocilizumab) is given as an injection (either through the veins or under the skin), typically weekly or every few weeks, depending on the condition you're taking it treat. There's also a biosimilar medication (Tofidence) available but it doesn't treat all the conditions that Actemra (tocilizumab) is approved for. Side effects of Actemra (tocilizumab) include a higher risk of infections and headache.
What is Actemra (tocilizumab)?
What is Actemra (tocilizumab) used for?
Moderate-to-severe rheumatoid arthritis (RA) in adults
Giant cell arteritis (GCA) in adults (Actemra brand only)
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) in adults (Actemra brand only)
Polyarticular juvenile idiopathic arthritis (PJIA) in people ages 2 years and older
Systemic juvenile idiopathic arthritis (SJIA) in people ages 2 years and older
Cytokine release syndrome (CRS) in people ages 2 years and older (Actemra brand only)
COVID-19 infection in hospitalized adults who are receiving corticosteroids and require oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) (Actemra brand only)
How Actemra (tocilizumab) works
Actemra (tocilizumab) is an interleukin-6 (IL-6) receptor antagonist. It blocks a chemical released by your immune system called IL-6 that causes inflammation and fever.
Drug Facts
More on Actemra (tocilizumab) essentials
What are the side effects of Actemra (tocilizumab)?
Common Side Effects
- Upper respiratory tract infections (up to 7%)
- Headache (up to 7%)
- High blood pressure (up to 6%)
- Higher liver enzymes (up to 6%)
Other Side Effects
- Dizziness
- Bronchitis
- Rash
- Mouth sores
- Stomach pain
Serious Side Effects
- Serious infections: fever, tiredness, chills, cough, trouble breathing
- Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
- Worsening liver problems or liver failure: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
- Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
bloody or cloudy urine
blurred vision
body aches or pain
chest pain or tightness
chills
cough with or without mucus
difficult, burning, or painful urination
difficulty breathing
difficulty swallowing
dizziness
ear congestion
fast heartbeat
feeling of warmth
frequent urge to urinate
headache
loss of appetite
loss of consciousness
loss of voice
lower back or side pain
nervousness
pain or tenderness around the eyes and cheekbones
painful blisters on the trunk of the body
pale skin
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness of the face, neck, arms, and occasionally, upper chest
slow or fast heartbeat
stomach pain
stuffy or runny nose
sudden sweating
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
Less common
Accumulation of pus
bladder pain
burning feeling in the chest or stomach
confusion
dark urine
decrease in height
difficulty moving
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, irregular, pounding, or racing heartbeat or pulse
feeling hot
general feeling of discomfort or illness
indigestion
itching, pain, redness, swelling, tenderness, or warmth on the skin at the injection site
joint pain
light-colored stools
muscle ache, pain, cramp, or stiffness
pain in the back, ribs, arms, legs, groin, or genitals
severe stomach pain
sharp back pain just below the ribs
shivering
stomach upset
sweating
swollen joints
swollen, painful, or tender lymph glands in the face, neck, armpit, or groin
swollen, red, or tender area of infection
tenderness in the stomach area
trouble with sleeping
unexplained runny nose or sneezing
vomiting
yellow eyes and skin
Rare
Belching
changes in skin color
coughing or spitting up blood
fainting
gaseous stomach pain
lightheadedness
neck pain
night sweats
noisy breathing
rapid, shallow breathing
recurrent fever
red, tender, or oozing skin at the wounded area
sudden high fever or low-grade fever for months
swelling of the foot or leg
Incidence not known
Blistering, peeling, loosening of the skin
dilated neck veins
extreme tiredness or weakness
pains in the stomach, side, or abdomen, possibly radiating to the back
red skin lesions, often with a purple center
red, irritated eyes
severe stomach pain, cramping, or burning
swelling of the face, fingers, feet, or lower legs
vomiting of material that looks like coffee grounds, severe and continuous
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning, dry, or itching eyes
discharge, excessive tearing
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
skin rash, encrusted, scaly and oozing
swelling or inflammation of the mouth
Less common
Abnormal or decreased touch sensation
bleeding or redness and swelling of the gums
blemishes on the skin
bloody eye
chapped, red, or swollen lips
feeling of constant movement of self or surroundings
irritation in the mouth
loose teeth
persistent breath odor or bad taste in your mouth
redness or swelling in the ear
scaling, redness, burning, pain, or other signs of inflammation on the lips
sensation of spinning
sore mouth or tongue
white patches in the mouth or on the tongue
Rare
Bleeding after passing stool
blindness
bloody nose
burning, numbness, tingling, or painful sensations
change in hearing
continuing ringing or buzzing or other unexplained noise in the ears
coughing or spitting up blood
decreased vision or other changes in vision
ear drainage
flushed, dry skin
fruit-like breath odor
hearing loss
increased hunger, thirst, urination
itching ears
uncomfortable swelling around the anus
unexplained weight loss
unsteadiness or awkwardness
weakness in the arms, hands, legs, or feet
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Actemra (tocilizumab)
Pros
Typically given every 1 to 4 weeks
Can be used in children age 2 years and older (for some conditions)
Comes as a prefilled syringe or autoinjector for easy at-home injections under the skin (Actemra only)
Available as a biosimilar (Tofidence) for some conditions, so more options to choose from
Cons
Needs to be given by an injection only
Only treats the symptoms and isn't a cure for inflammatory problems
Can cause liver problems
Raises your risk for infections because it weakens your immune system
Pharmacist tips for Actemra (tocilizumab)
Make sure to mark your appointments on your calendar to see your provider and receive your Actemra (tocilizumab) dose if you're receiving it as an IV infusion. This will help make sure you're properly being monitored and won't miss any doses.
Tell your provider or pharmacist that you're taking Actemra (tocilizumab) before receiving any vaccines. This is so your providers can check to make sure the vaccines are safe for you to get. It's not known whether the medication affects how your body responds to vaccines. You won't be able to receive live vaccines while taking Actemra (tocilizumab).
Tips for using Actemra (tocilizumab) injections under the skin at home
Actemra (tocilizumab) is administered through a subcutaneous injection, which is an injection under the skin, into either the front of your thighs, stomach, or back of your upper arms. Never inject it into your muscle or vein. Don't inject into moles, scars, bruises, or areas where your skin is tender, red, hard, or broken.
Actemra (tocilizumab) comes as a prefilled syringe and prefilled pen (called the ACTPen autoinjector device). Both the syringe and the pen contain 162 mg/0.9 mL for subcutaneous injection.
You should receive training from your provider or pharmacist on how to give yourself Actemra (tocilizumab) if your provider allows you to give yourself the medication at home. Make sure you know how to give yourself Actemra (tocilizumab) to avoid accidentally hurting yourself or wasting the medication. Read the instructions for use and ask your provider or pharmacist if you have any questions on how to use this medication.
Keep the medication in the carton to protect it from light and place it in the refrigerator. Or, you can store it at room temperature for up to 2 weeks. If you do store it at room temperature, make sure to write down the new expiration date.
Before injecting yourself, take the carton out of the refrigerator, without taking out the pen or syringe from the carton, and lay it on a flat surface to warm up. This will take about 30 minutes (for the prefilled syringe) to 45 minutes (for the pen). Don't try to warm up the medication any other way.
Always check the medication solution to make sure it's clear and colorless to pale yellow. If it's cloudy, discolored, or contains flakes or large particles, don't use it. Contact your pharmacy or the manufacturer about giving you a replacement.
After giving yourself the medication, throw it away in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle, to lower the risk of needle-stick injuries. Don't throw away needles or syringes in your trash can. When your sharps container is almost full, close it tightly with the cap. For more information on how to throw away your sharps container safely and guidance for your specific state, visit the FDA's website.
Frequently asked questions about Actemra (tocilizumab)
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What are the risks and warnings for Actemra (tocilizumab)?
Actemra (tocilizumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of serious infections
Risk factors: Active, chronic (long-term), or recurrent infection | Other conditions that raise your risk of infection | Taking medications that weaken your immune system
Actemra (tocilizumab) can make it more difficult for your body to fight off infections. This raises your risk of bacterial, viral, or fungal infections. The risk is higher for people who are taking or have recently taken other medications that weaken the immune system. Additionally, Actemra (tocilizumab) might reactivate (wake up) certain viruses that are already in your body, such as tuberculosis (TB) or hepatitis B. If you develop an infection, your provider will likely ask you to stop taking Actemra (tocilizumab) until your body fights off the infection. Let your provider know if you experience symptoms of these infections, such as fever, cough, difficulty breathing, or weakness.
Stomach tears and blockage
Risk factors: Taking NSAIDs | History of stomach problems (e.g., diverticulitis, narrowing of intestines)
Actemra (tocilizumab) might raise your risk or tears or damage to the stomach or intestines. Your risk can be higher if you have a history of certain stomach problems or are also taking NSAIDs. Stop taking Actemra (tocilizumab) and contact your provider right away if you experience stomach pain or blood in your urine or stool.
Worsening liver problems and risk of liver failure
Risk factors: History of liver problems | Drinking large amounts of alcohol | Taking other medications that cause liver damage
Though rare, Actemra (tocilizumab) can cause serious liver problems that can lead to liver failure. This can happen months to years after starting the medication. To be safe, your provider will order blood tests to check your liver health before you start Actemra (tocilizumab) and regularly during treatment to make sure your liver is working properly. Get medical attention right away if you notice swelling of your stomach, stomach pain, yellowing of your skin or the whites of your eyes, stool changes (black, tarry, or bloody stools), nausea, vomiting, confusion, or dark or brown urine. You might need to stop using the medication to prevent further liver damage.
Severe allergic reactions
Severe allergic reactions to Actemra (tocilizumab) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). If you notice dizziness, a choking sensation, nausea, swelling around your eyes, swelling of the lips or tongue, or difficulty breathing after using Actemra (tocilizumab), get medical attention right away.
Lower white blood cell (WBC) and platelet counts
Although rare, people taking Actemra (tocilizumab) have experienced lower WBC and platelet counts. This can raise the risk of serious infections and bleeding. Because of this, your provider will check your blood cell counts before you start Actemra (tocilizumab) and regularly while you're taking this emdication. If your blood cell counts drop too low, your provider might ask you to stop taking Actemra (tocilizumab). If you develop any signs of infection (e.g., fever, tiredness, chills, cough, trouble breathing) or signs of blood problems (pale skin, fast heart rate, lightheadedness, blood in your urine or stool), contact your provider right away.
High cholesterol
Actemra (tocilizumab) can raise your cholesterol (a type of fat). Your provider might order cholesterol blood tests every 1 to 3 months while taking Actemra (tocilizumab) to check your cholesterol level. If it's high, your provider might prescribe you cholesterol medication. To prevent high cholesterol levels, make sure to exercise regularly and eat a balanced diet.
Serious allergic reactions
Some people taking Actemra (tocilizumab) have experienced serious allergic reactions, including trouble breathing, closing of the throat, and serious rash. This can happen with any injection, even if you've previously received Actemra (tocilizumab) before without any problems. If you're receiving Actemra (tocilizumab) infusions, your healthcare team will standby and give you medical support if you experience a serious reaction. If you're injecting Actemra (tocilizumab) under the skin, get medical help right away if you experience an allergic reaction. Depending on how serious your reaction is, your provider might ask you to stop taking Actemra (tocilizumab).
Vaccines
There's limited information available on the effects of Actemra (tocilizumab) on your body's response to vaccines, including live vaccines. Make sure your shots are up-to-date before starting Actemra (tocilizumab). Talk with your provider before you receive any vaccines while receiving Actemra (tocilizumab) treatment. Avoid getting live vaccines while you're taking Actemra (tocilizumab) because there's a risk that you can get sick from them.
Actemra (tocilizumab) dosage forms
Typical dosing for Actemra (tocilizumab)
Both Actemra (tocilizumab) and Tofidence (tocilizumab-bavi) are given as an infusion through the veins (intravenous or IV) over 1 hour. Actemra (tocilizumab) may also be given as an injection under the skin (subcutaneous or SC).
Your provider will decide your dose based on how well the medication is working for you, your body weight, if it's being given as an IV or SC injection, and if it's causing side effects.
Rheumatoid arthritis:
IV: The typical dose is 4 mg/kg for the first dose, then 4 mg/kg to 8 mg/kg every month. The maximum dose is 800 mg per infusion.
SC:
Weight less than 220 lbs: The typical dose is 162 mg every 1 to 2 weeks.
Weight 220 lbs or more: The typical dose is 162 mg every week.
Giant cell arteritis
IV: The typical dose is 6 mg/kg every month. The maximum dose is 600 mg per infusion.
SC: The typical dose is 162 mg every 1 to 2 weeks.
Systemic sclerosis-associated interstitial lung disease
SC: The typical dose is 162 mg every week.
Polyarticular juvenile idiopathic arthritis
IV:
Weight less than 66 lbs: The typical dose is 10 mg/kg every month.
Weight 66 lbs or more: The typical dose is 8 mg/kg every month.
SC:
Weight less than 66 lbs: The typical dose is 162 mg once every 3 weeks.
Weight 66 lbs or more: The typical dose is 162 mg once every 2 weeks.
Systemic juvenile idiopathic arthritis
IV:
Weight less than 66 lbs: The typical dose is 12 mg/kg every 2 weeks.
Weight 66 lbs or more: The typical dose is 8 mg/kg every 2 weeks.
SC:
Weight less than 66 lbs: The typical dose is 162 mg once every 2 weeks.
Weight 66 lbs or more: The typical dose is 162 mg once a week.
Cytokine release syndrome
IV:
Weight less than 66 lbs: The typical dose is 12 mg/kg given as a single dose. If there's no improvement, your provider can give you up to 3 more doses, at least 8 hours apart. The maximum dose is 800 mg per infusion.
Weight 66 lbs or more: The typical dose is 8 mg/kg given as a single dose. If there's no improvement, your provider can give you up to 3 more doses, at least 8 hours apart. The maximum dose is 800 mg per infusion.
COVID-19
IV: The typical dose is 8 mg/kg given as a single dose. If there's no improvement, your provider can give you one more dose, at least 8 hours after your first dose. The maximum dose is 800 mg per infusion.
Interactions between Actemra (tocilizumab) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abatacept
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Infliximab
- Influenza Virus Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Vaccine
- Tofacitinib
- Typhoid Vaccine, Live
- Varicella Virus Vaccine, Live
- Yellow Fever Vaccine
- Zoster Vaccine, Live
What are alternatives to Actemra (tocilizumab)?
Moderate-to-severe rheumatoid arthritis (RA) in adults
Giant cell arteritis (GCA) in adults (Actemra brand only)
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) in adults (Actemra brand only)
Polyarticular juvenile idiopathic arthritis (PJIA) in people ages 2 years and older
Systemic juvenile idiopathic arthritis (SJIA) in people ages 2 years and older
Cytokine release syndrome (CRS) in people ages 2 years and older (Actemra brand only)
COVID-19 infection in hospitalized adults who are receiving corticosteroids and require oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) (Actemra brand only)
Moderate-to-severe rheumatoid arthritis (RA) in adults
Psoriatic arthritis (PsA) in adults
Moderate-to-severe polyarticular juvenile idiopathic arthritis (pJIA) in children ages 2 years and older
Prevention of short-term graft versus host disease (GVHD) in combination with a calcineurin inhibitor and methotrexate in adults and children ages 2 years and older
Rheumatoid arthritis (RA) - adults only
Juvenile idiopathic arthritis (JIA) - people age 2 and older
Psoriatic arthritis (PsA) - adults only
Ankylosing spondylitis (AS) - adults only
Crohn's disease (CD) - people age 6 and older
Ulcerative colitis (UC) - people age 5 and older
Plaque psoriasis - adults only
Hidradenitis suppurativa (HS) - people age 12 and older
Uveitis - people age 2 and older
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References
Best studies we foundBiogen MA Inc. (2023). TofidenceTM (tocilizumab-bavi) injection, for intravenous use.
Choi, I. A., et al. (2020). Tocilizumab increases body weight and serum adipokine levels in patients with rheumatoid arthritis independently of their treatment response: A retrospective cohort study. Journal of Korean Medical Science.
Genentech USA, Inc. (n.d.). Actemra SC is available in a prefilled syringe or Actemra ACTPen® autoinjector.
Genentech, Inc. (2022). Actemra- tocilizumab injection, solution, concentrate; tocilizumab injection, solution; Actemra Actpen- tocilizumab injection, solution [package insert]. DailyMed.
Genentech, Inc. (2022). Instructions for Use: Actemra® (AC-TEM-RA) (tocilizumab) injection, for subcutaneous use- single-dose prefilled syringe.
National Cancer Institute. (n.d.). Cytokine release syndrome.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
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